Xylitol and tooth decay
What 8 graded rows on xylitol agree on for tooth decay, and where they differ. Counted side by side, never averaged.
Consensus finder Rows from the Xylitol page, reviewed Oct 21, 2026 How it decides
What the rows agree on
Each block and row is one graded row from the Xylitol page, with its PubMed record.
Your question
Xylitol and tooth decay
8 rows · 14,579 peopleSplit. 4 rows found an improvement and 4 found no difference.
- CGrade C× 4
- DGrade D× 3
- ∅No effect× 1
- Rows
- 8
- Trials
- 31
- People
- 14,579
- Pooled reviews may count some twice
Where they differ
From the rowsThe best-graded row, grade C, is a meta-analysis of 6,325 people (2024) and found an improvement. 1 row is graded No effect, our grade for adequately powered trials that found no effect.
The 4 rows that found an improvement were larger: a median of 3,322 people, against a median of 327 people for the 4 rows that found no difference.
Only the 4 rows that found an improvement include pooled reviews of several trials (2 of 4); the 4 rows that found no difference are single studies.
Only the 4 rows that found an improvement name women in their population.
The rows
4 improved · 4 no difference- CGrade CTooth decay in permanent teeth of children and teens (pooled) · Improved
Meta-analysis, 15 studies · n 6,325 · 2024 · Children and adolescents aged 6 to 18 in 11 randomized and 4 controlled trials
As given in each included study · Varied by study
Xylitol reduced caries compared with no treatment or placebo (SMD −0.50, 95% CI −0.85 to −0.16); sorbitol had a smaller effect (SMD −0.10). Twelve of 15 studies were at moderate or high risk of bias.
- CGrade CTooth decay in children and adults (pooled) · Improved
Meta-analysis, 10 studies · n 5,903 · 2015 · Children and adults in 10 randomized trials (7 at high risk of bias)
Varied; 10% xylitol fluoride toothpaste in the main finding · Up to 2.5 to 3 years
Fluoride toothpaste with 10% xylitol may reduce cavities by 13% versus fluoride-only toothpaste (4,216 children, low-quality evidence). Evidence for lozenges, tablets, wipes and syrup was too uncertain to show a benefit; one infant study found 8 g/day syrup reduced caries by 58% versus 2.67 g/day.
- CGrade CNew cavities in schoolchildren (candies and gum) · Improved
RCT · n 740 · 2000 · 10-year-old children in 12 Estonian schools, in three clusters
5 g/day on school days · 2 or 3 years
After 3 years, all xylitol groups had 35% to 60% fewer new cavities than their control groups, with no consistent difference between candies and gum.
- DGrade DPassing cavity-causing bacteria from mother to child · Improved
RCT · n 107 · 2010 · Pregnant women with high salivary mutans streptococci in Japan, and their children to age 24 months
Maternal gum from the sixth month of pregnancy · 13 months of chewing; children followed to 24 months
Children of mothers who chewed xylitol gum were less likely to be colonized by mutans streptococci between 9 and 24 months and acquired them 8.8 months later than children in the control group.
- CGrade CTooth decay in schoolchildren: xylitol vs sorbitol candy · No difference
RCT · n 485 · 2014 · First- and second-grade children in southeastern Estonia
About 7.5 g/day of polyol on school days · 3 years
Children on xylitol candy did not have fewer dentin cavities than the sorbitol control group; the erythritol group had fewer dentin cavities and a longer time before lesions developed than both.
- DGrade DEarly childhood cavities with xylitol fluoride toothpaste · No difference
RCT · n 168 · 2014 · Four- to five-year-olds in four Head Start classrooms in the Marshall Islands (cluster-randomized)
Supervised toothbrushing · 6 months
The mean increase in decayed surfaces was 2.5 with xylitol toothpaste and 1.4 with the sorbitol toothpaste; the difference was not significant (P = 0.07). No adverse effects were reported.
- DGrade DCavities between teeth in high-risk adolescents (lozenges) · No difference
RCT · n 160 · 2008 · Children aged 10 to 12 at high caries risk, with a non-randomized no-tablet reference group of 70
2.5 g/day xylitol in six lozenges · 2 years
No significant difference in new cavities between groups or versus the no-tablet group. Only 41% followed the schedule well and 28% dropped out.
- ∅No effectNew cavities in adults at high caries risk · No difference
RCT · n 691 · 2013 · Adults aged 21 to 80 at elevated caries risk at three sites (X-ACT)
Five 1.0 g lozenges a day (5 g/day) · 33 months
Xylitol reduced the caries increment by 10%, less than one-third of a tooth surface a year, which was not statistically significant. There was no dose-response effect.