Birch Sugar, E967, Meso-Xylitol, Méso-Xylitol, Pentane-1,2,3,4,5-pentol, Sucre de Bouleau, Xilitol, Xylit, Xylite, Xylo-pentane-1,2,3,4,5-pentol.


Overview Information

Xylitol is a naturally occurring alcohol found in most plant material, including many fruits and vegetables. It is extracted from birch wood to make medicine.

Xylitol is widely used as a sugar substitute and in "sugar-free" chewing gums, mints, and other candies. However, sorbitol is the most commonly used sweetener in sugarless gums because it is less expensive than xylitol and easier to make into commercial products.

People use xylitol to prevent cavities. It is also used to prevent tooth plaque and ear infection (otitis media), and for many other uses, but there is no good scientific evidence to support these uses.

Dog owners should know that xylitol can be toxic to dogs, even when the relatively small amounts from candies are eaten. If your dog eats a product that contains xylitol, it is important to take the dog to a veterinarian immediately.

How does it work?

Xylitol tastes sweet but, unlike sugar, it is not converted in the mouth to acids that cause tooth decay. It reduces levels of decay-causing bacteria in saliva and also acts against some bacteria that cause ear infections.


Uses & Effectiveness?

Likely Effective for

  • Cavities. Xylitol-containing products, such as foods, chewing gum, candies, and toothpaste, reduce the risk for cavities in adults and children 5 years and older. Xylitol products appear to be better for preventing cavities than products containing sorbitol. But these products must provide at least 1-20 grams of xylitol each day. Some brands of chewing gum contain xylitol in only very small amounts. These amounts are too small to prevent tooth decay. Also, it's unclear if xylitol helps prevent cavities in children less than 5 years old.

Possibly Effective for

  • Ear infection (otitis media). Xylitol given in appropriate doses after meals to preschool children seems to significantly reduce the number of ear infections they get and the need for antibiotics. However, giving xylitol at the onset of symptoms of an acute respiratory infection does not seem to prevent ear infections.

Insufficient Evidence for

  • Tooth plaque. A solution containing xylitol doesn't reduce plaque in children. However, it is not known if other xylitol products might be more effective.
  • Swelling (inflammation) of the nasal cavity and sinuses (rhinosinusitis). Some people use a squeeze bottle or special equipment to rinse out their sinuses. Usually these bottles use salt in water (saline). Replacing xylitol for saline seems to reduce symptoms, like a stuffy nose, better than saline itself.
  • Prevention of dry mouth.
  • As a sugar substitute for people with diabetes.
  • Other conditions.
More evidence is needed to rate the effectiveness of xylitol for these uses.

Side Effects

Side Effects & Safety

When taken by mouth: Xylitol is LIKELY SAFE when used in the amounts found in foods. It is POSSIBLY SAFE when used as a medicine for most adults in amounts up to about 50 grams per day. However, taking higher doses by mouth is POSSIBLY UNSAFE. There is some concern that extremely high doses for long periods of time (more than three years) can cause tumors. Xylitol can cause diarrhea and intestinal gas.

When applied to the skin: Xylitol is POSSIBLY SAFE when used appropriately.

When used as a rinse in the nose: Xylitol is POSSIBLY SAFE when used in water to clear the sinuses.

Special Precautions & Warnings:

Pregnancy and breast-feeding: There isn't enough reliable information to know if xylitol is safe to use as medicine when pregnant or breast-feeding. Stay on the safe side and stick to food amounts.

Children: Xylitol is POSSIBLY SAFE when used orally as a medicine in amounts of up to 20 grams per day.



We currently have no information for XYLITOL Interactions.



The following doses have been studied in scientific research:



  • For cavities: A wide range of doses has been used. Typically, candies or chewing gum containing xylitol are used three to five times every day. In total, doses are from 1-20 grams per day. It is recommended that xylitol gum be chewed for 10-20 minutes after meals.

  • For cavities: A wide range of doses has been used in children 5 years and older. Typically, candies or chewing gum are used three to five times every day. In total, doses are from 1-20 grams per day. It is recommended that xylitol gum be chewed for 10-20 minutes after meals. Sucking on candies providing 5-8 grams of xylitol also seems beneficial.
  • For ear infection (otitis media): Total daily doses of 8.4-10 grams of xylitol in chewing gum, lozenges, or syrup given in five divided doses after meals.

