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Purpose: To investigate the antimicrobial effects of a mouthrinse containing silver nanoparticles (AgNP) on polymicrobial biofilms in vitro., Materials and Methods: Polymicrobial biofilms were grown on glass cover slips following the method of Exterkate. Saliva collected from a healthy human was added to McBain medium (including 0.2% sucrose) to achieve a 50-fold dilution. Glass coverslips were attached to the lid of a 24-well culture plate and suspended in the medium of each well. After 24 h of cultivating, coverslips with biofilms were immersed in each of four treatment solutions or sterile deionized water for 5 min. The control and four treatment groups were as follows: 1) control: sterile deionized water; 2) nanosilver (NS): mouthrinse containing AgNP; 3) 0.05C: 0.05% chlorhexidine gluconate; 4) 0.2C: 0.2% chlorhexidine gluconate; 5) Xyl: 25% xylitol. The biofilms were further regrown for 48 h. After removing the biofilms ultrasonically, they were cultured on blood agar, viable cells were counted, and the amount of lactic acid in the biofilms was analysed using a colorimetric assay., Results: Mouthrinse containing AgNP suppressed viable cells in the biofilm to the same degree or more than with chlorhexidine gluconate. Amounts of lactic acid after 72 h cultivation of biofilms treated with 0.2C and NS showed consistently low values., Conclusion: The mouthrinse containing AgNP suppressed viable cells in polymicrobial biofilms to the same level as 0.2% chlorhexidine or higher.

Objective: The human gut microbiota is composed of many viruses, bacteria, and fungi. Escherichia coli representatives are facultative anaerobic bacteria in the colon that play a crucial role in the metabolism of lactose, vitamin synthesis, and immune system modulation. E. coli forms a biofilm on the epithelial cell surface of the intestine that can be modified by diet compounds, i.e., gluten, xylitol, lactose, and probiotics., Methods: In the present study, the impact of probiotic-derived Lactobacillus rhamnosus GG strain on non-pathogenic E. coli biofilm was examined. The mono- and multispecies biofilm was also treated with gluten, xylitol, and lactose. We used 96-well plates to obtain biofilm growth. Biofilm was stained using crystal violet. To evaluate the type of interaction in mono- and multispecies biofilm, a new formula was introduced: biofilm interaction ratio index (BIRI). To describe the impact of nutrients on biofilm formation, the biofilm formation impact ratio (BFIR) was calculated., Results: The biofilms formed by both examined species are stronger than in monocultures. All the BIRI values were above 3.0. It was found that the monospecies biofilm of L. rhamnosus is strongly inhibited by gluten (84.5%) and the monospecies biofilm of E. coli by xylitol (85.5%). The mixed biofilm is inhibited by lactose (78.8%) and gluten (90.6%)., Conclusion: The relations between bacteria in the mixed biofilm led to changes in biofilm formation by E. coli and L. rhamnosus GG. Probiotics might be helpful in rebuilding the gut microbiota after broad spectrum antibiotic therapy, but only if gluten and lactose are excluded from diet., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Biofilms formed by Pseudomonas aeruginosa and Staphylococcus aureus, along with their antibiotic tolerance have posed challenges to treatment strategies for lung, wound, and other infections, particularly when co-infecting. In the present study, the inhibitory effect of xylitol on biofilm formation, as well as its eradication potential on pre-established biofilms formed by P. aeruginosa strain PAO1, methicillin-resistant S. aureus, and a mix of both species in an alginate bead model were tested. Xylitol concentrations of 2, 1, and 0.5 M reduced biofilm formation by P. aeruginosa strain PAO1, methicillin-resistant S. aureus, and the mixed-species biofilm in a concentration-dependent manner. Additionally, biofilms formed by these species were subjected to treatment with xylitol. Xylitol was also capable of eradicating biofilms established by P. aeruginosa strain PAO1, methicillin-resistant S. aureus, and the mixed-species biofilm by at least 20%, with the most effective eradication observed for P. aeruginosa strain PAO1. The present study indicates the effectiveness of xylitol as both an inhibitory and eradicating agent against biofilms formed by P. aeruginosa strain PAO1, methicillin-resistant S. aureus, and a mix of both species in an alginate bead model, which mimics the in vivo characteristics of P. aeruginosa aggregates., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Aims: The pathways and metabolites that contribute to residual cardiovascular disease risks are unclear. Low-calorie sweeteners are widely used sugar substitutes in processed foods with presumed health benefits. Many low-calorie sweeteners are sugar alcohols that also are produced endogenously, albeit at levels over 1000-fold lower than observed following consumption as a sugar substitute., Methods: Untargeted metabolomics studies were performed on overnight fasting plasma samples in a discovery cohort (n = 1157) of sequential stable subjects undergoing elective diagnostic cardiac evaluations; subsequent stable isotope dilution liquid chromatography tandem mass spectrometry (LC-MS/MS) analyses were performed on an independent, non-overlapping validation cohort (n = 2149). Complementary isolated human platelet, platelet-rich plasma, whole blood, and animal model studies examined the effect of xylitol on platelet responsiveness and thrombus formation in vivo. Finally, an intervention study was performed to assess the effects of xylitol consumption on platelet function in healthy volunteers (n = 10)., Results: In initial untargeted metabolomics studies (discovery cohort), circulating levels of a polyol tentatively assigned as xylitol were associated with incident (3-year) major adverse cardiovascular event (MACE) risk. Subsequent stable isotope dilution LC-MS/MS analyses (validation cohort) specific for xylitol (and not its structural isomers) confirmed its association with incident MACE risk [third vs. first tertile adjusted hazard ratio (95% confidence interval), 1.57 (1.12-2.21), P < .01]. Complementary mechanistic studies showed xylitol-enhanced multiple indices of platelet reactivity and in vivo thrombosis formation at levels observed in fasting plasma. In interventional studies, consumption of a xylitol-sweetened drink markedly raised plasma levels and enhanced multiple functional measures of platelet responsiveness in all subjects., Conclusions: Xylitol is associated with incident MACE risk. Moreover, xylitol both enhanced platelet reactivity and thrombosis potential in vivo. Further studies examining the cardiovascular safety of xylitol are warranted., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The gut microbiota should be included in the scientific processes of risk assessment of food additives. Xylitol is a sweetener that shows low digestibility and intestinal absorption, implying that a high proportion of consumed xylitol could reach the colonic microbiota. The present study has evaluated the dose-dependent effects of xylitol intake on the composition and the metabolic activity of the child gut-microbiota. The study was conducted in a dynamic simulator of the colonic microbiota (BFBL Gut Simulator) inoculated with a child pooled faecal sample and supplemented three times per day, for 7 days, with increasing xylitol concentrations (1 g/L, 3 g/L and 5 g/L). Sequencing of 16S rRNA gene amplicons and group-specific quantitative PCR indicated a xylitol dose-response effect on the abundance of Lachnospiraceae, particularly the genera Blautia, Anaerostipes and Roseburia. The microbial changes observed with xylitol corresponded with a dose-dependant effect on the butyrate concentration that, in parallel, favoured an increase in epithelial integrity of Caco-2 cells. The study represents a detailed observation of the bacterial taxa that are the main contributors to the metabolism of xylitol by the child gut microbiota and the results could be relevant in the risk assessment re-evaluation of xylitol as a sweetener., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study evaluated the effect of xylitol combined or not with fluoride (F) on reduction of demineralization and increase of remineralization of shallow and deep artificial enamel lesions., Methods: Bovine enamel samples were allocated to the following solutions groups: no xylitol (negative control), 5% xylitol, 10% xylitol, 20% xylitol, 500 ppm F (as NaF), 5% xylitol+F, 10% xylitol+F or 20% xylitol+F (n = 12-15). For the demin study, a pH-cycling model (demineralization-6 h, pH 4.7/remineralization 18 h, pH 7.0) was employed for 7 days. Treatments were applied 2 × 1 min. In the remin study, specimens were pre-demineralized for 2, 5 or 10 days. Afterwards, a pH-cycling protocol was conducted (2 h demineralizing and 22 h remineralizing solution/day for 8 days) and the same treatments were done. The response variables were percentage surface hardness loss (%SHL) and transverse microradiography. Data were analyzed by RM ANOVA/Tukey or Kruskal-Wallis/Dunn (p < 0.05) RESULTS: F and Xylitol combined with F reduced the %SHL (23-30%) compared to the negative control (61.5%). The integrated mineral loss and the lesion depth were not reduced by any treatment. Surface hardness recovery was seen only for shallow lesions in case of 20% xylitol+F compared to negative control. No lesion depth recovery, but significant mineral recovery was seen for F (2-days and 10-days lesion)., Conclusions: All concentrations of xylitol+F reduced enamel surface demineralization, while only 20% xylitol+F improved surface remineralization of shallow lesions in vitro., Clinical Significance: Our results suggest that while F or any concentration of xylitol + F reduces surface demineralization, only 20% xylitol+F improves surface remineralization of shallow lesions in vitro. Therefore, xylitol may be added into oral products, combined to F, to control dental caries., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relantionships that caould have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Glucose isomerase (GI) is extensively used in the food industry for production of high-fructose corn syrup and for the production of biofuels and other renewable chemicals. Structure-based studies on GI inhibitors are important for improving its efficiency in industrial applications. Here, we report the subatomic crystal structure of Streptomyces rubiginosus GI (SruGI) complexed with its inhibitor, xylitol, at 0.99 Å resolution. Electron density map and temperature factor analysis showed partial binding of xylitol to the M1 metal binding site of SruGI, providing two different conformations of the metal binding site and the substrate binding channel. The xylitol molecule induced a conformational change in the M2 metal ion-interacting Asp255 residue, which subsequently led to a conformational change in the side chain of Asp181 residue. This led to the positional shift of Pro25 by 1.71 Å and side chain rotation of Phe26 by 21°, where located on the neighboring protomer in tetrameric SruGI. The conformation change of these two residues affect the size of the substrate-binding channel of GI. Therefore, xylitol binding to M1 site of SruGI induces not only a conformational changes of the metal-binding site, but also conformational change of substrate-binding channel of the tetrameric SruGI. These results expand our knowledge about the mechanism underlying the inhibitory effect of xylitol on GI., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To investigate the antimicrobial activity of a novel commensal strain of Streptococcus salivarius, LAB813, against Streptococcus mutans biofilms., Methods: The inhibitory activity of LAB813 towards S. mutans was tested using mono-, dual-, and multi-species cariogenic biofilms formed on three types of orthodontic appliances (metal, ceramic, aligner). The activity of the commercially available probiotic, BLIS M18™ was used as control., Results: LAB813 significantly inhibited S. mutans biofilms with cell killing approximating 99% for all materials. LAB813 showed effectiveness at inhibiting S. mutans in more complex multi-species biofilms with cell killing approximating 90% for all three materials. When comparing the killing kinetics of the probiotics, LAB813 had a faster rate of killing biofilms than M18. Experiments conducted with cell-free culture supernatant confirmed the presence of an inhibitory substance of proteinaceous nature. The addition of xylitol, a common sugar substitute used for human consumption, potentiated the inhibitory effects of LAB813 against S. mutans embedded in a more complex fungal-bacterial biofilm., Conclusions: LAB813 possesses strong antimicrobial activity, potent anti-biofilm properties, and enhanced antimicrobial activity in the presence of xylitol. The identification and characterization of strain LAB813 exhibiting antimicrobial activity towards S. mutans hold exciting promise for this novel strain to be developed as an oral probiotic for use in the prevention of dental caries., Competing Interests: Declaration of Competing Interest The authors declare that they have no financial or non-financial interests to disclose., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Aim: To compare the prevalence of mutans streptococci (SM) prevalence and categorical distribution in the saliva of high caries-risk children after their 24 months exposure to 25% xylitol toothpaste applied twice a day. To also examine the early caries susceptibility at baseline., Background: An observational design with two times of collection. A total of 270 mother-infant dyads (mean age of infant 6.7 months) were initially recruited. At baseline, a dental exam looked for any early clinical signs of caries, and saliva collections were performed to assess SM prevalence. Two years later, other saliva collections were performed on a residual sample of 102 young children at the endpoint., Methods: Two hundred four saliva samples were analysed with Dentocult, a commercial kit estimating in four categories, the SM distribution, expressed as the number of colonies forming units per milliliter of saliva (CFU/ml). The dental exam used the ICDAS system to include initial carious lesions (d1-2). The dentist administrated a maternal socio-economic questionnaire as the study collector., Conclusion: A domestic strategy using a natural toothpaste containing 25% of xylitol as a vehicle, and tooth brushing as a habit, showed a promising antibacterial cariogenic effect. This approach could be a relevant alternative to in-home care to prevent ECC and early SM contamination.

