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Acute otitis media (AOM) is one of the most common pediatric diseases; almost all children experience at least one episode, and a third have two or more episodes in the first three years of life. The disease burden of AOM has important medical, social and economic effects. AOM requires considerable financial assistance due to needing at least one doctor visit and a prescription for antipyretics and/or antibiotics. AOM is also associated with high indirect costs, which are mostly related to lost days of work for one parent. Moreover, due to its acute symptoms and frequent recurrences, AOM considerably impacts both the child and family's quality of life. AOM prevention, particularly recurrent AOM (rAOM), is a primary goal of pediatric practice. In this paper, we review current evidence regarding the efficacy of medical treatments and vaccines for preventing rAOM and suggest the best approaches for AOM-prone children.

1. An experiment was conducted to determine the effect of a single administration of xylitol to newly hatched chicks on growth, digestive enzyme activity and immune responses at 12 d of age. 2. Female broiler chicks (Cobb) were given 0.5 ml of either 20% glucose, 20% xylitol or water alone within 24 h after hatch. Thereafter, all chicks were reared under conventional conditions and given a commercial broiler starter diet until 12 d of age in experiment 1. In experiment 2, they were deprived of feed and water for 24 h and kept at 27 degrees C to mimic transportation stress before given feed and water. 3. Body weights at 5 d of age did not differ among the treatments, but at 12 d of age chicks given 20% xylitol showed greater body weight than those in the other treatment groups. Bursa weight (mg per 100 g body weight) was greater in chicks given xylitol solution than in chicks given glucose solution or water at 5 and 12 d of age. 4. Amylase and chymotrypsin activities in the pancreas of chicks given xylitol solution were higher than in chicks given water or glucose solution at 5 and/or 12 d of age. 5. A single administration of xylitol within 24 h after hatch increased splenocyte proliferation against concanavalin A and pokeweed mitogen, and antibody titres to keyhole limpet haemocyanin (KLH) and Mycobacterium butyricum (Mb) as compared to glucose, administration at 12 d of age, but not as compared to water administration. 6. These results indicated that xylitol may be a functional carbohydrate source to improve growth rate and health and to relieve transportation stress in broiler chicks.

Objective: The aim was to investigate the effect of high and low amounts of xylitol on the interdental plaque-pH, directly and after sucrose challenge, in schoolchildren with habitual consumption., Material and Methods: The study group consisted of 11 healthy children (10-15 years) with low caries risk and the experiment had a single-blind crossover (Latin square) design. After a 2-week run-in period with a daily 4.0 g xylitol intake, the children were subjected to single-dose exposures of chewing gums with (i) paraffin (CTR; no xylitol), (ii) low-dose xylitol (LX; 2.0 g xylitol), and (iii) high-dose xylitol (HX; 6.0 g xylitol) in a randomized order separated by a washout period of 1 week. Samples of chewing-stimulated whole saliva were collected prior to and after the experimental period for determination of bacterial counts. The outcome measures were in situ plaque-pH (micro-touch method) and area under the pH curve (AUC)., Results: The AUC was significantly greater (p < 0.05) in the HX group compared to the LX and control groups during the first 5 min after chewing. After a 10% sucrose rinse, the interdental plaque-pH dropped in all groups but the HX regimen displayed significantly less reduction 0-5 min after chewing (p < 0.05). No significant alterations of the total viable counts or mutans streptococci levels in saliva were disclosed during the 4-week experimental period., Conclusions: The present results suggested that a high single dose of xylitol had a short and limited beneficial effect on interdental plaque-pH in habitual xylitol consumers, while a low single dose, resembling normal chewing gum use, did not differ from the control.

A novel slow-release administration device, the "Fall-Asleep Pacifier" (FAP), was studied as a prophylactic measure against mutans streptococcal oral infection and dental caries in a risk group of 1-year-old children by comparing the test (T, n = 34) and control (C, n = 88) groups in a prospective cohort study. In the T group the children received their fluoride tablets (Fludent, containing NaF corresp. 0.25 mg F0- , xylitol 159 mg and sorbitol 153 mg) in the evenings in FAP. In the C group the children received the same dose of Fludent crushed in food in the evenings. The proportion of children, whose plaque samples from the upper incisors were mutans streptococcus positive at the age of 24 months, was significantly (P < 0.05) greater in group C (25%) than in group T (9%). The children in the T group developed significantly (P < 0.001) less (none) new dentinal carious lesions in their primary dentitions than the children in the C group between 2 and 3 1/2 years of age. Fifty-four percent of the children to whom the FAP was offered complied with regular use of it. The beneficial effect observed in the T group compared with the C group was apparently mostly due to the administration mode via FAP, which could prolong the intra-oral bioavailability of the prophylactic preparation.

