Collaborative WHO xylitol field studies in Hungary I. Three-year caries activity in institutionalized children

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Abstract
The aim of this 3-year field study was to assess the value of partial substitution of sucrose with peroral xylitol (14–20 g/day) as a caries-preventive measure (X group) in comparison with systemic administration of fluoride (F group) and restorative treatment procedures solely (C group). An F dentifrice was used unsupervised in the X and F groups, the former containing 10% xylitol. The C group used customary, predominantly F-free dentifrices distributed by the local health authorities. The final material consisted of 689 institutionalized children (6–11 years). Caries was scored yearly in duplicate by two continuously calibrated teams. At base line the X group had a significantly higher caries prevalence than the F and C groups. The 3-year DMFS increment was 4.2 in the X group, 6.5 in the F group, and 7.7 in the C group. The corresponding ratio (RS) between caries incidence and the tooth surface population at risk was RSx, 4.9; RSF, 6.6; and RSc, 8.6. It is concluded that dietary xylitol in solid sweets resulted in a lower increment of caries than obtained in the F and C groups (p < 0.001, covariance analysis, with base-line prevalence, number of permanent teeth, and visible plaque index as covariants).