Xylitol has become a new favorite tool as I’ve dug into the research and prioritized oral health for both me and my family.
Nearly 25% of all U.S. children experience dental decay by the time they’re 5 years old (source). This is an astoundingly large number at such a young age. And we continue to see more children added to the list of those experiencing some type of dental decay. All of this, and the United States is one of the top spenders per capita on dental healthcare (source).
After years of fluoridating our water and our toothpaste as a first line of defense against cavities, we’ve now discovered the darker side of fluoride, including its IQ-lowering effects on our children. A January 2025 meta-analysis found a statistically significant association between higher fluoride exposure and lower children's IQ scores, showing that the more fluoride a child is exposed to, the more likely that child's IQ will be lower than if they were not exposed (source).
All of this begs the question, Is there a better way? While the answer to that question is as nuanced as the question itself, xylitol can be a powerful piece of the oral health puzzle. It is a science-backed, effective, safe, and relatively inexpensive way to protect oral health and lower the risk of cavities. And not just that! Xylitol is beneficial for its ability to lower ear infection prevalence, improve sinusitis, and fight bacteria and pathogens in the oral, nasal, and pharyngeal cavities. It is blood sugar-friendly and boasts a sweet taste as well! Let’s dive into why I love it…
What Is Xylitol?
Xylitol is a natural sugar alcohol sweetener. It is commonly found in foods and dental products. Similar to sugar, it has a crystal-like structure and a sweet taste. But unlike sugar, xylitol is not broken down in the mouth. This means it does not create an acidic environment, feed “bad” oral bacteria, or lead to cavities. Xylitol has a low glycemic index (GI) of 7, while table sugar has a GI around 65. For this reason, xylitol is often used as a blood sugar-friendly sugar substitute because of its minimal effect on blood glucose.
How Xylitol Works
Xylitol is two-parts unique in that 1) it doesn’t ferment or break down in the mouth and 2) it can dock on pathogenic bacteria biofilms, making it doubly effective at fighting pathogenic bacteria in the ear, nose, mouth, and throat.
First, because xylitol doesn’t break down in the mouth (unlike sugar!) it doesn’t feed the bad bugs or create an acidic environment. Both of which can cause cavities.
Secondly, xylitol can disrupt pathogenic biofilms. Bacteria build biofilms, or protective coverings, around themselves when they successfully attach to an area of the body (such as teeth, mucous membranes, etc.). These biofilms can make it very difficult to get rid of bad bacteria.
But xylitol attaches to “docking stations” on the biofilms. This means the bad bacteria must use their own energy to push out the xylitol. And at the same time, xylitol is taking up a docking station, which blocks bacterial communication to one another. With the phone lines down, bacteria can’t expand and connect biofilms to hold them together. This weakens the bacteria to where they are more easily removed (via brushing, floss, nasal irrigation, or naturally via the immune system).
Xylitol’s Widespread Benefits
Xylitol helps maintain healthy oral and nasal microbiomes, which is crucial for preventing cavities, gum disease, ear infections, sinus infections, and even upper respiratory infections.
Xylitol has been clinically proven to inhibit the growth of pathogenic bacteria, such as the S. mutans, S. sangui, S. pneumoniae, and H. influenzae bacteria. And it’s important to note that these particular bugs have been linked specifically to dental decay and many of the infections and illnesses mentioned just above – ear, sinus, gums, etc. (source, source, source).
We’ll dive deeper below, but here’s a quick list of the benefits of xylitol, which are well-documented and widely-applicable:
- Reducing the development and progression of dental cavities
- Reducing plaque formation
- Increasing salivary flow to aid in the repair of damaged tooth enamel
- Reducing pathogenic bacteria in the oral, nasal, and pharyngeal cavities
- Reducing the prevalence of ear infections
- Provides one third fewer calories than sugar and serves as a blood sugar-friendly sugar alternative
Let’s take a closer look at some of the specific benefits for which I use xylitol both for myself and my family…
Ear, Nose, and Throat Health
An important function of the oral, nasal, and pharyngeal (mouth, nose, and throat) microbiome is to deter the establishment of potential pathogens, which lead to dental decay, inflammation, and illness.
Pathogenic bacteria can travel from the oral or nasal passages into other areas, which is often the case for ear infections, sinus infections, and even upper respiratory infections.
Xylitol inhibits the growth and establishment of bad bacteria by disrupting their metabolic processes and preventing them from adhering to teeth and mucous membranes. Xylitol “starves” the bad bugs, stops their proliferation, and weakens them by breaking up their communication with one another.
Oral Microbiome Health + Cavity Prevention:
The dental health benefits of xylitol are well-established with plenty of research for backing:
- Effective for cavity prevention and reducing the risk of tooth decay
- Antiplaque effect on teeth surfaces
- Can reduce gingival (gum) inflammation
- Binds with calcium, promoting remineralization of tooth enamel
- Stopping and even possibly reversing existing dental decay. *Note: Studies showed these results to be long-lasting and possibly permanent in some cases.
- See references for above: source, source, source
The European Food Safety Authority held a panel that looked at 31 different studies, confirming the regular consumption of xylitol chewing gum and xylitol-based pastilles (mints) as an effective means of reducing the risk of tooth decay (source).
