Possible mechanisms for the cariostatic effect of xylitol.

Xylitol appears to be the only known cariostatic natural carbohydrate which meets most of the desiderata for a sweetener in the human diet. Possible mechanisms for this cariostatic action can be derived from a consideration of the factors which may be operating at a molecular and microbiological level. These include: a) Molecular size and e.g. the short, open-chain structure and absence of reducing groups b) Absence or relative lack in most oral microorganisms of xylitol-binding factors in dental plaque c) Lack of bacterial genes coding for xylitol-utilizing enzymes or of inducible or de-repressible genes for this purpose d) Inhibition of enzymes involved in cariogenesis (competitive in case of some isomerases) e) Enzyme specificity requirements f) Higher osmotic pressure exerted by xylitol as compared to hexoses and disaccharides g) Ability of xylitol to produce a favourable electrolyte concentration in the saliva without lowering plaque pH h) Ability of xylitol to increase the secretion and activity of salivary lactoperoxidase and certain other (muco) proteins. Xylitol may enhance the adsorption of glycoproteins on the tooth surfaces and strengthen the acquired pellicle.