View References


  • Alanzi A, Soderling E, Varghese A, Honkala E. Xylitol chewing gums on the market: Do they prevent caries? Oral Health Prev Dent 2016;14:459-466. View abstract.
  • Aluckal E, Ankola AV. Effectiveness of xylitol and polyol chewing gum on salivary streptococcus mutans in children: A randomized controlled trial. Indian J Dent Res. 2018;29(4):445-449. View abstract.
  • Antonio AG, Pierro VS, Maia LC. Caries preventive effects of xylitol-based candies and lozenges: a systematic review. J Public Health Dent 2011;71:117-24. View abstract.
  • Azarpazhooh A, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev 2016 Aug 3;(8):CD007095. View abstract.
  • 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 2011Nov 9;(11):CD007095. View abstract.
  • Cocco F, Carta G, Cagetti MG, Strohmenger L, Lingström P, Campus G. The caries preventive effect of 1-year use of low-dose xylitol chewing gum. A randomized placebo-controlled clinical trial in high-caries-risk adults. Clin Oral Investig 2017 Mar 16. View abstract.
  • Crapo PA. Use of alternative sweeteners in diabetic diet. Diabetes Care 1988;11:174-82. View abstract.
  • Electronic Code of Federal Regulations. Title 21. Part 101.80 - Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries. Available at: https://www.ecfr.gov/cgi-bin/text-idx?SID=c7e427855f12554dbc292b4c8a7545a0&mc=true&node=pt21.2.101&rgn=div5#se21.2.101_180. Accessed August 17, 2020.
  • Everything added to food in the US. US Food and Drug Administration, November 2011. Available at: https://www.fda.gov/Food/FoodIngredientsPackaging/ucm115326.htm
  • Gales MA, Nguyen TM. Sorbitol compared with xylitol in prevention of dental caries. Ann Pharmacother 2000;34:98-100. View abstract.
  • Gales MA, Nguyen TM. Sorbitol compared with xylitol in prevention of dental caries. Ann Pharmacother 2000;34:98-100. View abstract.
  • Janakiram C, Deepan Kumar CV, Joseph J. Xylitol in preventing dental caries: A systematic review and meta-analyses. J Nat Sci Biol Med 2017;8:16-21. View abstract.
  • Lee B, Sue D. Xylitol for prevention of dental caries. DICP 1989;23:691-2.
  • Lin L, Tang X, Wei J, Dai F, Sun G. Xylitol nasal irrigation in the treatment of chronic rhinosinusitis. Am J Otolaryngol 2017;38:383-389. View abstract.
  • Makinen KK. Can the pentitol-hexitol theory explain the clinical observations made with xylitol? Med Hypotheses 2000;54:603-13. View abstract.
  • Makinen KK. The rocky road of xylitol to its clinical application. J Dent Res 2000;79:1352-5.
  • Marghalani AA, Guinto E, Phan M, Dhar V, Tinanoff. Effectiveness of xylitol in reducing dental caries in children. Pediatr Dent 2017;39:103-110. View abstract.
  • Merck Index, 12th ed. Whitehouse Station: Merck Research Laboratories, 1996.
  • Mickenautsch S, Yengopal V. Effect of xylitol versus sorbitol: a quantitative systematic review of clinical trials. Int Dent J 2012;62:175-88. View abstract.
  • Moyer VA; US Preventive Services Task Force. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. Pediatrics 2014;133:1102-11. View abstract.
  • Okamoto K, Kagami M, Kawai M, et al. Anaphylaxis to xylitol diagnosed by skin prick test and basophil activation test. Allergol Int. 2019;68(1):130-131. View abstract.
  • Rethman MP, Beltrán-Aguilar ED, Billings RJ, et al.; American Dental Association Council on Scientific Affairs Expert Panel on Nonfluoride Caries-Preventive Agents. Nonfluoride caries-preventive agents: executive summary of evidence-based clinical recommendations. J Am Dent Assoc 2011;142(9):1065-1071. View abstract.
  • Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults. Cochrane Database Syst Rev 2015;(3):CD010743. View abstract.
  • Simões Moraes R, Modesto A, Regina Netto Dos Santos K, Drake D. The effect of 1% chlorhexidine varnish and 40% xylitol solution on Streptococcus mutans and plaque accumulation in children. Pediatr Dent 2011;33:484-90. View abstract.
  • Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res 2000;79:882-7. View abstract.
  • Tapiainen T, Luotonen L, Kontiokari T, et al. Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics 2002;109:E19. View abstract.
  • Thorild I, Lindau B, Twetman S. Long-term effect of maternal xylitol exposure on their children's caries prevalence. Eur Arch Paediatr Dent 2012;13:305-7. View abstract.
  • Uhari M, Kontiokari T, Koskela M, Niemela M. Xylitol chewing gum in prevention of acute otitis media: double-blind, randomized trial. BMJ 1996;313:1180-4. View abstract.
  • Uhari M, Kontiokari T, Niemela M. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics 1998;102:879-84. View abstract.
  • Weissman JD, Fernandez F, Hwang PH. Xylitol nasal irrigation in the management of chronic rhinosinusitis: a pilot study. Laryngoscope 2011;121:2468-72. View abstract.

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