Xylitol: Oral Health Benefits and Emerging Cardiovascular Concerns
- Christine Daecher, DO
- Dec 17
- 3 min read
I like to chew gum—for the health benefits, believe it or not. I chew gum to help maintain muscle tone in my lower facial muscles and to support bone density in my maxilla and mandible (the upper and lower jaw bones). Years ago, I became interested in xylitol as it was emerging as a popular alternative sweetener used in chewing gum.
Xylitol is a five-carbon sugar alcohol naturally found in small amounts in fruits such as plums, strawberries, and raspberries. For many years, it was believed to be metabolically inert in humans. However, more recent research has raised concerns about potential adverse cardiovascular effects, particularly when xylitol is consumed in larger, processed quantities.
Xylitol is commonly found in chewing gums, lozenges, syrups, nasal sprays, toothpastes, and mouthwashes.
Teeth and Xylitol
Although xylitol tastes sweet, many people find its flavor more pleasant than artificial sweeteners such as saccharin or aspartame. Importantly, xylitol has been shown to reduce the risk of dental caries (cavities). This benefit is not solely because it is sugar-free—xylitol also appears to interfere with bacterial biofilm formation, which plays a key role in tooth decay.
Xylitol has also been shown to improve the oral microbiome by reducing certain bacteria associated with periodontal disease.1 In particular, it appears to be effective against Porphyromonas gingivalis, a major pathogen implicated in gum disease.1 The presence of P.gingivalis is also associated with increased prevalence of rheumatoid arthritis and its severity.
However, when xylitol is used in gum or lozenges for dry mouth, a significant portion is swallowed. There is growing concern that repeated ingestion may negatively affect the gut microbiome, an area that warrants further study.
The Nose and Xylitol
While xylitol is often used for its sweetening properties, many of its benefits—particularly in nasal sprays—are related to its antibacterial effects. In this setting, xylitol is mainly used to reduce microbial adherence and disrupt biofilms within the nasal passages. It is used to manage chronic sinusitis.
A recent rat study found that it helps the nasal mucosa heal when rhinitis medicamentosa is present. The study found that use of xylitol nasal spray was as effective as using a steroid nasal spray containing mometasone.2 Rhinitis medicamentosa is a condition that develops after using nasal decongestants for 3-5 days or more.
The Cardiovascular System and Xylitol
In 2023, a study published in Europe and conducted in collaboration with the Cleveland Clinic reported an association between xylitol and increased platelet reactivity and thrombosis risk. The study followed 1,157 stable patients with known cardiovascular disease over a three-year period and found a 57% increase in cardiovascular risk among individuals with elevated circulating xylitol levels.3
It is important to note that the amount of xylitol naturally present in fruits is hundreds of times lower than the amounts found in processed foods and sugar-free products. After reviewing this study, the methodology appears sound, and the findings were derived from high-level laboratory and clinical data.
Additional studies using cell cultures and animal models have demonstrated similar increases in clotting risk. As a result, researchers have recommended that clinicians exercise caution and avoid routinely recommending xylitol (as well as erythritol) as artificial sweeteners, particularly in patients with cardiovascular risk factors.
Dogs and Xylitol
While xylitol was historically considered safe for humans, it is extremely dangerous for dogs. If you have a dog in your home, all xylitol-containing products should be kept entirely out of reach. In dogs, xylitol ingestion can cause rapid hypoglycemia, electrolyte disturbances, and acute liver failure.
References:
Chen SY, Delacruz J, Kim Y, Kingston R, Purvis L, Sharma D. Effect of xylitol on Porphyromonas gingivalis: A systematic review. Clin Exp Dent Res. 2023 Apr;9(2):265-275. doi: 10.1002/cre2.724. Epub 2023 Mar 9. PMID: 36894516; PMCID: PMC10098279.
Cam B, Sari M, Midi A, Gergin O. Xylitol treats nasal mucosa in rhinitis medicamentosa: an experimental rat model study. Eur Arch Otorhinolaryngol. 2019 Nov;276(11):3123-3130. doi: 10.1007/s00405-019-05605-3. Epub 2019 Aug 29. PMID: 31468129.
Witkowski M, Nemet I, Li XS, Wilcox J, Ferrell M, Alamri H, Gupta N, Wang Z, Tang WHW, Hazen SL. Xylitol is prothrombotic and associated with cardiovascular risk. Eur Heart J. 2024 Jul 12;45(27):2439-2452. doi: 10.1093/eurheartj/ehae244. PMID: 38842092; PMCID: PMC11492277.