Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up.

Xylitol is effective as a noncariogenic or even cariostatic sugar substitute. Habitual xylitol consumption appears to select for mutans streptococci (MS) which shed easily into saliva from plaque. We have earlier shown that habitual xylitol consumption of mothers was associated with a statistically significant reduction in the probability of mother-child transmission of MS assessed at 2 years of age. The aim of the present study was to assess the children's MS counts 1 and 4 years after the maternal xylitol consumption had been discontinued. At baseline, during pregnancy, all mothers (n = 195) showed high salivary levels of MS. The mothers were randomly assigned to xylitol, fluoride (F) and chlorhexidine (CHX) groups. In the xylitol group, the mothers chewed xylitol-sweetened gum, for 21 months, starting 3 months after delivery. In the two control groups, the mothers received CHX or F varnish treatments at 6, 12 and 18 months after delivery. At the 2-year examination, 169 mother-child pairs participated. At the 3-year and 6-year examinations, there were 159 and 147 children in the study, respectively. For children's MS analyses, visible plaque was collected using toothpicks at the age of 3 and paraffin-stimulated saliva at the age of 6. The persons involved in the collection and analysis of the microbiological samples were blinded as to the study design and group. Both the plaque and salivary MS were cultured on Mitis salivarius agars containing bacitracin. In all groups, the colonization percentages increased during the follow-up. At the 3-year examination, the children's risk of having MS colonization was 2.3-fold in the F group (95% CI 1.3-4.2) compared to the xylitol group. This difference was statistically significant. Even at 6 years of age, the salivary MS levels were significantly lower in the xylitol group than in the other groups (ANOVA, p<0.001). In conclusion, the earlier demonstrated, xylitol-associated reduction in the probability of mother-child transmission of MS was still found in the children's MS counts at the age of 3 and 6 years.