Although the association of polyols/polyphosphates/fluoride has been demonstrated to promote remarkable effects on dental enamel, little is known on their combined effects on biofilms. This study assessed the effects of solutions containing fluoride/sodium trimetaphosphate (TMP)/xylitol/erythritol on dual-species biofilms of Streptococcus mutans and Candida albicans . Biofilms were grown in the continuous presence of these actives alone or in different associations. Quantification of viable plate counts, metabolic activity, biofilm biomass, and extracellular matrix components were evaluated. Overall, fluoride and TMP were the main actives that significantly influenced most of the variables analyzed, with a synergistic effect between them for S. mutans CFUs, biofilm biomass, and protein content of the extracellular matrix ( p < 0.05). A similar trend was observed for biofilm metabolic activity and carbohydrate concentrations of the extracellular matrix, although without statistical significance. Regarding the polyols, despite their modest effects on most of the parameters analyzed when administered alone, their co-administration with fluoride and TMP led to a greater reduction in S. mutans CFUs and biofilm biomass compared with fluoride alone at the same concentration. It can be concluded that fluoride and TMP act synergistically on important biofilm parameters, and their co-administration with xylitol/erythritol significantly impacts S. mutans CFUs and biomass reduction.

Objective: This review was conducted to assess the effectiveness of xylitol against Porphyromonas gingivalis anaerobic species, a key microbe contributing to periodontal disease pathogenesis., Material and Methods: Relevant studies published on seven online databases (Cochrane, Ovid, Pubmed, Pubmed Central, Scopus, Google Scholar, and Web of Science) were included in accordance with the PRISMA guidelines. Inclusion criteria allowed all study designs involving xylitol and P. gingivalis, literature published since the year 2000, and all xylitol delivery forms., Results: The initial search yielded 186 papers. After the removal of duplicates, five reviewers screened every article for eligibility and seven articles were selected for data extraction. Four out of seven included studies assessed the dose-dependent effect of xylitol on P. gingivalis growth, two studies assessed the effect of xylitol on P. gingivalis-induced cytokine expression, and one study assessed both domains., Conclusions: From the in vitro studies included in this systematic review, there is some evidence of xylitol's inhibitory effect on P. gingivalis. However, more evidence derived from in vivo studies is required to confirm its effectiveness warranting their routine use., (© 2023 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Objective: Regular use of toothpaste with fluoride (F) concentrations of ≥ 1000 ppm has been shown to contribute to reducing caries increment. However, when used by children during the period of dental development, it can lead to dental fluorosis. In this study, we aimed to evaluate the in vitro effect of a toothpaste formulation with reduced fluoride (F) concentration (200 ppm) supplemented with sodium trimetaphosphate (TMP: 0.2%), Xylitol (X:16%), and Erythritol (E: 4%) on dental enamel demineralization., Methodology: Bovine enamel blocks were selected according to initial surface hardness (SHi) and then divided into seven experimental toothpaste groups (n=12). These groups included 1) no F-TMP-X-E (Placebo); 2) 16% Xylitol and 4% Erythritol (X-E); 3) 16% Xylitol, 4% Erythritol and 0.2%TMP (X-E-TMP); 4) 200 ppm F (no X-E-TMP: (200F)); 5) 200 ppm F and 0.2% TMP (200F-TMP); 200 ppm F, 16% Xylitol, 4% Erythritol, and 0.2% TMP (200F-X-E-TMP); and 7) 1,100 ppm F (1100F). Blocks were individually treated 2×/day with slurries of toothpastes and subjected to a pH cycling regimen for five days (DES: 6 hours and RE: 18 hours). Then, the percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), fluoride (F), calcium (Ca), and phosphorus (P) in enamel were determined. The data were analyzed by ANOVA (1-criterion) and the Student-Newman-Keuls test (p<0.001)., Results: We found that the 200F-X-E-TMP treatment reduced %SH by 43% compared to the 1100F treatments (p<0.001). The ΔKHN was ~ 65% higher with 200F-X-E-TMP compared to 1100F (p<0.001). The highest concentration of F in enamel was observed on the 1100F treatment (p<0.001). The 200F-X-E-TMP treatment promote higher increase of Ca and P concentration in the enamel (p<0.001)., Conclusion: The association of 200F-X-E-TMP led to a significant increase of the protective effect on enamel demineralization compared to the 1100F toothpaste.

This study evaluated the antimicrobial and anticaries effects of toothpaste containing hydroxyapatite nanoparticles (nanoHAP - 5 or 10%), xylitol (2 or 3%) and propolis (1 or 2%), associated or not with 1500 ppm fluoride (F). An in vitro model was used with microcosm biofilm produced from a pool of human saliva and McBain saliva (1:50) in the first 8 h of culture on 162 bovine enamel specimens. At the end of the experimental period, analyses of metabolic activity, colony forming units (CFU) and transverse microradiography (TMR) were performed. This study showed a possible decrease in demineralization and increase in remineralization by the commercial toothpaste (1500 ppm F) and for the experimental toothpaste containing the highest concentration of all agents, combined with F. In addition, a reduction in antimicrobial activity possibly caused by propolis and xylitol, mainly in relation to cariogenic bacteria, was observed.

