Xylitol is an artificial sweetener. It has the same benefit of other artificial sweeteners - less calories/sugar without losing sweetness - with some unique additional benefits. Xylitol has been found to decrease tooth decay. It also slows the growth of certain bacteria that live in the mouth. If a bacteria cannot multiply then it cannot as easily progress to an infection. The bacteria in the mouth may not only be responsible for infections in the mouth but may also play a role in infections that develop in throat and ears.
Analysts from The Cochrane Database wanted to know if xylitol could help decrease local bacterial infections such as acute otitis media (ear infections) in children. The study, published in Cochrane Databases, found that xylitol sugar was in fact associated with decreased risk of ear infection.
The systematic review included three randomized trials with 1,826 children aged 12 years or younger. The children were followed for the development of ear infections after using xylitol or placebo (fake xylitol)/no treatment. The xylitol was given on a daily basis and may have been a syrup (10 grams/day), lozenge (10 grams/day), or gum (8.4 grams/day). Ear infections developed in 30% of children who received placebo or no treatment.
Individually, two of the three trials with 1,163 children found that xylitol was associated with decreased risk of ear infections but one trial with 663 children did not find a benefit. When these three trials results were combined, the use of xylitol in any form was associated with a 25% decrease in risk of ear infections (xylitol would prevent an ear infection in one out of every 10-28 children given xylitol).
Finally, one of the trials comparing the effectiveness of different forms of xylitol found:
- Xylitol chewing gum led to less ear infections (16%) than xylitol syrup (28%)
- No significant difference in number of ear infections when comparing xylitol lozenge to xylitol syrup or chewing gum
Systematic reviews are generally reliable since they can include large numbers of trials and patients. These increased number and statistical combination of results produce more reliable outcomes than individual trials alone. In this review there were only three trials, one of which had results inconsistent with the other two. The fact that there were inconsistent results and so few trials may decrease reliability of results.
Ear infections are one of the most common bacterial infection in children. While it rarely leads to complications and can often clear on its own, an ear infection can be a miserable experience for the child and caretaker. This evidence, although positive, does not suggest everyone stockpile the xylitol. However, if your child chews gum, choosing a gum made with xylitol may decrease the risk of the next ear infection. Keep in mind that the children in these studies chewed two pieces of gum five times a day for at least five minutes each time, which is a lot of gum. If your child frequently gets ear infections, ask your doctor about steps you can take for prevention, which may include some xylitol gum. It is a preventative health step your child may be eager to comply with.
Azarpazhooh, Amir, Limeback, et al. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD007095.
Last reviewed January 2012 by Brian P. Randall, MD
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