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What's best to use - xylitol chewing gum, xylitol drops/candy, xylitol gel or simply xylitol sugar (powder)?

Since xylitol is the only truly active and effective ingredient, the following rule applies: the longer and more thoroughly mouth and teeth including the interstices are bathed in xylitol, the better and the more complete the effect.

This means that the clear winner is

xylitol sugar (xylitol powder)

The plus points of xylitol sugar/powder:

Pure xylitol is relatively (by far) the cheapest and the most effective. Its dosage can easily be adjusted according to one's own needs and requirements. When rinsing one's mouth with xylitol, it becomes very well distributed in the oral cavity where it stays for a long time and hence allows prolonged contact with both teeth and gums (which is the central secret of its effectiveness!). All of this shows that in all likelihood xylitol in its pure form will give the fastest and most thorough results in terms of better dental health.

The minus points of xylitol sugar/powder:

One could consider as such the fact that sugar/powder doesn't come preportioned so a bit more time may be required to handle it. Air passengers carrying xylitol in powder form may consider of relevance that powder of such suspicious whiteness may not be able to pass the airport security controls. (compare Can I take xylitol or xylitol products along when travelling by air?).

Xylitol chewing gums (use only 100% sweetened with xylitol)

The plus points of xylitol chewing gums

Practical to use, store and transport, easy to handle, they taste good, and as shown in numerous studies since the 1970s, they work well (compare Xylitol studies).

The minus points of xylitol chewing gums

Very expensive, very wasteful packaging (lots of plastic etc.) and thus not just bad for the environment but also for the pavement, the individual gums are tiny in my experience so that several have to be put into the mouth to even "get a grip". Also, chewing gums contain very little xylitol (a maximum of 1g per gum from what I've seen). When chewing the gum(s), the saliva cum xylitol mix is typically quickly swallowed, so teeth and gums are not bathed very long, thus reducing xylitol's beneficial effect.

As mentioned above, this doesn't happen when xylitol sugar/powder (or xylitol gel or drops) are used since with these substances or products, xylitol will be in longer contact with the oral cavity. Nor are the additives (such as artificial aromas, beeswax, soy lecithin etc.) presumably frequently found in chewing gums a plus point incl. for people suffering from allergies.

Last but far from least: since chewing gum increases the release of mercury from any amalgam fillings you may be carrying in your mouth, chewing gums are better not used at all by people with amalgams.2

Xylitol drops (for sale, can also be made at home)

Practical to use, store and transport, easy to handle.

Xylitol gel (new product, perhaps not easily available outside Germany)

Easy to handle and transport, particularly ideal for people in need of help/with disabilities unable to look after their own teeth (compare Xylitol: other helpful applications).

What about products which contain both xylitol and various other types of sugar?

Since both sucrose (saccharose, common table sugar) and related carbohydrates are considered highly cariogenic, mixing xylitol with sucrose makes little sense.

In animal experimentation (the results of which are not necessarily transferable to humans)1, xylitol has been shown to be effective against caries even when added to highly cariogenic foodstuffs containing sugar and/or starch.

With carious teeth, using xylitol in pure form still appears to make the most sense. Where other types of carbohydrate must be added, one could choose maltitol and maltitol syrup, erythritol as well as small amounts of sorbitol or related substances4. The studies done to date however suggest that for caries prophylaxis, products sweetened with 100% xylitol are superior to those containing sorbitol.

When using xylitol "by the teaspoon", it will work even when combined with cariogenic table sugar, see If I don't brush my teeth after eating sweets but simply pop half a teaspoon of xylitol, why would that work?. Also compare Best tooth-friendly sugar substitutes.

How long should I expose my mouth and teeth to xylitol and how much should I use?

There is no strict rule in this matter and even a minute appears to be very helpful. Longer times of xylitol exposure do tend to bring phantastic results however, such as teeth being smooth as porcelain, desensitization of previously sensitive tooth necks, plaque reduction etc. (A quick reminder here that rinsing your mouth with water afterwards will noticeably weaken the effectiveness of xylitol.)

Generally, Dr. Bruhn recommends using 3-5 g at each application (approximately equivalent to 1/2 to one teaspoon xylitol powder), with 4 g xylitol (or more) being optimal (yielding the best effect), particularly in the first four weeks of xylitol use. In-between, even just one gram used several times a day is sufficient to prevent damage to the teeth.

What is the simplest way to treat my teeth with xylitol?