Objectives: A systematic review of published data was conducted with the aim of assessing the effects of sugar-free polyol chewing gums on gingival inflammation., Materials and Methods: Electronic and hand searches were performed to find clinical studies concerning the effects of sugar-free chewing gums on gingival scores. Prospective randomized controlled clinical trials published between 1971 and 2021 were included in the review., Results: The initial search identified 46 erythritol, 102 xylitol, 23 sorbitol, and nine maltitol chewing gum articles. After applying inclusion and exclusion criteria, seven xylitol chewing gum studies, one sorbitol, and one maltitol chewing gum study with either high or fair quality were reviewed. In five out of the seven xylitol studies, xylitol gum decreased gingival scores. In two studies, xylitol decreased gingival scores compared to a polyol gum, and in three studies compared to no gum/gum base. As for sorbitol and maltitol, only sorbitol gum chewing showed a small decrease in gingival scores compared to the controls., Conclusions: Habitual xylitol gum chewing may reduce gingival inflammation. The low number of studies and their heterogeneity provide clear indications that the effects of sugar-free polyol chewing gums on gingival inflammation need further, well-controlled studies., Clinical Relevance: Sugar-free chewing gums, especially xylitol gum, may function as adjuncts to toothbrushing for reducing gingival inflammation, but the evidence so far is inconclusive., (© 2022. The Author(s).)

Objectives: This in vitro study evaluated the efficacy of toothpaste containing fluoride (F), sodium trimetaphosphate (TMP), and xylitol and erythritol (XE) to inhibit or repair initial enamel erosion lesions., Materials and Methods: Bovine enamel blocks (n = 120) were selected according to surface hardness (SH) and randomly divided into 5 experimental groups (n = 24 blocks/group): Placebo (no F, TMP, XE); 1100 ppm F; 16% xylitol + 4% erythritol (XE); 200 ppm F + 0.2% TMP (200 ppm F/TMP); and 200 ppm F + 0.2% TMP + 16% xylitol + 4% erythritol (200 ppm F/TMP/XE). The sound and softened blocks were immersed in toothpaste slurry in human saliva for 2 min. The blocks were then submitted to 4 erosive challenges in citric acid (0.75%, pH 3.5), each challenge for 1 min, with stirring. The SH of the blocks was determined after treatment (t) and after the 4 erosive challenges. In addition, the precipitates were analyzed by scanning electron microscopy (SEM). Variables were submitted to a two-way repeated-measures analysis of variance followed by a Student-Newman-Keuls test (p < 0.05)., Results: Toothpaste containing 200 ppm F/TMP/XE led to the highest protective and repair effect compared to the other groups (p < 0.001). The protective and repair effect was XE > 200 ppm F/TMP > 1100 ppm F > placebo (p < 0.001). All groups produced precipitates with a thicker layer for XE and TMP groups., Conclusions: Toothpaste containing 200 ppm F, TMP, and polyols demonstrated a superior protective and repair effect in initial enamel erosive lesions in vitro., Clinical Relevance: Toothpaste containing F and polyols could be an advantage in patients affected by dental erosion, due to its higher preventive potential, mainly in individuals who frequently drink acidic beverages. However, future studies are needed to confirm these results., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Postoperative ileus after cesarean is a common complication. The delay of bowel functions after cesarean influences early parenthood experience, increases the need for analgesic use, extends the duration of hospital stay, and causes cost increase. This study aimed to explore the effect of xylitol gum chewing after cesarean on bowel functions., Design: A prospective randomized controlled trial was conducted on subjects immediately after second hour of the cesarean in a ward of maternity., Methods: A total of 69 women were randomized to the xylitol gum chewing group (n = 23), the nonxylitol gum chewing group (n = 23), or the control group (n = 23). Data were collected from the women who agreed to participate and met the inclusion criteria. Starting with the second hour after the cesarean, women in the xylitol and nonxylitol gum chewing group were asked to chew gum for 15 minutes every 2 hours. The practice of chewing gum minimum of 8 hours and a maximum of 12 hours continued (until midnight). The data regarding the first times for bowel sounds, flatulation, defecation, a feeling of hunger, and length of hospital stay were compared., Findings: There is no difference in starting time of first bowel sounds (P = .070) and the first feeling of hunger (P = .098) among the groups. The first flatulation started at an earlier time in the xylitol gum chewing group than the control group (17.35 ± 6.27 vs 11.18 ± 5.39 hours, P = .003); first defecation time started earlier in the xylitol gum chewing group than nonxylitol gum chewing group (44.05 ± 9.4 vs 37.58 ± 9.96 hours, P = .022). Xylitol gum chewing group (51.77 ± 10.3 vs 46.33 ± 8.11 hours, P = .028) and nonxylitol gum chewing group (51.77 ± 10.3 vs 50.23 ± 5.72 hours, P = .024) were discharged from the hospital earlier than control group., Conclusions: In nursing care after cesarean, early period xylitol gum chewing is an efficient and user-friendly method to prompt bowel functions earlier. Xylitol gum chewing in nursing care is suggested to be involved., (Copyright © 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

We investigated the effect of xylitol or/and funoran on biofilm formation by Streptococcus mutans, one of cariogenic bacteria, on the surfaces coated and non-coated with saliva. Effects of xylitol and/or funoran were observed on biofilm formation of S. mutans in non-coated and salivary components-coated polystyrene microtiter 96-well plates (s-plate) and flow cell system. Xylitol did not strongly affect biofilm formation of S. mutans UA159 on non-coated and s-plates and, however, changed the quality of the biofilm on the cells in a flow cell system. Funoran had effects on biofilm formation, and the combination of xylitol and funoran strongly inhibited S. mutans biofilm formation on non-coated plates. In particular, funoran had inactivation effects on membrane vesicles (MVs) and inhibited MV-dependent biofilm formation of S. mutans on non-coated plate surfaces but not on the s-plate. These findings suggest that the combination of xylitol and funoran might be useful to remove the oral biofilm formation in elderly individuals with decreased saliva production. This result suggests that the synergistic effect of funoran and xylitol might be useful for the prevention of biofilm-associated diseases such as dental caries in saliva-decreased patients such as elderly patients., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: There is a growing consensus that sugar consumption should be reduced and the naturally occurring, low-calorie sweeteners xylitol and erythritol are gaining popularity as substitutes, but their effect on brain circuitry regulating appetite is unknown., Aim: The study's objective was to examine the effects of the two sweeteners on cerebral blood flow (rCBF) and resting functional connectivity in brain networks involved in appetite regulation, and test whether these effects are related to gut hormone release., Methods: The study was performed as a randomized, double-blind, placebo-controlled, cross-over trial. Twenty volunteers received intragastric (ig) loads of 50g xylitol, 75g erythritol, 75g glucose dissolved in 300mL tap water or 300mL tap water. Resting perfusion and blood oxygenation level-dependent data were acquired to assess rCBF and functional connectivity. Blood samples were collected for determination of CCK, PYY, insulin and glucose., Results: We found: (i) xylitol, but not erythritol, increased rCBF in the hypothalamus, whereas glucose had the opposite effect; (ii) graph analysis of resting functional connectivity revealed a complex pattern of similarities and differences in brain network properties following xylitol, erythritol, and glucose; (iii) erythritol and xylitol induced a rise in CCK and PYY, (iv) erythritol had no and xylitol only minimal effects on glucose and insulin., Conclusion: Xylitol and erythritol have a unique combination of properties: no calories, virtually no effect on glucose and insulin while promoting the release of gut hormones, and impacting appetite-regulating neurocircuitry consisting of both similarities and differences with glucose.

Objective: To investigate the effect of a novel mineral containing toothpaste in comparison to a fluoride toothpaste in children with white spot lesions., Methods: The clinical study was conducted from 2016 to 2018 at Marmara University Department of Pediatric Dentistry Clinic after approval from the ethics review committee of Yeditepe University, Istanbul, Turkey and comprised children of either gender aged 4-5 years having white spot lesions. They were randomly allocated into two groups. The FT (Fluoridated Toothpaste) group was given a 500ppm fluoridated toothpaste, while the Mineral Containing Toothpaste (MCT) group was given toothpaste containing calcium glycerophosphate, magnesium chloride, and 12% xylitol. The white spot lesions were examined using Laser Fluorescence (LF) at baseline and after a month of usage. The two readings were compared. Stimulated saliva was collected for measuring the salivary potential of hydrogen, buffering capacity, and streptococcus mutans. Data was analysed using SPSS 19., Results: Of the 26 children, 10(38%) were girls and 16(62%) were boys. The overall mean age was 4.77±0.54 years. There were 13(50%) subjects in each of the two groups. Of the 381 measurements done, 198(52%) were in the MCT group and 183(48%) in the FT group. LF scores decreased in both the groups (p=0.001). The remineralising potential was not significantly different (p=0.866), while salivary buffering capacity and potential of hydrogen increased in both the groups but the change was not significant (p>0.05). The number of children positive for streptococcus mutans decreased in both the groups (p>0.05)., Conclusions: The toothpaste containing calcium glycerophosphate, magnesium chloride and 12% xylitol had the remineralization properties needed for the prevention of gwhite spot lesions in children.

