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Introduction: Besides the main etiological factors other factors are also involved in development of caries. Bacteria (Streptococcus mutans, lactobacilli) and saliva (its buffering capacity, and rate of secretion) are also risk factors in the development of caries., Material, Method, Results: The authors were the first in Hungary to use the Dentocult kits for assessing the number of lactobacilli in saliva, to use the Oricult-N plate for the determination of the number of Candida, and the medium containing Dentocult-SM plates in the assessment of the number of Streptococcus mutans colonies in saliva. Children in Fót were divided into two groups: children who consumed sorbitol-containing sweets, and another consisting of children who consumed sucrose-containing sweets. The number of lactobacilli, as well as the caries-index was determined. The proportion of children with high lactobacillus counts was significantly lower in the sorbitol group than in the sucrose group. Caries prevalence and salivary lactobacillus counts were determined in 140 second and third graders and 150 adults. The difference between caries-active and caries-inactive subjects was statistically significant in both age groups. A relationship between lactobacillus and Candida albicans counts was found in 396 children between the ages of 6 and 11 living in children's homes. The microbiological assessment of the saliva of 269 children, from seven different children's home, all between the ages of 7 and 12, who were included in the WHO's three-year xylitol caries-preventive program, was also done. Cariological, saliva and microbiological investigations were carried out on 349 adolescents secondary school students. The amount of bacteria and yeasts showed a strong relationship with the caries mean values. The saliva of 210 fixed orthodontic appliances wearing--using amine fluoride-containing products--children, was investigated. According to the results, amine fluoride has a pronounced effect on the mouth's microflora, especially on the number of lactobacilli and Candida.

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 aim of this study was to assess the practical value of peroral xylitol at low to moderate dosage as a caries preventive measure. The trial was planned as a field study to test the feasibility of partial sucrose substitution in the relatively uniform conditions expected to occur in institutionalized children. The caries increment in the experimental group (X-group) was compared with the increments in other groups following the systemic administration of fluoride in milk or drinking water (F-group), and conventional dental treatment procedures alone (C-group). Conventional treatment was also provided for children in the X- and F-groups who used in an unsupervised manner a fluoride-containing dentifrice. The dentifrice used by the X-group also contained 10 per cent xylitol. The C-group used predominantly fluoride-free dentifrices. At baseline there were 990 children in the study. At the end of the 3-year study period there were 689 subjects. The caries scoring into four main categories was carried out yearly according to WHO criteria. The analysis of the data showed highly significant differences between the X-, F- and C-groups when measuring caries activity as the increment of DMF teeth and tooth surfaces, and also as the increment rate assessing the true caries incidence in a biostatistical sense. These results were obtained in conditions where caries prevalence and incidence continued to be high. The observations indicate that peroral xylitol has a cariostatic effect.

Four field studies assessing the caries preventive value of partial substitution of sucrose by xylitol or a mixture of xylitol and sorbitol were recently conducted. The trials (in Thailand, Hungary and two in French Polynesia) had certain common features, i.e. protocols approved by the WHO; low intake of polyol(s); non-randomized young study populations, differing baseline caries prevalences between groups; and planned duration of 32-36 months. Analysis of the findings was facilitated through the use of rates to measure caries increments expressed as DMF teeth and surface counts in relation to the numbers of teeth at risk. Irrespective of baseline differences, all studies revealed, in comparison to known methods, that partial substitution of sucrose was associated with a preventive effect.

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).