It has been argued that stimulation of the immune system depresses performance. Accordingly, an experiment was conducted to determine the effect of dietary xylitol (150 g/kg diet) on growth and selected inflammatory responses in male broiler chickens. During the final 6 d of the experimental periods, chicks were injected with antigens: Escherichia coli lipopolysaccharide (LPS) on days 1, 3 and 5 and with Sephadex-G50 superfine on days 2 and 4 to stimulate macrophage functions. The immune stimulation reduced body weight gain and food intake, but enhanced alpha 1 acid glycoprotein (AGP) concentration and interleukin (IL-1) like activity in plasma. Feeding the xylitol diet partially, but significantly, prevented the reductions in body weight gain and food intake, without affecting the early stage of inflammatory responses triggered by LPS and Sephadex injections.

Several studies indicate that xylitol (X) consumption is associated with certain biochemical changes in dental plaque and whole saliva. In making X-containing saliva stimulants more cost-effective and palatable, manufacturers may use maltitol syrup (MS, which normally contains some sorbitol and higher polyols) or polydextrose (PD, a polysaccharide molecule with a mass > 22 kDa) as bulking agents. Combinations of X with MS and PD have not been tested regarding their salivary effects. One hundred and eighty-eight young subjects (mean age, 22 years) of both sexes were divided into three groups of equal size for a 4-month study. The subjects in one group used X-MS dragees (in 7 daily episodes; 8 g X per day), while the subjects in another group used X-PD dragées in as many daily episodes (8 g X per day). Subjects in the third (comparison) group did not receive saliva stimulants. Paraffin-stimulated whole saliva samples were collected at baseline, after 2 months, and at endpoint. The usage of X-MS was associated with a significant (P < 0.05) reduction in the salivary sucrase activity. After 4 months, the activity of enzymes hydrolyzing N(alpha)-benzoyl-DL-arginyl-p-nitroaniline was significantly reduced in all groups, while the levels of free sialic acid were reduced in group X-PD only (P < 0.05). These salivary changes most likely reflected microbial shifts in the oral cavity and suggest that information from saliva studies may be of avail when deciding which bulking agents should be used in xylitol-based saliva stimulants.

The aim of this investigation was to compare the effect of an enzyme-containing dentifrice without sodium lauryl sulfate but with addition of xylitol (Zendium Dentine) on mutans streptococci (MS) in saliva and dental plaque with that of the same dentifrice without xylitol. The subjects were divided into a test group, using a dentifrice with 10% xylitol (part A) or 5% xylitol (part B), and a control group, using a dentifrice without xylitol, for 3 months. In part A the MS counts in saliva and plaque were significantly lower in the xylitol group (n = 50) than in the control group (n = 57) (P < 0.01 and P < 0.001, respectively). In part B (n = 89 + 91), evaluating MS counts in saliva only, no significant difference was found. Thus, this study demonstrated I) that addition of 10% xylitol to an enzyme-containing dentifrice without sodium lauryl sulfate has an inhibitory effect on MS counts in saliva and dental plaque, and 2) that the inhibitory effect seems to be dose-dependent.

Twenty-nine 3-month-old female Wistar rats were labeled by means of a single intraperitoneal tetracycline injection. Nineteen animals were subsequently ovariectomized, whereas a control group of 10 animals underwent sham operations. All the animals received the basal diet, and 10 of the ovariectomized animals were given an additional dietary xylitol supplementation (5%). Three months later the animals were killed by decapitation, and dentinal apposition on the molars was measured. The results indicate that supplementation of the diet with 5% xylitol had an attenuating effect on the enhanced dentin formation caused by ovariectomy, but the mechanism remains unsolved.