Background: Zygosaccharomyces rouxii plays an irreplaceable role in the manufacture of traditional fermented foods, which are produced in a high-salt environment. However, there is little research on strategies for improving salt tolerance of Z. rouxii., Results: In this study, metabolomics was used to reveal the changes in intracellular metabolites under salt stress, and the results show that most of the carbohydrate contents decreased, the contents of xanthohumol and glycerol increased (fold change 4.07 and 5.35, respectively), while the contents of galactinol, xylitol and d-threitol decreased (fold change -9.43, -5.83 and -3.59, respectively). In addition, the content of four amino acids and six organic acids decreased, while that of the ten nucleotides increased. Notably, except for stearic acid (C18:0), all fatty acid contents increased. Guided by the metabolomics results, the effect of addition of seven exogenous fatty acids (C12:0, C14:0, C16:0, C18:0, C16:1, C18:1, and C18:2) on the salt tolerance of Z. rouxii was analyzed, and the results suggested that four exogenous fatty acids (C12:0, C16:0, C16:1, and C18:1) can increase the biomass yield and maximum growth rate. Physiological analyses demonstrated that exogenous fatty acids could regulate the distribution of fatty acids in the cell membrane, increase the degree of unsaturation, improve membrane fluidity, and maintain cell integrity, morphology and surface roughness., Conclusion: These results are applicable to revealing the metabolic mechanisms of Z. rouxii under salt stress and screening potential protective agents to improve stress resistance by adding exogenous fatty acids. © 2022 Society of Chemical Industry., (© 2022 Society of Chemical Industry.)

Objective: The aim was to determine the effect of chewing gum containing xylitol and freeze-dried blackberry powder on oral bacteria., Design: This was a randomized, controlled, cross-over study (RCT #: NCT05133557). Fifty participants chewed gum over an 8 h period, four times for 20 min at 2-hour intervals, containing 700 mg xylitol (CG) with or without 50 mg blackberry powder (BG), while wearing a stent containing a sterile enamel chip. After a 1 week washout, participants chewed gum from the other group following the same protocol. The primary outcome was the amount of nine oral bacteria in saliva as determined by quantitative PCR. The secondary outcome was bacteria formed on enamel chips., Results: Chewing BG for four twenty-minute intervals reduced mean total bacteria load and the relative abundance of six of the nine bacteria studied in saliva (p < 0.05). In comparison, only four bacteria were reduced in abundance in the CG group. After gum chewing and regardless of group, S. sanguinis and A. naeslundii were the predominant bacteria adherent to enamel, with S. mutans representing < 1 % of the total bacteria on enamel., Conclusion: Bacterial loads in saliva were rapidly, differentially, and significantly reduced after one day of chewing BG., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Biomolecular carbon dots (CDs) have immense potential for various industries due to exceptional bioactivity, biocompatibility, low toxicity, and biodegradability. In the present work xylitol (Xlt), a natural sweetener produced by microbial fermentation of sugarcane bagasse (71.98% conversion) has been used for CDs preparation by microwave-assisted carbonization in the presence of ethylene diamine (EDA). The resultant xylitol carbon dots (XCDs) were irregular shaped, rough with an average size of 8.88 nm and exhibiting fluorescence between 400 and 450 nm. The presence of EDA preserves the native chemical structure of Xlt even after exposure to microwaves. Purified XCDs were conjugated (AM-XCD) with ketoconazole and tetracycline for fungi and bacteria, respectively. In comparison to Xlt, XCDs have higher inhibitory potential and reduced dosage size of antimicrobials against Cryptococcus neoformans, Candida albicans, Streptococcus pyogenes, and Escherichia coli by 75%, 75%, 87.50%, and 50%, respectively. For Listeria monocytogenes and Salmonella typhi also inhibitory potential was increased by 14.68% and 21.38%. Increased efficacy advocated the improved drug delivery in the presence of XCDs. However, no inhibitory effect was recorded against DU145 (human prostate cancer) and HCT-15 (human colon adenocarcinoma) cell lines. The findings of the current work suggested the possible use of Xlt as an important antimicrobial agent besides an efficient drug carrier in healthcare., (© 2021 International Union of Biochemistry and Molecular Biology, Inc.)

Introduction: Chlorhexidine is considered the most potent chemotherapeutic agent against Streptococcus mutans. However, its side effects due to prolonged use, indicates need for alternatives. The study intended to assess and compare antimicrobial efficacies of probiotic, xylitol and chlorhexidine mouth rinses in children and elderly., Methods: The study was a Double blind Randomized Controlled Trial conducted among residential school children aged 5-12 years and elderly greater than 60 years residing in old age homes. (ClinicalTrials.gov ID: NCT04399161). 30 participants each among children and elderly were chosen based on eligibility criterion (high risk for caries). They were further randomly divided into 3 groups with 10 participants in each group. Participants were asked to rinse with 15 ml of freshly prepared mouth rinses once daily for 2 minutes for 14 days. Antimicrobial efficacy was determined by assessing change in Streptococcus mutans levels in dental plaque., Results: Significant reduction in Streptococcus mutans counts were observed in both children and elderly (Chlorhexidine: mean difference = 3.11 log10CFU/g, p = 0.022, Xylitol: mean difference = 0.93 log10CFU/g, p = 0.046, Probiotic: mean difference = 1.91 log10CFU/g, p = 0.023 in children); (Chlorhexidine: mean difference = 2.23 log10CFU/g, p = 0.004, Xylitol: mean difference = 1.39 log10CFU/g, p = 0.009, Probiotic: mean difference = 1.61 log10CFU/g, p = 0.018 in elderly). Intergroup comparison showed no significant difference., Conclusions: Antimicrobial efficacy of xylitol and probiotic mouth rinses were comparable to that of chlorhexidine in both children and elderly. Probiotics could potentially be more efficacious than xylitol among children., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2022 Pacini Editore SRL, Pisa, Italy.)

Type 2 diabetes (T2D) is a metabolic disorder that has become a major threat to public health. Epidemiological and experimental studies have suggested that whey protein isolate (WPI) and xylitol (XY) play an important role on T2D. This manuscript hypothesizes the supplementation of whey protein and xylitol complex (WXY) has the hypoglycemic and hyperlipidemia effect of T2D mice induced by the conjoint action of a high-fat diet and streptozotocin (STZ) by modulating of intestinal microbiota. The mice with diabetes displayed higher levels of fasting blood glucose (FBG), insulin, glycosylated hemoglobin, total triglycerides, total cholesterol, aspartate aminotransferase, alanine aminotransferase and other serum parameters than the normal mice. Treatment with WXY for 6 weeks significantly modulated the levels of FBG and insulin, improved insulin sensitivity, pancreas impairment and liver function in T2D mice, and the effect was better than that observed with WPI and XY groups. Moreover, supplementation with WXY significantly changed the diversity and composition of the intestinal microbiota in T2D mice and restored the intestinal bacteria associated with T2D (Firmicutes, Bacteroidetes, and Lactobacillus). This may be a potential mechanism for alleviating T2D symptoms. Spearman correlation analysis showed that the relative abundances of specific genera (Turicibacter, Lachnospiraceae&#95;NK4A136&#95;group, Lactobacillus, Candidatus&#95;Saccharimonas, Faecalibaculum and Coriobacteriaceae&#95;UCG-002) were correlated with the levels of blood glucose and serum parameters. Therefore, WXY may be considered a promising dietary supplement for T2D treatment in the future., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The highly prevalent white spot lesions around orthodontic brackets necessitate introducing preventive materials without relying on patient compliance., Objective: To evaluate the antidemineralizing effect of two concentrations of xylitol varnish., Trial Design: Triple-blind, four-arm, parallel-group, single-center, randomized controlled clinical trial., Methods: A total of 120 orthodontic patients were randomly assigned to four groups (n = 30), using a computer-generated randomized block list. The treatment groups were: 10% xylitol, 20% xylitol, 5% fluoride, and placebo. Tooth demineralization was measured with DIAGNOdent at T1 (before treatment), followed by varnish application. At T2 (third month), the varnish was re-applied, and at the third (T2) and sixth (T3) months, and after treatment (T4), the demineralization was measured. The white spot lesion frequency was assessed visually after treatment. The participants, the clinician, and data assessors were all blinded to group assignments., Results: A total of 115 patients underwent per-protocol analyses. At T2, the mean DIAGNOdent numbers in the fluoride and 10% xylitol groups were significantly lower than the placebo group (P = 0.00), with a mean difference of 0.63 (95% CI, 0.15-1.10) and 0.5 (95% CI, 0.04-0.95), respectively. At T3, the fluoride and 10% xylitol groups had significantly lower mineral loss than the placebo group (P=0.046) with a mean difference of 0.52 (95% CI, 0.14-0.89) in the fluoride and 0.45 (95% CI, 0.03-0.86) in the 10% xylitol groups, respectively. However, at T4, only the mean for the 10% xylitol group was significantly different (P=0.049) from the placebo group, with a mean difference of 1.18 (95% CI, 0.42-1.93). Visual assessment showed that after treatment, the prevalence of white spot lesions in the fluoride (P=0.03) and 10% xylitol (P=0.00) groups was less than the placebo group with the odds ratio of 0.67 (95% CI, 0.46-0.96) and 0.43 (95% CI, 0.28-0.64), respectively., Conclusion: The 10% xylitol varnish short-term effects on caries control were significantly greater than 20% xylitol varnish and placebo but similar to fluoride varnish. However, the 10% xylitol long-term effect was almost better than fluoride varnish., Trial Registration: The protocol was registered at IRCT.ir under the code IRCT20180913041032N1., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Many types of cancer have metabolic alterations with increased glycolysis. Identification of alternative sweeteners that do not fuel cancer is a novel approach to cancer control. The present study aimed to investigate the effects of xylitol on tumor growth and survival of mice bearing orthotopic xenograft of tongue cancers. The results showed that partial substitution of glucose with xylitol (glucose 0.35 g plus xylitol 2.06 g/kg body weight) non-significantly reduced tumor volume, and significantly prolonged the median survival time from 19 days in the control to 30.5 days in the xylitol group. Immunohistochemical data of the tongue tissue shows significantly lower intense-to-mild staining ratios of the proliferation marker Ki-67 in the xylitol than those of the control group ( p = 0.04). Furthermore, the xylitol substitution significantly reduced the expression of the rate-limiting glycolytic enzyme, phosphofructokinase-1 (PFK-1) ( p = 0.03), and showed a non-significant inhibition of PFK activity. In summary, partial substitution of glucose with xylitol at the equivalent dose to human household use of 10 g/day slows down tumor proliferation and prolongs survival of mice bearing an orthotopic oral cancer xenograft, possibly through glycolytic inhibition, with minimal adverse events. The insight warrants clinical studies to confirm xylitol as a candidate sweetener in food products for cancer survivors.

