Xylitol and the Gateway Microbiome
Why Chewing Gum Improves Maternal-Fetal Outcomes and Reduces Dental Caries in Children
By Peter A. McCullough, MD, MPH
The oropharynx harbors thousands of bacteria and fungi that live in symbiosis with the human body. This is called the “gateway microbiome” since the nose and the mouth are the entry point for air, water, and food to the human body. Several cups of secretions from the nose and mouth are swallowed everyday, so what is in these secretions affects the gastro-intestinal tract and the entire body.
The teeth, tongue, and gums depend on a healthy balance of micro-organisms saliva and the periodontal fluid in the dental recesses. It is amazing to think that even maternal-fetal outcomes are impacted by the mother’s gateway microbiome and that the nascent oral health of newborn could be set by what the mother does during pregnancy and obvious contact with the baby after birth including breast feeding.
Exogenous xylitol (chewing gum, mints, oral/nasal rinses, etc.) is one of the most available and direct ways of favorably impacting the gateway microbiome. Xylitol and other non-hexose polyols which are natural substances found in fruits and vegetables and can be obtained from berries, oats, mushrooms, corn husks and sugar cane. Xylitol can help maintain the gateway microbiome in a state of eubiosis or balance.
Aagaard et al conducted a large clinical study using xylitol based chewing gum in pregnant women—the results were astonishing, a 24% reduction in pre-term birth. This may have occurred due to a lesser risk of febrile infections or other factors that trigger premature labor.
“10,069 women were enrolled (4549 intervention vs 5520 control) with 9,670 outcomes available at follow-up. Perinatal xylitol chewing gum use resulted in a significant reduction in pre-term births (12.6% vs. 16.5%; aRR 0.76, 95% CI 0.59-0.99) and fewer < 2500g neonates (8.9% vs 12.9%; aRR 0.70, 95% CI 0.49-0.99)…Among n=4220 subjects compliant with dental visits, a significant reduction in periodontitis occurred with xylitol gum use.”
Isokangas et al, found the maternal intervention of chewing xylitol gum on a regular basis had lasting beneficial effects in the growing children through age 5 years. Xylitol inhibits the colonization of a bacterium mutans streptococci (MS) which is associated with tooth decay.
“In the microbiological part of the present study in Ylivieska, Finland, with 195 mothers with high salivary MS levels [unfavorable], regular maternal use of xylitol chewing gum [intervention] resulted in a statistically significant reduction in MS colonization in their children's teeth at the age of 2 years compared with teeth in children whose mothers received fluoride or chlorhexidine varnish treatment. The children did not chew gum or receive varnish treatments. For the present study, the children were examined annually for caries occurrence by experienced clinicians who did not know whether the children were colonized with MS. Regardless of the maternal prevention group, the presence of MS colonization in children at the age of 2 years was significantly related to each child's age at the first caries attack in the primary dentition. In children at the age of 5 years, the dental caries in the xylitol group were reduced by about 70% as compared with that in the fluoride or chlorhexidine group. We conclude that maternal use of xylitol chewing gum can prevent dental caries in their children by prohibiting the transmission of MS from mother to child.”
Finally, if the children chew xylitol gum on a regular basis at school, along with good dental hygiene, there is a reduction in the risk of dental caries. Makinen et al conducted a large study, N=1277, using multiple types of gum and found:
“The four xylitol gums were most effective in reducing caries rates, the most effective agent being a 100% xylitol pellet gum (relative risk, 0.27; 95% confidence interval, 0.20 to 0.36; p = 0.0001). This gum was superior to any other gum (p < 0.01).”
The most commonly used products containing xylitol are sugar-free chewing gum and candies (such as mints, caramels, and chocolates) which have both been endorsed by state and national dental associations. The suggested quantity is ~5 g/day which means chewing gum/mints 3-5 times per day.
In conclusion, these data should give you something positive to “chew on” and smile about as we move into the New Year. I know I have been convinced on the benefits of xylitol. A safe product we can use to improve our gateway microbiome and affect a host of favorable clinical outcomes—particularly among young mothers and children.
All the best to you and yours as we move into 2024! Happy New Year!
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Peter A. McCullough, MD, MPH
President, McCullough Foundation
A personal anecdote to add: I noticed a small cavity forming in one of my teeth, while not painful it was a legitimate hole opening in a tooth, and so I started chewing xylitol gum because I heard Dr Rhonda Patrick say it could help with cavities and it did for me, the tooth regrew and I no longer have a random hole in my tooth
Dr McCullough, do you realize that xylitol even in very small amounts can cause liver failure and death in dogs? I have a difficult time with something so toxic to dogs being “healthy” for humans. I wonder if xylitol studies are paid for by Big Pharma to only look at the results Big Pharma wants while ignoring the long-term horrific health outcomes. You can barely find gum without xylitol in it. And xylitol is in many sugar-free products. Several people have fed xylitol containing peanut butter to their dogs as a treat and their dogs died of liver failure within a few days.
https://vcahospitals.com/know-your-pet/xylitol-toxicity-in-dogs#:~:text=This%20occurs%20because%20xylitol%20can,or%20even%20death%20in%20dogs.