Cavities, technically called dental caries, are caused by a bacteria called
. This bacteria lives in the mouth and thrives on sugar and other carbohydrates. In the presence of carbohydrates,
produces acids that dissolve the enamel of teeth, causing cavities.
Strong evidence indicates that
toothpastes help prevent cavities. These toothpastes are so widely used, in fact, that water fluoridation is probably of little to no value except in poorer, less developed countries where use of fluoride toothpastes is not so universal.
Fluoride rinses may offer some additional benefit.
However, there is little to no scientific support for the use of the much more expensive, professionally applied, fluoride varnishes.
Double-blind studies enrolling almost 4,000 people, mostly children, have found that the natural sugar
can prevent cavities.
These trials used xylitol-sweetened gum, candies, or toothpaste. The best evidence regards xylitol gum.
One study suggested that gummi bears may be an effective alternative method of administering xylitol to children.
In one of the largest of these trials, researchers tested gum sweetened with various concentrations of xylitol and/or sorbitol against gum sweetened with sucrose and a control group receiving no gum.
This 40-month trial was completed by 861 children. Gum containing 100% xylitol reduced the incidence of cavities the most. However, all of the xylitol and sorbitol gum groups showed significant reductions in cavities as compared to the control group. In contrast, the children receiving sucrose-sweetened gum had a slight increase in cavities compared to the control group.
double-blind, placebo-controlled study
of 1,677 children compared a standard fluoride toothpaste with a similar toothpaste that also contained 10% xylitol.
Over the 3-year study period, children given the xylitol-enriched toothpaste developed significantly fewer cavities than those in the fluoride-only group. Studies in adults and children have shown similar results for xylitol gum and candy.
Another series of studies suggests that children acquire cavity-causing bacteria from their mothers, and that regular use of xylitol by a mother of a newborn child may provide long lasting protection to the child as well.
Xylitol is thought to prevent cavities by inhibiting the growth of the
For more information, including dosage and safety issues, see the full
Another sugar substitute called sorbitol may work as well as xylitol for the prevention of cavities in children.
However, xylitol appears to work better than sorbitol for preventing cavities in adults.
Friendly bacteria (
) have been proposed for the prevention of cavities, on the ground that they can fight harmful cavity-causing bacteria.
The best evidence regards a probiotic product called
(LGG). In a double-blind, placebo controlled trial, 594 children aged 1-6 years old were given either normal milk or milk with LGG had been added.
After the 7-month trial, the results showed significantly fewer cavities in the children receiving LGG.
One very preliminary study found suggestive evidence that use of a toothpaste containing the herb
plus fluoride is more effective for cavity prevention than fluoride alone.
Weak evidence hints at benefits with chewing gum that contains
Cranberry juice has also shown a bit of promise,
as has a special extract of
called “hop bracts polyphenols.”
One study failed to find benefit through the use of calcium-rich chewing gum.
Other natural treatments advocated for preventing cavities, but that lack any meaningful scientific support, include
, myrrh, and
Marinho VC, Higgins JP, Sheiham A, et al. Fluoride toothpastes for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev
Marinho VC, Higgins JP, Logan S, et al. Fluoride varnishes for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev
Gales MA, Nguyen T-M. Sorbitol compared with xylitol in prevention of dental caries.
Makinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries rates: a 40-month cohort study.
J Dent Res
Makinen KK, Hujoel PP, Bennett CA, et al. Polyol chewing gums and caries rates in primary dentition: a 24-month cohort study.
Makinen KK, Pemberton D, Makinen P-L, et al. Polyol-combinant saliva stimulants and oral health in Veterans Affairs patients—an exploratory study.
Spec Care Dent
Isokangas P, Alanen P, Tiekso J, et al. Xylitol chewing gum in caries prevention: a field study in children.
J Am Dent Assoc
Sintes JL, Escalante C, Stewart B, et al. Enhanced anticaries efficacy of a 0.243% sodium fluoride/10% xylitol/silica dentrifrice: 3-year clinical results.
Am J Dent
Alanen P, Isokangas P, Gutmann K. Xylitol candies in caries prevention: results of a field study in Estonian children.
Community Dent Oral Epidemiol
Soderling E, Isokangas P, Pienihakkinen K, et al. Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up.
Isokangas P, Soderling E, Pienihakkinen K, et al. Occurrence of dental decay after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age.
J Dent Res
Soderling E, Isokangas P, Peinihakkinen K, et al. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants.
J Dent Res
Uhari M, Kontiokari T, Niemela. A novel use of xylitol sugar in preventing acute otitis media.
Nase L, Hatakka K, Savilahti E, et al. Effect of long-term consumption of a probiotic bacterium,
GG, in milk on dental caries and caries risk in children.
Dodes JE. The amalgam controversy. An evidence-based analysis.
J Am Dent Assoc
Marinho VC, Higgins JP, Logan S, et al. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;CD002284.
Nikawa H, Makihira S, Fukushima H, et al. Lactobacillus reuteri in bovine milk fermented decreases the oral carriage of mutans streptococci.
Int J Food Microbiol
Hong SJ, Jeong SS, Song KB, et al. Effects of sanguinaria in fluoride-containing dentifrices on the remineralisation of subsurface carious lesion in vitro.
Int Dent J
Weiss EI, Kozlovsky A, Steinberg D, et al. A high molecular mass cranberry constituent reduces mutans streptococci level in saliva and inhibits in vitro adhesion to hydroxyapatite.
FEMS Microbiol Lett
Hayashi Y, Ohara N, Ganno T, et al. Chewing chitosan-containing gum effectively inhibits the growth of cariogenic bacteria.
Arch Oral Biol
. 2006 Nov 15 [Epub ahead of print]
Schirrmeister JF, Seger RK, Altenburger MJ, et al. Effects of various forms of calcium added to chewing gum on initial enamel carious lesions in situ.
Tagashira M, Uchiyama K, Yoshimura T, et al. Inhibition by hop bract polyphenols of cellular adherence and water-insoluble glucan synthesis of mutans streptococci.
Biosci Biotechnol Biochem.
Pizzo G, Piscopo MR, Pizzo I, et al. Community water fluoridation and caries prevention: a critical review.
Clin Oral Investig.
2007;11:189-193. Epub 2007 Feb 27.
Ly KA, Riedy CA, Milgrom P, et al. Xylitol gummy bears snacks: a school-based randomized clinical trial.
BMC Oral Health.
2008 Jul 25.
Last reviewed December 2015 by EBSCO CAM Review Board
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.