In a different clinical application, increasing attention is being given to xylitol in the prevention of upper respiratory and ear infections. The mechanism of action is similar to that of dental caries prevention, except the bacterium that is inhibited is Streptococcus pneumonia, a common cause of otitis media and rhinosinusitis.7

In addition to having a bactericidal effect, xylitol may also have a direct action against infection by inhibiting bacterial adhesion to the mucosal surface.8 Saline nasal rinses containing xylitol have been found to be more effective than traditional saline rinses to reduce the symptoms of chronic rhinosinusitis.9

Use of xylitol has also been reported to result in an overall reduction of at least 25% in acute otitis media in children attending daycare centers, although there were differing outcomes depending on the form of xylitol used.10

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Safety, interactions, side effects

The U.S. Department of Agriculture lists xylitol as a food additive that is “generally regarded as safe.”11 There are no known food or drug interactions, but excessive consumption of xylitol can cause diarrhea. 

Cost, how supplied, dose

Xylitol can be purchased in a variety of forms, but studies of chewing gum have shown the most efficacy in either oral or upper respiratory health.10 Symptoms of chronic rhinosinusitis did, however, improve best with a saline-xylitol rinse.9

Chewing gum containing xylitol is recommended for frequent use throughout the day, with a total xylitol intake ranging from 1 g to 20 g per day. Price varies among different manufacturers, but a month’s supply at five pieces per day costs about $15. 


It is not often that a low-cost, well-tolerated, and easily available product is proven effective for combating a wide range of conditions. Considering the professional, economic, and personal cost of dental caries and upper respiratory infections, health care providers should increase their recommendations for use of this pleasant-tasting remedy.

Sherril Sego, FNP-C, DNP, is a staff clinician at the VA Hospital in Kansas City, Mo., where she practices adult medicine and women’s health. She also teaches at the nursing schools of the University of Missouri and the University of Kansas. 


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  3. Nayak PA, Nayak UA, Khandelwal V. The effect of xylitol on dental caries and oral flora. Clin Cosmet Investig Dent. 2014;6:89-94. Available at
  4. Policy on the use of xylitol in caries prevention. In: American Academy on Pediatric Dentistry Council on Clinical Affairs. Reference Manual—Oral Health Policies. 2010;32(6):36-38. Available at
  5. Mäkinen KK. Sugar alcohols, caries incidence, and remineralization of caries lesions: a literature review. Int J Dent. 2010;981072. Available at
  6. Bader JD, Vollmer WM, Shugars DA, et al. Results from the Xylitol for Adult Caries Trial (X-ACT). J Am Dent Assoc. 2013;144(1):21-30. Available at 

  7. Wargo R, Campbell M. Is xylitol effective in the prevention of acute otitis media? Ann Pharmacother. 2014;48(10):1389-1391.

  8. Ferreira AS, Silva-Paes-Leme AF, Raposo NR, da Silva SS. By passing microbial resistance: xylitol controls microorganisms’ growth by means of its anti-adherence property. Curr Pharma Biotech. 2015;16(1):35-42. Available at 

  9. Weissman JD, Fernandez F, Hwang PH. Xylitol nasal irrigation in the management of chronic rhinosinusitis: a pilot study. Laryngoscope. 2011;121(11):2468-2472. 

  10. Azarpazhooh A, Limeback H, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2011;11:CD007095. 

  11. United States Department of Agriculture: National Agricultural Library. Nutritive and nonnutritive sweetener resources. Available at 

All electronic documents accessed April 1, 2015.