Aim: This study was conducted to evaluate the remineralization potential of Remin Pro Forte vs Remin Pro remineralizing agents on white spot lesions (WSLs) post-orthodontic treatment., Materials and Methods: Twenty patients with post-orthodontic WSLs were divided into the following two equal groups based on treatment ( n = 10): (1) A 3-month program of hydroxyapatite, fluoride, xylitol, ginger, curcuma-containing cream (Remin Pro Forte) as intervention group; (2) A 3-month cream regimen including hydroxyapatite and fluoride, xylitol (Remin Pro) as control group. The main outcomes including caries regression (assessed by ICDAS II), mineral content (assessed by VistaCam iX camera), and color of WSLs (assessed by digital image analysis by Adobe photoshop) were measured at the time of enrollment and 1, 2, and 3 months afterward. Mann-Whitney test used to compare between tested groups. The statistical significance was set at p <0.05., Results: Both Remin Pro Forte and Remin Pro elicited much better caries regression and significantly higher mineral content in WSLs over a 3-month period ( p <0.05). However, the difference in mineral content of WSLs between groups did not reach statistical significance ( p = 0.414). In both experimental groups, the appearance of WSLs improved significantly ( p <0.05)., Conclusion: Both Remin Pro Forte and Remin Pro were successful in reducing caries, increasing mineral content, and enhancing the appearance of demineralized enamel, indicating that both products could be suggested for post-orthodontic WSL management., Clinical Significance: Natural herbal products could be employed as remineralizing agents and included into tooth preventive measures. It is a less harmful alternative to traditional chemical remineralization methods.

Aim: To investigate the effects of bleaching with 35% hydrogen peroxide on the structure of tooth enamel and the role of two remineralizing agents for their potential to remineralize any damaged regions of enamel., Materials and Methods: Freshly extracted 32 mature permanent central incisors were selected and sectioned at the level of the cemento-enamel junction. The teeth were divided into four groups consisting of eight teeth each: No bleaching (control) [Group 1], bleaching with 35% hydrogen peroxide [Group 2], bleaching with 35% hydrogen peroxide followed by application of casein phosphopeptide amorphous calcium phosphate fluoride paste [Group 3], and bleaching with 35% hydrogen peroxide followed by application of xylitol-coated calcium phosphate fluoride varnish [Group 4]. The enamel surfaces were analyzed under the scanning electron microscope and quantitative energy dispersive X-ray analysis., Results: Results were statistically analyzed by one-way analysis of variance and Tukey's posthoc test. Group 2 revealed changes in enamel surface morphology and a statistically significant decrease in mineral content. Groups 3 and 4 showed statistically significant remineralization potential. Intergroup comparison showed that samples in Group 4 had a higher mineral content compared to Group 3., Conclusions: The application of the tested remineralizing agents following bleaching was effective in repairing the enamel surface morphology with higher efficacy for the fluoride varnish product. Since bleaching regimes with high concentrations of hydrogen peroxide adversely affect the enamel surface, these findings can translate to clinical practice to reduce the long-term damaging effects of tooth bleaching., Competing Interests: None

In the present study, we investigated the therapeutic effect of xylitol on glycogen content, oxidative stress, purinergic and cholinergic dysfunction, and lipid dysmetabolism in hepatic tissue of diabetic rats. Seven-week-old male Sprague-Dawley rats were divided into five groups as follows: normal control (NC), diabetic control (DC), diabetic xylitol 5% (DX5), diabetic xylitol 10% (DX10), and diabetic xylitol 20% (DX20). Type 2 diabetes (T2D) was induced in the diabetic groups, and after the confirmation of diabetes, the xylitol groups were supplied with their respective solutions. After 8 weeks intervention period, the animals were humanely sacrificed, and their hepatic tissues were harvested. Treatment with 10% xylitol compared with the other treatment groups had significantly (p < .05) higher liver glycogen level, reduced glutathione (GSH), superoxide dismutase (SOD), catalase and ENTPase activities, with concomitant reduction in malondialdehyde MDA level, ATPase and acetylcholinesterase activities. It further modulated lipid metabolism and restored hepatic morphology. The data suggest that xylitol at 10% had a better therapeutic effect against hepatic dysfunction associated with T2D. However, further clinical studies are still required to affirm these findings. PRACTICAL APPLICATIONS: The global prevalence of diabetes mellitus is increasing progressively. Maintaining normal control of glucose metabolism and homeostatic glycemic levels is a key management strategy in delaying the onset of diabetic-related complications. The use of foods sweetened with sugar alcohols has brought an escalating interest, particularly among diabetic patients. Xylitol has been reported as a potential antidiabetic sweetener in various studies. Our findings in this study have shown that a 10% xylitol dietary dose can be used as a potential functional food additive for the alleviation of hepatic complications associated with T2D., (© 2022 Wiley Periodicals LLC.)

Introduction: Chronic rhinosinusitis is an inflammatory condition of the nasal cavity and the paranasal sinuses that requires multifactorial treatment. Xylitol can be employed with nasal irrigation and can provide better control of the disease., Objective: To evaluate the association between the effects of nasal lavage with saline solution compared to nasal lavage with a xylitol solution., Methods: Fifty-two patients, divided into two groups (n = 26 in the "Xylitol" group and n = 26 in the "Saline solution" group) answered questionnaires validated in Portuguese (NOSE and SNOT-22) about their nasal symptoms and general symptoms, before and after endonasal endoscopic surgery and after a period of 30 days of nasal irrigation., Results: The "Xylitol" group showed significant improvement in pain relief and nasal symptom reduction after surgery and nasal irrigation with xylitol solution (p < 0.001). The "Saline solution" group also showed symptom improvement, but on a smaller scale., Conclusion: This study suggests that the xylitol solution can be useful in the postoperative period after endonasal endoscopic surgery, because it leads to a greater reduction in nasal symptoms., (Copyright © 2020 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Prevention of dental caries is important for nutrition and health of the child. Sucrose being considered an arch criminal, various substitutes are recommended. Xylitol is an artificial sweetener which cannot be metabolized by bacteria. Thus, it seems to be a promising method in prevention of dental caries., Materials and Methods: Fifty children between the age of 3-6 years were randomly divided into two groups; Group 1: Control group (without lollipops) and Group 2: Experimental group (with sugar substitute lollipops). The saliva sample was collected at four different time intervals, and pH of saliva was determined using universal pH indicator., Results: There was a significant drop in the pH after drinking sweetened beverages in both the groups, but there was a significant rise in pH after having xylitol + erythritol lollipops which almost returned to baseline after 15 min., Conclusion: Lollipops containing xylitol and erythritol can be used in small children and it has potential to increase salivary pH, thus not allowing the pH to fall below the critical value., Competing Interests: None