Nasal Cavity Bacteria-Fighting Benefits + Sinusitis Relief:
Studies have found that not only is xylitol in water well-tolerated for nasal and sinus irrigation, it has pathogen-fighting and symptom-relieving benefits.
Xylitol pulls small amounts of water into the nose, which works to optimize our own nasal defenses. Since xylitol reduces nasal pathogens, allergens, and contaminants as well as enhances our own defenses, regular use of xylitol nasal spray results in fewer respiratory infections and decreased nasal symptoms.
- Xylitol irrigation results in greater improvement of symptoms of chronic rhinosinusitis as compared to saline irrigation (source).
- Research suggests that xylitol nasal sprays and irrigations can reduce bacteria in the nasal cavity and sinuses, and may help treat chronic rhinosinusitis and even COVID-19 in some cases (source, source, source).
- Xylitol is effective at inhibiting the growth of pathogenic bacteria in the nasal cavity which then travels to sinuses, eustachian tubes, etc., causing broader infections and irritation (source).
Ear Infection Prevention:
Some of the more compelling research that motivated me to incorporate xylitol as a regular part of my boys’ health routine surrounds its beneficial effects at reducing the development of ear infections.
Commonly in ear infections, we see the bacteria S. pneumoniae and H. influenzae travel from the nasopharynx through the eustachian tube and into the middle ear, where it colonizes and causes middle ear infections.
Xylitol is my favorite easy way to fight this pattern:
- Studies have shown that xylitol markedly reduces the growth of alpha-hemolytic streptococci, including S. pneumoniae. The concentrations of xylitol required for effective treatment could easily and realistically be achieved in the oral cavity (source).
- Biofilm formation and expression of genes involved in biofilm formation of ear infection-causing pneumococcal bacteria can be reduced with xylitol treatment (source).
There is convincing evidence from numerous studies on the benefits of xylitol in reducing ear infection risk due to its pathogenic bacteria-fighting properties (source).
Blood Sugar Friendly Sweetening:
One of my favorite characteristics of xylitol is that while it is effective at preventing and reversing a number of pathogenic conditions, it also offers blood sugar-friendly sweetening power!
Although having a similar sweetness as sucrose and glucose, xylitol has completely different molecular properties and a drastically lower glycemic index than either sucrose or glucose. So while sucrose and glucose cause large spikes in blood glucose and insulin levels, xylitol does not (source).
For its oral, nasal, and pharyngeal microbiome benefits as well as blood sugar friendliness, xylitol is an excellent choice for oral health products such as toothpaste, gums, mints, etc.
Xylitol Products
So you’ve read the research, seen the science, and understand the positive impact that xylitol can have on your health. But what are the products that can help you reap the rewards, and how do you use them?! Great news, they’re surprisingly accessible, affordable, and easy to use…
Xylitol Products for Adults + Children:
- Mints: Epic, Spry, Happy Teeth
- Gum: Pur Gum
- Nasal Sprays: Xlear, Xlear for kids, Beekeeper’s Nasal Spray - Xlear was developed by a Texas physician and his wife, who put the combination together in order to prevent their granddaughter’s recurring ear infections. It worked so well, they knew they needed to offer it to others.
How to Use Xylitol Products
Frequency is key. When we’re talking about the effectiveness of xylitol products for keeping the mouth and nose cleared of bad bacteria, we need to think in terms of consistency. The easiest way to remember is, “Strive for 5.” Ideally, you’ll be exposing your oral and/or nasal cavities to a xylitol-based product 5x/day.
Here are some quick guidelines for xylitol usage:
- “Strive for 5.”
- Always after eating something sticky, sugar-y, or acidic.
- Always after meals.
- Up the exposure during times of travel, illness, compromised immunity (such as seasons of higher stress, cold and flu season, etc.).
An Important Differentiation
A main complaint against xylitol is its potential to cause bloating or upset stomach. This is where it’s important to differentiate the type of usage. The quantity required to release a minimal but effective amount of xylitol into the mouth multiple times a day for its oral/nasal health benefits is much smaller than if you were to use it as a dietary sugar substitute.
Ingesting large amounts of xylitol, such as when you use it as a part of your everyday diet, is very different from using it daily as an oral health tool.
Because of its potential for digestive upset, I do not use it as an everyday staple in my or my family’s diet, but I’m absolutely using it daily as an oral + nasal microbiome health tool in our chewing gums, mints, toothpaste, etc. And with no digestive disruption at all!
Final Thoughts
If you or your child have struggled with frequent cavities, gum disease, poor oral health, recurrent sinus infections, or ear infections, I strongly advise you to consider the use of xylitol-based products as part of your everyday health routine.
These are relatively low-cost and benign products with the potential for a large positive impact! And as always, a nutrient-dense diet full of high quality Fab Four (protein, fat, fiber, greens!) foods is perhaps the most profound way to take care of not just your oral health, but your overall health.
If you want to learn more about how to use the Fab Four to nourish the minds and bodies of you and your family, I have so many resources to get you going:
And as always, feel free to connect with me on social as I share real-life looks into how I prioritize health for me and my family.