The news is again full of shocking stories about the state of kids’ teeth. According to the BBC, in 2013-14 nearly 26,000 five to nine year-olds were admitted to hospitals in England with tooth decay (up 14% from 2011). Tooth decay is now the most common reason kids this age end up in hospital. The Royal College of Surgeons says many hospitals are reaching “crisis point” managing these numbers. And as Prof Nigel Hunt, dean of the Royal College of Surgeons’ dental faculty rightly says; “It is absolutely intolerable that in this day and age, in a civilised country, children are having so many teeth out for decay, which is over 90% preventable”.
So what can be done? Sugar is obviously a big culprit and it’s important to reduce the amount and importantly the frequency, of kids’ sugar intake. No doubt many children could also do more of the basics; brushing for two minutes, twice a day. But what most parents don’t know is that the state of their own dental health could be contributing to the problem.
To explain, let’s start with a dental health 101. Decay all starts with harmful bacteria in your mouth. It’s these bacteria that feed on sugars, form plaque and ultimately cause decay.
Now here’s the interesting bit. Babies aren’t born with these bad bacteria in their mouths and they don’t have the teeth for the bacteria to form around or stick to. So where do they get it from? Well research has shown that it actually comes from their mothers (or main carers) through close contact, like kissing or sharing spoons.
So imagine if there was a way of stopping the bad bacteria going from the mother to the child. Could this lead to children having less issues with decay?
It was a clever Finnish professor called Eva Soderling who first thought of conducting clinical trials to see if reducing the amount of bacteria in mum’s mouth (with xylitol) would have a knock on effect on their kid’s dental health. The results were very interesting indeed. Babies whose mothers chewed xylitol confectionery had less bad bacteria (Mutans Steptococci) at the end of the study1. Incredibly importantly this meant the children tended to have less decay, even up to the age of ten2. Powerful stuff.
The excitement around this research led to many similar studies being conducted. Recently (February 2015) there was an independent systematic review of all of these (“Maternal Xylitol and Mutans Streptococci Transmission”) to assess whether they agreed with Professor Soderling’s findings. The review analysed 11 studies involving a total of 601 patients. Within the studies, mothers consumed between 2grams and 5grams of xylitol, daily, when their children were just born or less than 5 months of age.
Their conclusion: that habitual xylitol consumption by mothers with high Mutan Streptococci levels was associated with a significant reduction in the mother-to-child transmission of these bad bacteria. The impact of this is huge as it means that eating xylitol confectionery can not only make your own teeth healthier but also have a significant impact on the on-going dental health of your child.
The authors point out that more quality research is required (see the note below) and we hope this’ll lead to further studies in this fascinating area.
NOTE ON RESEARCH REVIEW:
For research buffs and to provide full disclosure here is a brief review of the quality of the review. The good bits first. The study was very well described with lots of detailed information presented. Like the Cochrane study the review was well structured, with the ability to see why and how studies were included, and there was lots of technical stuff included in the analysis (the authors did a comprehensive analysis of what was good and bad about the research they included). Importantly the review discusses some of the issues with getting quality evidence in xylitol research. In many studies there were high drop outs (in one study 60% of participants didn’t complete the study). This is often the problem with these kinds of studies. As anyone who’s had a baby knows, it’s tough and so also participating in research can become impractical.
Statistically the authors performed a meta-analysis (a big complicated way of combining all the results together) and showed a significant difference in the amount of bacteria (Mutans Streptococci) transmitted from mother to infants in the xylitol group compared with groups who didn’t consume xylitol. It was more difficult for the authors to come to conclusions on whether this then translates to a reduction in dental decay (like it did in Professor Soderling’s study) as there were simply not enough studies for them to do this.
So is there anything you could criticise in this review? No nothing significant. Again research purists would argue that there could have been a few details included; the authors could have described how they searched for papers; there should also have been a little more discussion on the bias associated with some of the papers. Some critiques would go further and say that it is difficult to do a meta-analysis on these papers as they are all quite different – many use different doses of xylitol, different ages of children, and the mothers in the non-xylitol groups all consume different stuff. They also didn’t look at unpublished studies, and there are ongoing studies.
In summary, it’s a well conducted review with a positive conclusion for xylitol. The reviewers, like us, call for further high quality research.
(1) Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. Soderling. 1999.
(2) Long-term effects of maternal prevention on children’s dental decay and need for restorative treatment. Laitala. 2013.