Last year observed a global pandemic caused by SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) infection affecting millions of individuals worldwide. There is an urgent unmet need to provide an easily producible and affordable medicine to prevent transmission and provide early treatment for this disease. Since the nasal cavity and the rhinopharynx are the sites of initial replication of SARS-CoV-2, a nasal spray may be an effective option to target SARS-CoV-2 infection. In this study, we tested the antiviral action of three candidate nasal spray formulations against SARS-CoV-2 in vitro. We determined that iota-carrageenan in concentrations as low as 6 μg/mL inhibits SARS-CoV-2 in vitro. The concentrations of iota-carrageenan with activity against SARS-CoV-2 in vitro may be easily achieved through the application of nasal sprays as commonly used in several countries. Recently a double-blind, placebo-controlled study showed that iota-carrageenan in isotonic sodium chloride reduces ca. five times the risk of infection by SARS-CoV-2 in health care personnel. Further, xylitol at a concentration of 50 mg/mL (ca. 329 mM) was found to exert some antiviral action, though this preliminary finding needs further confirmation., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: I have a commercial affiliation to Laboratorio Pablo Cassará S.R.L, who provided the formulations for the study and to Amcyte Pharma Inc.. This submission is related to US Patent No. 11.013.687 “PREVENTIVE AND THERAPEUTIC TREATMENT FOR COVID 19 AND ANY OTHER DISEASE CAUSED BY SARS COV 2”, whose inventor is Julio César Vega. This does not alter our adherence to PLOS ONE’s policies on sharing data and materials.

In patients with obesity, accelerated nutrients absorption is observed. Xylitol and erythritol are of interest as alternative sweeteners, and it has been shown in rodent models that their acute ingestion reduces intestinal glucose absorption. This study aims to investigate whether a chronic intake of xylitol and erythritol impacts glucose absorption in humans with obesity. Forty-six participants were randomized to take either 8 g of xylitol or 12 g of erythritol three times a day for five to seven weeks, or to be part of the control group (no substance). Before and after the intervention, intestinal glucose absorption was assessed during an oral glucose tolerance test with 3- Ortho -methyl-glucose (3-OMG). The effect of xylitol or erythritol intake on the area under the curve for 3-OMG concentration was not significant. Neither the time (pre or post intervention), nor the group (control, xylitol, or erythritol), nor the time-by-group interaction effects were significant ( p = 0.829, p = 0.821, and p = 0.572, respectively). Therefore, our results show that a chronic intake of the natural sweeteners xylitol and erythritol does not affect intestinal glucose absorption in humans with obesity.

Polyols are effective against caries-causing streptococci but the effect on oropharynx-derived pyogenic streptococci is not well characterised. We aimed to study the effect of erythritol (ERY) and xylitol (XYL) against Streptococcus pyogenes isolated from peritonsillar abscesses (PTA). We used 31 clinical isolates and 5 throat culture collection strains. Inhibition of bacterial growth by polyols at 2.5%, 5% and 10% concentrations was studied and the results were scored. Amylase levels in PTA pus were compared to polyol effectivity scores (PES). Growth curves of four S. pyogenes isolates were analysed. Our study showed that XYL was more effective than ERY inhibiting 71-97% and 48-84% of isolates, respectively, depending of concentrations. 48% of clinical and all throat strains were inhibited by polyols in all concentrations (PES 3). PES was negative or zero in 26% of the isolates in the presence of ERY and in 19% of XYL. ERY enhanced the growth of S. pyogenes isolated from pus with high amylase levels. Polyols in all concentrations inhibited the growth in exponential phase. In conclusion, ERY and XYL are potent growth inhibitors of S. pyogenes isolated from PTA. Therefore, ERY and XYL may have potential in preventing PTA in the patients with frequent tonsillitis episodes., (© 2021. The Author(s).)

Objective: To evaluate the effect of low-fluoride (F - ) toothpaste and sodium trimetaphosphate (TMP) associated with xylitol and erythritol (XE) on enamel demineralization and biofilm composition., Methods: This crossover double-blind in situ study consisted of five phases (seven days each), in which 14 volunteers wore oral appliances containing four enamel bovine blocks. The cariogenic challenge was performed by exposure to a 30% sucrose solution (6x/day). The toothpaste treatments (3x/day) were as follows: placebo (no F - /TMP/XE); 200 ppm F - (NaF) (200F); 1,100 ppm F - (1100F); 16% Xylitol and 4% Erythritol (XE); and 200 ppm F - , 0.2% TMP, 16% xylitol, and 4% erythritol (200F-TMP-XE). Percentage of surface hardness loss (%SH) and integrated loss of subsurface hardness (ΔKHN), and calcium (Ca 2+ ), phosphate (PO 4 3- ), and F - on enamel and biofilm were determined; as well as insoluble extracellular polysaccharide (EPS)., Results: XE and 1100F groups showed no significant difference for %SH and ΔKHN values (p = 0.220 and p = 0.886), and the 200F-TMP-XE group had the lowest mineral loss (p < 0.001). Ca 2+ and PO 4 3- in the enamel showed the highest values (p < 0.001) for the 200F-TMP-XE group. Higher values of F - in the enamel and biofilm were observed for the 1100F group (p < 0.001). There was no difference for Ca 2+ (p = 1.00) and EPS (p =0.918) values between XE and 200-TMP-XE groups in the biofilm, but their values were higher and lower than the 1100F (p = 0.002 and p = 0.029), respectively., Conclusions: 200F-TMP-XE promoted a greater protective effect against enamel demineralization and significantly affected the composition of biofilm formed in situ compared to 1100F toothpaste., Clinical Significance: Low-F - toothpaste containing TMP and polyols can be considered an effective and safe measure to improve the oral health of individuals, especially patients with high caries activity., (Copyright © 2021. Published by Elsevier Ltd.)

Sugar consumption is associated with a whole range of negative health effects and should be reduced and the natural sweetener xylitol might be helpful in achieving this goal. The present study was conducted as a randomized, placebo-controlled, double-blind, cross-over trial. Twelve healthy, lean volunteers received intragastric solutions with 7, 17 or 35 g xylitol or tap water on four separate days. We examined effects on: gut hormones, glucose, insulin, glucagon, uric acid, lipid profile, as well as gastric emptying rates, appetite-related sensations and gastrointestinal symptoms. We found: (i) a dose-dependent stimulation of cholecystokinin (CCK), active glucagon-like peptide-1 (aGLP-1), peptide tyrosine tyrosine (PYY)-release, and decelerated gastric emptying rates, (ii) a dose-dependent increase in blood glucose and insulin, (iii) no effect on motilin, glucagon, or glucose-dependent insulinotropic peptide (GIP)-release, (iv) no effect on blood lipids, but a rise in uric acid, and (v) increased bowel sounds as only side effects. In conclusion, low doses of xylitol stimulate the secretion of gut hormones and induce a deceleration in gastric emptying rates. There is no effect on blood lipids and only little effect on plasma glucose and insulin. This combination of properties (low-glycemic sweetener which stimulates satiation hormone release) makes xylitol an attractive candidate for sugar replacement.

Purpose: The use of a mouthwash as an adjunct to mechanical plaque removal may be useful to improve oral hygiene. In this study, cetylpyridinium chloride (CPC)-based mouthwashes containing sodium fluoride and xylitol (X-PUR Opti-Rinse 0.05% NaF and X-PUR Opti-Rinse 0.2% NaF) were evaluated for their antimicrobial activity against important oral pathogens associated with dental caries, periodontal disease, and candidiasis. Moreover, their biocompatibility and anti-inflammatory properties were assessed., Materials and Methods: Antimicrobial activity was determined using a disk-diffusion assay, a microplate dilution assay, and the European standard protocols for antiseptics. Microbicidal properties were assessed against both planktonic and biofilm cultures. An oral epithelial cell model was used to evaluate the biocompatibility of mouthwashes and their ability to attenuate cytokine secretion., Results: Using three different antimicrobial assays, the CPC-based mouthwashes were found to be highly active against the tested microorganisms. More specifically, the mouthwashes met the European Standard NF EN 1040 and NF EN 1275 defined as a log10 reduction ≥ 5 (≥ 99.999% killing) for bacteria and log10 reduction ≥ 4 (≥ 99.99% killing) for fungi, respectively. The CPC-based mouthwashes were also bactericidal against biofilms of S. mutans, S. sobrinus, and P. gingivalis. Using an oral epithelial cell model, the CPC-based mouthwashes were found to be less cytotoxic than a chlorhexidine-containing mouthwash used as control. Lastly, the CPC-based mouthwashes decreased the secretion of interleukin-6 and interleukin-8 by lipopolysaccharide-stimulated oral epithelial cells. , Conclusion: The CPC-based mouthwashes supplemented with sodium fluoride (0.05% or 0.2%) and xylitol (10%) were highly active against important oral pathogens. Moreover, using an oral epithelial cell model, these mouthwashes were found to be biocompatible and to exhibit anti-inflammatory activity.

