Effect of Xylitol Consumption on the Plaque-Saliva Distribution of Mutans Streptococci and the Occurrence and Long-term Survival of Xylitol-resistant Strains

Since the exposure of mutans streptococci to xylitol is known to select for xylitol-resistant (XR) natural mutants, the occurrence and long-term survival of such xylitol-resistant strains was evaluated in a cross-sectional sampling of participants of the Ylivieska xylitol study four years after the original two-year experimental period. Paraffin-stimulated whole saliva was first collected, and then plaque was collected and pooled. The salivary and dental plaque mutans streptococci were enumerated after growth on TSY20B agar. The proportion of XR strains was determined by autoradiography with 14C-xylitol. A strong and significant correlation (r = 0.645 and p = 0.005) between the number of mutans streptococci in saliva and in dental plaque was observed in non-consumers of xylitol. Such a correlation totally disappeared (r = 0.098 and p = 0.612) in xylitol-exposed consumers (habitual and former xylitol-consumers). The proportion of the salivary XR mutants (35%) in non-consumers (n = 16) was significantly lower than in the xylitol-exposed consumers (79%) (n = 27), (p = 0.0001) or in former consumers (75%) (n = 13), (p = 0.0008) or in the habitual consumers (83%) (n = 14), (p = 0.004). The proportion of XR mutants in dental plaque was, on the average, much lower than in the corresponding saliva. The proportion of XR in the plaque of xylitol non-consumers was half of that of the xylitol-exposed group, but the difference was not statistically significant. Taken together, the results suggest that: (1) xylitol consumption modifies the mutans streptococci distribution between the dental plaque and the saliva; (2) once selected by the habitual use of xylitol and established in the mouth, the XR natural mutant population maintains itself for up to four years after the withdrawal of the selective agent or at least under minimal and irregular consumption of the agent; and (3) an unknown characteristic of the XR mutants allows them to be more easily shed into the saliva from the plaque than the xylitol-sensitive parental strains.