The utilization of a 4:2:1 mixture of glucose, fructose, and xylitol (GFX) was studied by indirect calorimetry in patients undergoing abdominal surgery. Sixteen patients undergoing gastrectomy under general anesthesia received GFX intravenously at 0.25 g/kg h-1 during surgery. VO2, VCO2, and RQ were measured continuously for 150 min using an Engström metabolic computer, and urea nitrogen excretion was determined at 30-min intervals during surgery. Blood levels of glucose, fructose, and xylitol plateaued after 1 h. The RQ decreased over the first 90 min from 0.84 +/- 0.06 to 0.75 +/- 0.05 and then gradually increased to 0.79 +/- 0.04 at 150 min. VO2 did not change significantly over the 150-min period. From the RQ, VO2, and nitrogen excretion data, carbohydrate oxidation was estimated. The amount of carbohydrate oxidized was 9.7 +/- 6.9 g during the first 30-min period, 3.5 +/- 5.2 g during the 60 to 90-min period, and 7.5 +/- 4.5 g in the 120 to 150-min study period. Simultaneously, lipid oxidation increased. These observations suggest that the GFX solution is adequately metabolized during surgery and therefore may be a suitable energy source for patients.

Two double-blind crossover studies were performed to test a sugar-free lozenge containing bicarbonate and phosphate buffers (Profylin). The studies were performed in groups of 20 and 13 individuals. In Study I active buffering or placebo lozenge (not buffered) was given, and the pH of plaque and saliva was measured after 2, 5, 10, 20, and 30 min. In study II the lozenges were given 10 min after a sucrose rinse, and both the pH and the potential and polarization of amalgam restorations that made contact in the oral cavity were measured. In study I both lozenges increased the pH of plaque and saliva, but the values after sucking on the active lozenge were significantly higher than after placebo. In study II a pH recovery of plaque and saliva after the sucrose rinse was recorded for both types of lozenge, but it was most pronounced for the active, buffering lozenge. A statistically significant difference was, however, found only 5 min after sucking on the lozenge. No influence on the current magnitude was observed. The results thus indicate that the buffering sugar-free lozenge raises the pH of plaque and saliva and accelerates the pH recovery after a sucrose rinse but seems to have no influence on the galvanic current magnitude of amalgam restorations in contact.

The aim was to assess caries increment as influenced by partial substitution of sucrose by xylitol (X group) over a 2-year period in comparison with systemic fluoride (F group) and restorative treatment only (C group). The study differed from the 3-year field study of the same series primarily in that existing base-line differences were eliminated because the protocol required that all the new subjects entering the institutions in the 1st year were to be included for a 2-year trial. During this period the number of dropouts was 243 (19.9% of all subjects), the final material consisting of 976 children (6-12 years old). The 2-year DMFS increment was 3.8 in the X group, 4.8 in the F group, and 6.0 in the C group. The corresponding ratio (RS) between caries incidence and the tooth surface population at risk was RSX, 4.5; RSF, 5.5; and RSC, 7.5. The xylitol regimen resulted in a lower increment of caries than measured in the F and C groups (p less than 0.001; convariance analysis, with base-line prevalence, number of permanent teeth, and visible plaque index as covariants.

The consumption of sucrose and xylitol and the exposure to fluoride (F) were analyzed in a field study aimed at assessing the value of peroral xylitol as a caries-preventive measure. The coverage of the general background referred to the conditions of 689 institutionalized children observed for a 3-year-period. The material in the dietary substudy consisted of 286 subjects aged 8-13 years. The intake and excretion of F was monitored at all institutions in a total of 380 children. The frequency of the consumption of sucrose was high, its intake increasing over the weekend in comparison with weekdays. The consumption of the xylitol-containing products did not reduce the frequency of sucrose intake. Varying and fluctuating levels of exposure to systemic F was registered, as also reflected in the urinary F/creatinine quotient.

The aim of this 3-year field study was to assess the value of partial substitution of sucrose with peroral xylitol (14-20 g/day) as a caries-preventive measure (X group) in comparison with systemic administration of fluoride (F group) and restorative treatment procedures solely (C group). An F dentifrice was used unsupervised in the X and F groups, the former containing 10% xylitol. The C group used customary, predominantly F-free dentifrices distributed by the local health authorities. The final material consisted of 689 institutionalized children (6-11 years). Caries was scored yearly in duplicate by two continuously calibrated teams. At base line the X group had a significantly higher caries prevalence than the F and C groups. The 3-year DMFS increment was 4.2 in the X group, 6.5 in the F group, and 7.7 in the C group. The corresponding ratio (RS) between caries incidence and the tooth surface population at risk was RSx, 4.9; RSF, 6.6; and RSC, 8.6. It is concluded that dietary xylitol in solid sweets resulted in a lower increment of caries than obtained in the F and C groups (p less than 0.001, covariance analysis, with base-line prevalence, number of permanent teeth, and visible plaque index as covariants).