Surprising Xylitol Trial Results

Results from the Xylitol for Adult Caries Trial (X-ACT)

1. James D. Bader, DDS, MPH⇓,
2. William M. Vollmer, PhD,
3. Daniel A. Shugars, DDS, PhD, MPH,
4. Gregg H. Gilbert, DDS, MBA,
5. Bennett T. Amaechi, BDS, MS, PhD,
6. John P. Brown, BDS, MS, PhD,
7. Reesa L. Laws, BS,
8. Kimberly A. Funkhouser, BS,
9. Sonia K. Makhija, DDS, MPH,
10. André V. Ritter, DDS, MS and
11. Michael C. Leo, PhD
    Group for the X-ACT Collaborative Research

+ Author Affiliations

1. Dr. Bader is a research professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill. He also is the associate editor for evidence-based dentistry for The Journal of the American Dental Association.
2. Dr. Vollmer is a senior investigator, Kaiser Permanente Center for Health Research, Portland, Ore.
3. Dr. Shugars is a professor, Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill.
4. Dr. Gilbert is a professor and the chair, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham.
5. Dr. Amaechi is an associate professor and the director of cariology, Department of Comprehensive Dentistry, Dental School, University of Texas Health Science Center at San Antonio.
6. Dr. Brown is a professor emeritus, Department of Comprehensive Dentistry, Dental School, University of Texas Health Science Center at San Antonio.
7. Ms. Laws is a coordinating centers manager, Kaiser Permanente Center for Health Research, Portland, Ore.
8. Ms. Funkhouser is a data manager, Kaiser Permanente Center for Health Research, Portland, Ore.
9. Dr. Makhija is an associate professor, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham.
10. Dr. Ritter is a professor and the graduate program director, School of Dentistry, University of North Carolina at Chapel Hill.
11. Dr. Leo is an investigator, Kaiser Permanente Center for Health Research, Portland, Ore.

1. Address reprint requests to Dr. Bader at School of Dentistry, University of North Carolina at Chapel Hill, CB#7450, Chapel Hill, N.C. 27599-7450, e-mail jim_bader@unc.edu. 

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Abstract

Background Although caries is prevalent in adults, investigators have tested few preventive therapies in adult populations. In a randomized controlled trial, the authors evaluated the effectiveness of xylitol lozenges in preventing caries in adults at elevated risk of developing caries.

Methods The Xylitol for Adult Caries Trial (X-ACT) was a three-site placebo-controlled randomized trial. Participants (n = 691) aged 21 through 80 years consumed five 1.0-gram xylitol or placebo lozenges daily for 33 months. They underwent clinical examinations at baseline and at 12, 24 and 33 months.

Results Xylitol lozenges reduced the caries increment 10 percent. This reduction, which represented less than one-third of a surface per year, was not statistically significant. There was no indication of a dose-response effect.

Conclusions Daily use of xylitol lozenges did not result in a statistically or clinically significant reduction in 33-month caries increment among adults at an elevated risk of developing caries.

Clinical Implications. These results suggest that xylitol used as a supplement in adults does not reduce their caries experience significantly.