This study evaluated the effect of some natural additives and the structure imparted by them on microbial growth and rheological characteristics in acidic model foods with reduced glycidic content. Systems were formulated using gellan gum, as gelling agent; xylitol, as a w depressor; and natamycin, as antimicrobial. Additive-free control systems were prepared. The pH was adjusted to 3.50 or 5.50 as required. Systems were inoculated with Zygosaccharomyces bailii. The effect of additives alone and combined on Z. bailii growth was studied. In some cases, the possible use of additives as yeast nutrients was evaluated. Furthermore, systems rheological characterization was performed. Additives and the structure given by gellan gum significantly affected yeast growth. Gellan gum initially slowed Z. bailii development, but as storage progressed, it acted as yeast carbon source, promoting its growth. A similar trend was observed when xylitol effect was studied. Natamycin inhibited yeast growth in all systems assayed. Additives modified the rheological characteristics of the gels and this effect depended on gellan gum concentration and pH. Obtained results emphasize the importance of considering the different effects that additives and their combinations can exert on the growth of deteriorating microorganisms and on the physical characteristics of gels., (Copyright © 2020. Published by Elsevier B.V.)

Objective: Among the preventive and therapeutic options available for dental caries, sugar alcohols (xylitol and sorbitol) have been widely promoted as oral healthcare products due to its perceived anticariogenic effect. However, the therapeutic efficacy of these sugar alcohols against Streptococcus mutans and Candida albicans in a sucrose supplemented environment, as found in disease-prone conditions in the oral cavity, has not been adequately investigated., Methods: Single and mixed-species biofilm formation was evaluated in medium with different concentrations of xylitol, sorbitol with or without sucrose supplementation. Biofilm quantification methods such as crystal violet assay, XTT assay, CFU counting complemented with confocal and electron microscopic techniques were used., Results: Under sucrose-free conditions, xylitol and sorbitol demonstrated a significant dose-dependent inhibitory effect on S. mutans biofilms, whereas inhibitory effect on C. albicans biofilm was weak. The presence of 1 % sucrose in the environment diminished the inhibitory effect of both xylitol and sorbitol on S. mutans and C. albicans mono-species biofilms. Sucrose supplementation on pre-formed S. mutans biofilms also reduced the inhibitory effect of xylitol. Xylitol and sorbitol presence reduced mixed-species biofilm formation and altered the biofilm architecture and glucan production. However, sucrose supplementation reduced the inhibitory effect of sugar alcohols and enhanced the mixed-species biofilm formation., Conclusions: Xylitol and sorbitol exerts an inhibitory effect on S. mutans and C. albicans biofilm formation and this inhibitory effect is repressed by the presence of sucrose., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Dental caries is an infectious disease with predominantly of cariogenic bacteria such as Streptococcus mutans (S mutans). Xylitol is considered as one of the effective agents that can limit this dental infection. In this randomised, placebo-controlled trial, we aimed to evaluate the potential reflection of short-term xylitol consumption on pro-inflammatory cytokines (TNF-α, IL-6 and IL-8) and S mutans counts by ELISA and qPCR (Quantitative real-time PCR), respectively., Methods: In this study, 154 participants were assigned to two groups, control and xylitol. Dental examination, saliva and swab samples were done at baseline and at 3-week for clinical and microbiological assessment., Results: In xylitol group at the end of 3-week, gingival and plaque index scores were significantly decreased with respect to baseline values (P < .001 and P < .05, respectively). The salivary concentration of TNF-α, IL-6 and IL-8 were statistically declined at 3-week, more so than those at baseline in xylitol group (P < .001). S mutans expression was reduced about fivefold at 3-week use of xylitol and it was a statistically significant difference compared to baseline (P < .001)., Conclusion: Intriguingly, even short-term consumption of xylitol might play a favourable role in maintaining the oral health status, possibly as a result of decreasing the release of pro-inflammatory cytokines and the counts of S mutans. Nonetheless, this investigation warrants further endorsement., (© 2020 John Wiley & Sons Ltd.)

The aim of this study was to evaluate synergy and inhibitory effects of xylitol and erythritol on Streptococcus mutans and Streptococcus sobrinus growth and biomass production on a polystyrene plastic surface. Study design; S. mutans and sobrinus strains (American Type Culture Collection reference strains 31341, 35668, 25175, sobrinus 33478) were cultivated in media (Todd Hewitt Broth with 1% sucrose or heart-brain infusion broth with 1% sucrose) at differing concentrations of xylitol or erythritol in microtiter assay plates incubated for 48 hours. Bacterial growth was quantified and measured by optical density using a microplate reader. Experiments assessing synergy and biofilm growth were carried out also using microdilution assays. All four strains were inhibited by 30% (w/v) xylitol, and 15% erythritol at 150mg/ml erythritol, 2/4 strains had reduced growth; at 270mg/ml, 4/4 strains were inhibited. Bactericidal effects were not observed at any polyol concentration. Combinations of both polyols in a checker board array were used to determine if there were any benefits of polyol combinations. Results The combination studies yielded mixed outcomes with indifference in growth for strains 68 and 78, potential additive effect for strain 75 and possible antagonism for strain 41. Assessment of biomass formation and polyol interference were also performed post MIC assessment. Strains 41, 68 and 75 produced significant biomass in the absence of either polyol. Both polyols inhibited biomass formation in a dose-dependent fashion. Strain 75 is a poor biomass producer and could not be assessed for polyol effects in our assay. Conclusion: Our results demonstrate significant polyol influence on the oral Streptococcal strains tested in our laboratory.

Background: Regular consumption of xylitol decreases the number of cariogenic streptococci in dental plaque. In vitro biofilm models to study the mechanism of xylitol action have been set-up, but the obtained results are contradictory. Biofilm growth is a dynamic process with time-specific characteristics that may remain undetected in conventional end-point biofilm tests. In this study we used an impedance spectroscopy instrument, xCELLigence Real Time Cell Analyzer (RTCA), that allows label-free, non-invasive real-time monitoring of biofilm formation, to explore effects of xylitol on biofilm formation by Streptococcus mutans. Based on the obtained information of biofilm dynamics, we assessed the number of viable bacteria, the polysaccharide content, and the expression levels of selected genes involved in glucan-mediated biofilm formation in different biofilm stages. Xylitol inhibition was compared with that of erythritol; another polyol suggested to have a positive impact on oral health., Results: Our results showed that real-time monitoring provided new information of polyol-induced changes in S. mutans biofilm formation dynamics. The inhibitory effect of polyols was more pronounced in the early stages of biofilm formation but affected also the measured total amount of formed biofilm. Effects seen in the real-time biofilm assay were only partially explained by changes in CFU values and polysaccharide amounts in the biofilms. Both xylitol and erythritol inhibited real-time biofilm formation by all the nine tested S. mutans strains. Sensitivity of the strains to inhibition varied: some were more sensitive to xylitol and some to erythritol. Xylitol also modified the expression levels of gbpB, gtfB, gtfC and gtfD genes that are important in polysaccharide-mediated adherence of S. mutans., Conclusion: The erythritol- and xylitol- induced inhibition of biofilm formation was only partly explained by decrease in the number of viable S. mutans cells or the amount of polysaccharides in the biofilm matrix, suggesting that in addition to reduced proliferation also the matrix composition and thereby the surface attachment quality of biofilm matrix may be altered by the polyols.

Non-cariogenic sweet substances, like sugar alcohols, are used to decrease the risk of caries by reducing the growth of dental plaque. The aim of our study was to reveal the impact of xylitol and erythritol on the growth and biofilm formation of cariogenic bacteria including as a novelty, set of clinical mutans streptococci and Scardovia wiggsiae and to assess the possible synergistic influence of these polyols. We found both xylitol and erythritol to express high growth inhibition effect on cariogenic bacteria. In synergistic effect experiments, 10% polyol combination with excess of erythritol was found to be more effective against growth of Streptococcus mutans and the combination with excess of xylitol more effective against growth of Streptococcus sobrinus and S. wiggsiae. In biofilm inhibition experiments, solutions of 10% polyols in different combinations and 15% single polyols were equally effective against mutans streptococci. At the same time, higher biofilm formation of S. wiggsiae compared to experiments without polyols was detected in different polyol concentrations for up to 34%. In conclusion, both erythritol and xylitol as well as their combinations inhibit the growth of different cariogenic bacteria. Biofilm formation of mutans streptococci is also strongly inhibited. When applying polyols in caries prophylaxis, it is relevant to consider that the profile of pathogens in a particular patient may influence the effect of polyols used.

