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Objective: The aim of this study was to test the efficacy of long-term, daily intake of erythritol and xylitol candy, compared with sorbitol candy, on the development of enamel and dentin caries lesions. Methods: The study was a double-blind randomized controlled prospective clinical trial. Altogether 485 primary school children, first- and second-graders at baseline, from southeastern Estonia participated in this 3-year intervention. Each child consumed four erythritol, xylitol or sorbitol (control) candies three times per school day. The daily intake of polyol was about 7.5 g. The International Caries Detection and Assessment System (ICDAS) was used in the clinical examinations by four calibrated examiners at baseline and at 12, 24 and 36 months. Results: The annual examination analyses and the follow-up analyses confirmed that the number of dentin caries teeth and surfaces at 24 months follow-up and surfaces at 36 months follow-up was significantly lower in the mixed dentition in the erythritol group than in the xylitol or control group. Time of enamel/dentin caries lesions to develop and of dentin caries lesions to progress was significantly longer in the erythritol group compared to the sorbitol and xylitol groups. Also the increase in caries score was lower in the erythritol group than in the other groups. Conclusions: In the follow-up examinations, a lower number of dentin caries teeth and surfaces was found in the erythritol group than in the xylitol or control groups. Time to the development of caries lesions was longest in the erythritol group. Trial registration: ClinicalTrials.gov Identifier NCT01062633.

Manuscript. Published version available at http://dx.doi.org/10.1159/000450762 Objective: Assess the effect of daily consumption of erythritol, xylitol, and sorbitol candies on caries development in mixed dentition during a three-year intervention and three years after the intervention. Methods: 485 Estonian first and second grade primary school children participated. Children were randomly allocated to an erythritol, xylitol, or sorbitol (control) group. Polyol-containing candies were administered on school days with a daily polyol consumption of 3x2.5 g. Yearly, caries development was assessed by calibrated dentists using the ICDAS criteria. Six years after initiation of the study and three years after cessation of daily polyol consumption, 420 participants were re-examined to identify potential long-term effects of polyol consumption. Survival curves were generated at the end of the intervention period and three years post intervention. The model included age of the subjects, schools, tooth surface ages and years of surface exposure to intervention. ICDAS scoring system based events included enamel/dentine caries development, dentine caries development, increase in caries score, and dentist intervention. Results: At the end of the intervention, time to enamel/dentine caries development, dentine caries development, increase in caries score, and dentist intervention was significantly longer in the erythritol group as compared to the sorbitol group. Except for increase in caries score, all effects persisted three years after cessation of daily polyol consumption. Conclusions: A caries preventive effect of three-year erythritol consumption as compared to sorbitol was established in children with mixed dentition. The effect persisted up to three years after the end of the intervention. Trial registration: ClinicalTrials.gov Identifier NCT01062633.

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 mass22 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 (P0.05) 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 (P0.05). 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.

Panoramic radiographs were taken of 392 Estonian schoolchildren (33% boys and 67% girls) aged 14-17 years, 197 in Tartu and 195 in Tallinn. The mean number of permanent teeth was 31.5. In 14% of the children one to four teeth (excluding wisdom teeth) were missing. The frequencies of missing wisdom teeth and supernumerary teeth agreed with those in the literature, being 17% and 3%, respectively. The mean number of radiographically detected carious teeth was 1.9 in Tartu and 3.3 in Tallinn. Secondary caries was common, being found radiographically in half of the schoolchildren. Endodontic treatment had been given to 13% of the subjects in Tartu and to 46% in Tallinn, the success rates being 47% and 44%, respectively. The percentage of radiographic signs in the mandibular condyles of girls (5%) was greater than that of the boys (1%). Changes in the maxillary sinuses were found in 16% of the children. Eight odontogenic cysts, one cyst of the incisal canal, and one solitary bone cyst were found. Tumors included two odontomas, two cemento-ossifying lesions, and one osteoma in the maxillary sinus. The health status of the jaws of the Estonian schoolchildren was considered to be fairly good.

The dental health of 392 Estonian schoolchildren aged 14-17 years (197 in Tartu and 195 in Tallinn) was studied. In Tartu only 1 child had lost teeth because of caries, as against 30 in Tallinn. Clinically caries-free dentitions were found in 15% of the children in Tartu and in 3% in Tallinn. The mean DMFT value was 3.7 in Tartu and 7.0 in Tallinn, being higher among girls in both cities. The mean DT value was 1.0 in Tartu and 2.6 in Tallinn. All subjects examined had a gingival bleeding index (GBI) higher than zero. The mean GBI was 20% in Tartu and 18% in Tallinn.