Cavities (Dental Caries)

Cavities, technically called dental caries, are caused by a bacteria called Streptococcus mutans. This bacteria lives in the mouth and thrives on sugar and other carbohydrates.

In the presence of carbohydrates, S. mutans produces acids that dissolve the enamel of teeth, causing cavities.

Good dental hygiene and regular dental care can help prevent cavities. Contrary to claims made by some alternative medical authorities, strong evidence indicates that fluoride toothpastes help prevent cavities.1

However, there is relatively little scientific evidence for the use of professionally applied fluoride varnishes.2

Principal Proposed Natural Treatments

Double-blind studies enrolling almost 4,000 people, mostly children, have found that the natural sugar xylitol can prevent cavities.3�8 These trials used xylitol-sweetened gum, candies, or toothpaste. The best evidence regards xylitol gum.

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.4

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.

A double-blind, placebo-controlled study of 1,677 children compared a standard fluoride toothpaste with a similar toothpaste that also contained 10% xylitol.8

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.6,9

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.10�12

Xylitol is thought to prevent cavities by inhibiting the growth of the Streptococcus mutans bacteria.13

For more information, including dosage and safety issues, see the full xylitol article.

Other Proposed Natural Treatments

Another sugar substitute called sorbitol may work as well as xylitol for the prevention of cavities in children.3 However, xylitol appears to work better than sorbitol for preventing cavities in adults.

Friendly bacteria (probiotics) 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 Lactobacillus GG (LGG).

In a double-blind, placebo controlled trial, 594 children aged 1�6 years old were given either normal milk or milk to which LGG had been added, for a period of 7 months.14 The results showed signicantly fewer cavities in the children receiving LGG.

Other natural treatments advocated for preventing cavities, but that lack reliable scientific support, include black tea, myrhh, and propolis.


1. Marinho VC, Higgins JP, Sheiham A, et al. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;(1):CD002278.

2. Marinho VC, Higgins JP, Logan S, et al. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2002;(3):CD002279.

3. Gales MA, Nguyen T-M. Sorbitol compared with xylitol in prevention of dental caries. Ann Pharmacother. 2000;34:98�100.

4. Makinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res. 1995;74:1904�1913.

5. Makinen KK, Hujoel PP, Bennett CA, et al. Polyol chewing gums and caries rates in primary dentition: a 24-month cohort study. Caries Res. 1996;30:408�417.

6. 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. 1996;16:104�115.

7. Isokangas P, Alanen P, Tiekso J, et al. Xylitol chewing gum in caries prevention: a field study in children. J Am Dent Assoc. 1988;117:315�320.

8. 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. 1995;8:231�235.

9. Alanen P, Isokangas P, Gutmann K. Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral Epidemiol. 2000;28:218�224.

10. Soderling E, Isokangas P, Pienihakkinen K, et al. Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up. Caries Res. 2001;35:173�177.

11. 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. 2000;79:1885�1889.

12. Soderling E, Isokangas P, Peinihakkinen K, et al. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res. 2000;79:882�887.

13. Uhari M, Kontiokari T, Niemela. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998;102:879�884.

14. Nase L, Hatakka K, Savilahti E, et al. Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children. Caries Res. 2001;35:412�420.

15. Dodes JE. The amalgam controversy. An evidence-based analysis. J Am Dent Assoc. 2001;132:348�56.


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