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Recently Pendrys has suggested that, early tooth brushing habits have an important impact on the prevalence of mild-to-moderate enamel fluorosis in both nonfluoridated and optimally fluoridated areas. The instigator has concluded that at least one-third of the fluorosis cases in nonfluoridated areas and two-thirds of the cases in optimally fluoridated areas could be explained by specific patterns of early fluoride toothpaste use .
Since sugars play a major rule in tooth cavity process, many studies have reviewed the effect of substitution of sucrose with sugar alcohols in chewing gums and lozenge candies as caries-preventive policy. Sugar alcohols have been tested in vitro for fermentation by oral micro-organisms and can be classified as hypo- or non-acidogenic. The most widely used sugar alcohols are xylitol and sorbitol . A collaborative WHO field study in Hungary showed a caries-preventive effect in a group of children using xylitol in gums, chocolate and other confectionery daily. This xylitol group developed 35% less caries than a fluoride control group and 45% less than a non-fluoride, non-xylitol control group . It is often claimed that xylitol is superior to the other sugar alcohols for caries control. Clinical trials suggest a higher caries-preventive effect of chewing gum sweetened with xylitol than with sorbitol. An important confounder may be the drop-out rate, which was lower for sorbitol than xylitol . Because it is not fermented by oral bacteria, xylitol is considered to be non-cariogenic, while sorbitol in solution can be fermented slowly by mutants streptococci . Moreover, Wennerholm et al. (1994) showed that when gums were sweetened with 70% sorbitol, there was a significant increase in numbers of mutans streptococci . A result that was confirmed by Mäkinen et al., (2002), who established an increase in the number of mutans streptococci in dental plaque after 64 days of use of sorbitol gum 5 times a day . However, the mutans increasing effect of sorbitol seems to be counteracted when xylitol is added to the gum . Nevertheless, researches have regarded to the inclusion of the polyol sweeteners in human diets; where they recommended that, all of the polyols can cause osmotic diarrhea in humans if higher levels are consumed . This fact is denoted by Vernacchio L. et al., (2007) who concluded that the main limitation of the use of sugar alcohols is a dose-dependent osmotic laxative effect. Verification of these findings was denoted by the Food and Drug Administration through the Division of Dockets Management (WFA-305) which has confirmed that overdoing use of sugar alcohols can bring on diarrhea. To support the safety and effectiveness of many ingredients including xylitol, department of Health and Human Services of Food and Drug Administration have reviewed labeled ingredients contained in marketed products and submitted data to the Subcommittee of Oral Health Care Drug Products for Over-the-Counter Human Use of Antigingivitis/Antiplaque Drug Products, it was established that, xylitol is not eligible for inclusion in the OTC drug review, and that submitted data subsequently withdrew xylitol from consideration by the Subcommittee .
As a consequence, numerous approaches have been investigated as defensive trials against dental caries; A new buffering lozenge was evaluated that comprised a combination of xylitol, fluoride, calcium, phosphate, zinc, where a significant elevation both in salivary pH and buffer effect was observed .Nilner K, et al., (1991) indicated that sugar-free lozenge containing bicarbonate and phosphate buffers (Profylin) raised the pH of plaque and saliva and accelerated the pH recovery after a sucrose rinse