Objectives: The aim of this study was to evaluate the efficiency of xylitol chewing gums enriched with propolis, remineralizing softly demineralized dentin in vitro., Design: Four groups of chewing gum were developed; Group1: xylitol (1.8 %), Group2: xylitol + casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (3%), Group3: xylitol+Hydroxyapatite (3%) and Group4: xylitol + propolis (5%). A control group was designed without chewing gum, but with artificial saliva. Sections of embedded crowns and cleaned roots of twenty five bovine incisors were demineralized in carbonated drink. Crown specimens were half-varnished. Remineralization process was run for all the dental specimens in the 4 groups with gum extracts and in the control group with artificial saliva for 20 min at 37 °C three times a day during 7 days. Mineral contents were evaluated by scanning electron microscopy with energy dispersive X-ray spectroscopy (EDX-SEM). Surface morphology and roughness were analyzed using atomic force microscopy (AFM). Micro-hardness was measured using Vickers micro-hardness tester among varnished and unvarnished sides., Results: Calcium/Phosphate mean ratio showed a significant decrease between the control group, group1, group2 and group4. Control group and group3 were not significantly different. Micro-hardness increased significantly for all treated groups. AFM showed obstruction of dentinal tubules in all the groups and roughness decreased in the treated side of the dentin compared to the untreated side for tested groups., Conclusion: Xylitol chewing gum enriched with propolis showed dentinal tubules occlusion, significant improvement of micro-hardness and slight decrease in roughness. Ca/P ratio analysis suggests that a mineral compound other than hydroxyapatite is responsible of tubules occlusion., Competing Interests: Declaration of Competing Interest Wafa Gargouri benefited from a scholarship granted by the confectioner TRIKI-Le Moulin (Sfax, Tunisia). Mazen Elleuche works at Triki le Moulin., (Copyright © 2020. Published by Elsevier Ltd.)

Xylitol and erythritol are widely used in a variety of food and oral care products as sugar substitutes. Although a number of studies have been conducted on the health benefits of xylitol since the 1960s, erythritol only attracted the attention of researchers during the early 1990s. Historically, researchers mainly focused on the effects of xylitol and other sugar alcohols on oral and dental healthcare while the anti-diabetic or antihyperglycemic effects have only been revealed recently. Though a few reviews have been published on the health benefits of sugar alcohols in the last few decades, none of them closely evaluated the antihyperglycemic potential and underlying mechanisms, particularly with a focus on xylitol and erythritol. The current review thoroughly analyzes the anti-diabetic and antihyperglycemic effects as well as other metabolic effects of xylitol and erythritol using articles published in PubMed since the 1960s, containing research done on experimental animals and humans. This review will help researchers ascertain the controversies surrounding sugar alcohols, investigate further beneficial effects of them as well as aid food industries in exploring the possibilities of using sugar alcohols as anti-diabetic supplements in diabetic foods and food products.

Objectives: The aim of this in vitro study was to evaluate the effects of casein phosphopeptides (CPP)-ACPF, NovaMin+ fluoride-containing toothpaste and Xylitol+ fluoride containing cream on demineralized areas on the enamel surface., Materials and Methods: A total of 100 enamel slab samples was prepared to investigate in the laboratory experiments. For this purpose, a total of 50 freshly extracted third molar teeth which completed root formation split into two portions in the mesiodistal direction. Enamel surfaces were immersed in a pH cycling protocol as described in the literature to simulate oral conditions for 9 days in order to evaluate the effect of test materials on the artificial enamel lesions. Then the remineralization agents were applied on the enamel surfaces, and we analyzed their effects., Results: We used Vickers Microhardness with the purpose of calculating the amount of lost or acquisition of minerals on the enamel surface qualitatively; inductively coupled plasma atomic emission spectroscopy (ICP-AES) to define the calcium and phosphorus ions that dissolved in acid. One-way ANOVA and Tukey's T Post-Hoc tests were performed to distinguish significant differences among groups (P < 0.05)., Conclusions: Remineralization was provided in all treated groups, according to the data obtained from all tests. NovaMin was more effective in increasing acid resistance. It was also found that all three experimental groups were effective in increasing the surface hardness, but CPP-ACPF and NovaMin are more effective than Xylitol. However, there was no statistically significant difference between the experimental groups., Competing Interests: None

Dental biofilm - in which a diverse set of microorganisms are embedded in a complex polysaccharide matrix that adheres to oral components - is one of the most complex microbial communities in the human body. As biofilm formation is related to oral infections, such as caries and periodontal diseases, strategies for biofilm control are crucial for maintaining oral health. Xylitol, a synthetic sugar used as a sucrose substitute, has been shown to reduce biofilm formation. However, its precise mechanism of action on biofilm reduction has so far not been elucidated. Previous studies demonstrate that bacterial β-glucosidase action is crucial for biofilm formation. Here, we investigated the correlation between salivary β-glucosidase activity and dental plaque occurrence. We found a positive correlation between enzymatic activity and the presence of dental biofilm. We observed that xylitol inhibits β-glucosidase in human saliva. Kinetic studies also confirmed that xylitol acts as a mixed type inhibitor of salivary β-glucosidase. Based on our data, we suggest that xylitol impairs oral biofilm formation by the inhibition of bacterial β-glucosidase, which is essential for biofilm formation in the oral cavity., (© 2019 Eur J Oral Sci.)

Xylitol has been widely documented to have dental health benefits, such as reducing the risk for dental caries. Here we report on other health benefits that have been investigated for xylitol. In skin, xylitol has been reported to improve barrier function and suppress the growth of potential skin pathogens. As a non-digestible carbohydrate, xylitol enters the colon where it is fermented by members of the colonic microbiota; species of the genus Anaerostipes have been reported to ferment xylitol and produce butyrate. The most common Lactobacillus and Bifidobacterium species do not appear to be able to grow on xylitol. The non-digestible but fermentable nature of xylitol also contributes to a constipation relieving effect and improved bone mineral density. Xylitol also modulates the immune system, which, together with its antimicrobial activity contribute to a reduced respiratory tract infection, sinusitis, and otitis media risk. As a low caloric sweetener, xylitol may contribute to weight management. It has been suggested that xylitol also increases satiety, but these results are not convincing yet. The benefit of xylitol on metabolic health, in addition to the benefit of the mere replacement of sucrose, remains to be determined in humans. Additional health benefits of xylitol have thus been reported and indicate further opportunities but need to be confirmed in human studies.

The house fly, Musca domestica (L.) (Diptera: Muscidae), and the stable fly, Stomoxys calcitrans (L.) (Diptera: Muscidae), are two filth flies responsible for significant economic losses in animal production. Although some chemical control products target adults of both species, differences in mouthpart morphology and behavior necessitates distinct modalities for each. For these reasons, larvicides are an attractive means of chemical control. We assessed the potential of the polyol sweeteners erythritol and xylitol as larvicides to the house fly and stable fly. LC 50 values of erythritol against 2 nd instar larvae were 34.94 mg/g media (house fly) and 22.10 mg/g media (stable fly). For xylitol, LC 50 values were 74.91 mg/g media (house fly) and 41.58 mg/g media (stable fly). When given a choice, neither species showed a preference for ovipositing in media treated with either sweetener at various concentrations or in media without sweetener. Significantly lower development from egg to adult was observed when the 2 nd instar LC 50 equivalent of each sweetener was present in the media compared to controls. Erythritol and xylitol both have larvicidal qualities, however their effective concentrations would necessitate creative product formulation and deployment methods to control all stages of developing flies., (© 2019 The Society for Vector Ecology.)

Background: Oral microbiome has significant impact on both oral and general health. Polyols have been promoted as sugar substitutes in prevention of oral diseases. We aimed to reveal the effect of candies containing erythritol, xylitol or control (sorbitol) on salivary microbiome., Methods: Ninety children (11.3 ± 0.6 years) consumed candies during 3 years. Microbial communities were profiled using Illumina HiSeq 2000 sequencing and real-time PCR., Results: The dominant phyla in saliva were Firmicutes (39.1%), Proteobacteria (26.1%), Bacteroidetes (14.7%), Actinobacteria (12%) and Fusobacteria (6%). The microbiome of erythritol group significantly differed from that of the other groups. Both erythritol and xylitol reduced the number of observed bacterial phylotypes in comparison to the control group. The relative abundance of the genera Veillonella, Streptococcus and Fusobacterium were higher while that of Bergeyella lower after erythritol intervention when comparing with control. The lowest prevalence of caries-related mutans streptococci corresponded with the lowest clinical caries markers in the erythritol group., Conclusions: Daily consumption of erythritol, xylitol or control candies has a specific influence on the salivary microbiome composition in schoolchildren. Erythritol is associated with the lowest prevalence of caries-related mutans streptococci and the lowest levels of clinical caries experience., Trial Registration: ClinicalTrials.gov Identifier NCT01062633.