If money is no particular issue, then using xylitol drops and xylitol gel is probably the easiest (although really, the work involved in using "straight" xylitol sugar rather than drops or gel is hardly worth mentioning). If for social reasons, you can't find a moment to rinse your mouth with xylitol where you are (such as at your workplace), then of course xylitol candy is better.

Is it more effective to suck/rinse with xylitol or to brush one's teeth with it?

By using the xylitol-saturated saliva like toothpaste for brushing one's teeth, xylitol's tooth-cleaning effect is considerably increased.

After using xylitol, should I additionally use toothpaste?

That makes little sense.

Can I forget my toothpaste (or even toothbrush) and just use xylitol to prevent cavities and care for my mouth?

Yes, xylitol powder can indeed be sufficient by itself (that said, daily flossing is recommended to remove food particles stuck between the teeth).

A toothbrush only allows to reach a part of the entire surface of the teeth (in fact, according to the German Stiftung Warentest magazine, 40% of the total tooth surface is located between the teeth) and is hardly used to clean the gums or the tongue. But xylitol does reach and "wash" a large part of the oral cavity when you do a several-minute "rinse cycle", so it effectively inhibits the formation of cariogenic plaque throughout your mouth.

If you also discontinue using your toothbrush, however, you may occasionally see unsightly but harmless light brown coatings on your teeth. These are removed by using a toothbrush to brush the saliva-xylitol-mix thoroughly over your teeth. If you miss the peppermint flavour of normal toothpaste, simply add a drop of essential peppermint oil (use organic if at all possible) to your xylitol.

If I don't brush my teeth after eating sweets but simply pop half a teaspoon of xylitol, why would that work?

While it is correct that the table sugar continues to be in your mouth, surprisingly xylitol often works by itself, i.e. without even brushing your teeth (the main reason being its ability to inhibit certain enzymes, see Xylitol's three outstanding benefits). When there are sweets in your mouth, bacteria will indeed consume them. But when there is xylitol simultaneously present which the bacteria are unable to distinguish from normal sugar, upon ingestion many of them will be killed, thus diminishing the production of dangerous acids and hence the risk of tooth decay. Xylitol also strongly stimulates saliva production, which exerts an additional cleaning effect on your teeth, quite apart from another cleaning effect "X" xylitol obviously possesses as well but which so far has not been researched . As described under Xylitol's three outstanding benefits, upon ingestion of table sugar, it would be advisable to keep the xylitol concentration high in your mouth.3

Can I use xylitol immediately after a meal or should I wait 30 minutes before brushing my teeth (like with eating something sour, so as to avoid damaging the enamel)?

Actually, it's advantageous to use xylitol directly after a meal, for two reasons.

1. For one thing, xylitol strongly stimulates saliva production and flow, and components of (healthy) saliva stemming from the food ingested will neutralise any acids present and remineralise teeth whose surface has been slightly etched, and the earlier after the meal xylitol is taken, the more effective this will be (compare Tooth remineralisation & demineralisation, saliva & pH).

2. Xylitol inhibits the activity of acid-producing bacteria. It is generally correct that one should wait after eating acidic foodstuffs before brushing one's teeth, since the tooth surface will be slightly acid-softened in which case brushing one's teeth immediately would scrub off some of the enamel as well. While you wait the recommended timespan, components of the saliva are supposed to reharden the softened enamel surface.

This process however might be accelerated using xylitol. In this case, one should ideally start with a xylitol rinse only, and if possible and at hand, perhaps follow it up, 1 to 2 minutes later, with using the toothbrush to well distribute the saliva-cum-xylitol mix over one's teeth.

Can xylitol be used even with active tooth decay (large open carious lesions)?

Experiences made to date have shown that xylitol leads to a reduction in bacterial populations. In other words, as far as we know today, there are no bacteria whose growth is encouraged by feeding xylitol. The only observation re inflammation has been that these were reduced.

Should I brush my teeth only after 5 minutes of rinsing with xylitol or immediately?

In our experience, one thing is as good as the other.

Footnotes

1 Please note that Healing Teeth Naturally does not support animal experimentation. Many reasons for this are being discussed for instance at Animal Experimentation Unscientific, On Differences Between Species, Better Science: Benefits of Using Non-Animal Tests, The Harms to Humans from Animal Experimentation and Better Science: Limitations of Animal Tests.

2 Compare On the dangers of amalgam fillings.

3 Be aware however that even using xylitol after sugar consumption will not prevent the systemic effect of concentrated sucrose intake on dentinal fluid flow.

4 Compare Tooth-friendly sugar replacements.

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