Journal of ental Hygiene Science Vol. 10, No. 2 pp. 123~129 (2010) 자일리톨의 Streptococcus mutans 억제효과 ½ w e Joo-Won Kim epartment of dental hygiene, Sorbol ollege, 165, honghyo-dong, yeongju-city, yeongbuk, Korea "TUSU To examine whether the effects of chewing gum containing xylitol are purely based on xylitol itself rather than the preventive effects on dental caries based on other constituents or factors, gargling was done using xylitol solution which was diluted in a distilled water. Then, attempts were made to perform an experiment for the bacterial activity of S. mutans depending on the amount of xylitol. argling was done using solutions containing xylitol at an amount of 30, 50, 60, 70, 80 and with the same methods after 48 hours. When gargling was done using a solution containing xylitol at a volume of in those who experienced dental caries, the bacterial activity of S. mutans was decreased by 35% as compared with the control group. When gargling was done using a solution containing xylitol at a volume of, the bacterial activity of S. mutans was decreased by as compared with the control group. These results indicate that there was a significant difference between the two groups (p<0.05). esides, similar result appeared in those who did not experience dental caries(p<0.05). ased on the above results, under the hypothesis that the effects of xylitol contained in a chewing gum were not associated with other constituents, it is presumed that the amount of xylitol at a ratio of > is effective in reducing the bacterial activity of S. mutans with no respect to experiences of dental caries. ut we need an another experiment to confirm whether this result is due to xylitol's effect or not.,z XPST Streptococci mutans, Xylitol, hewing gum, ental caries 서 orresponding author Tel: 054-770-3663 ax: 054-770-3649 -mail: allceram@sorabol.ac.kr 론 w l w, w» (acid) w, e e y y wù. z ƒ š ù w w š. š g xylitol, sorbitol, mannitol, maltitol, lactitol, lycasin, palatinit m ƒ ü ³ w w g j z 1). w üš m yw 5 H 12 O 5 152.15. e w m z» k ekü S. mutans z š2)» xylitolresistant mutans³ ùkù šƒ 3,4). S. mutans ³, x w, yw S. cricetus, S. rattus, S. mutans, S. sobrinus, S. downei, S. macacae, S. ferus 7 ³ 5), S. mutans, S. sobrinusƒ ü ƒ š, e ƒ ¾ ek ü ùkù š š 6). w Helderman w ³ S. mutans S. sobrinus e ùkù š w 7). m w v e 30~ w š8) eù, k, rench Polynesia, elize w 9-11). Scheinin m w» m w e w š12) ü m w e z w š13), ywe» w 3z, 10 g m Ë 4 ã w e z ƒ tw 14). quirre-zero dgar w ƒ kë k
124 가시키고 젖산 생산을 감소시켜 치태 내의 산도를 중화시 킬 수 있고 구강 내 잔존 당을 감소시킴으로써 타액 내 무기이온의 과포화를 증가시킨다고 하였다. Honkala와 Honkala는 치아 우식증을 예방하기 위하여 모든 어린이에게 자일리톨 섭취를 권장하기 보다는 선택 적으로 다발성 우식증을 가진 어린이, 구강위생 지수가 낮게 나타난 어린이, 구강 건강을 소홀히 하는 어린이들 과 같이 우식 위험군에서 자일리톨을 섭취 하도록 하는 것이 합리적이라고 주장했다. 이러한 자일리톨을 식빵 에 첨가하여 당뇨환자나 심장병 같은 특별한 의학적 문제 가 있는 환자에게 효과가 나타는데 이런 저칼로리 제품으 로 다이어트에 효과가 있다는 연구도 있다. 최근 식품 의약품안전청이나 보건복지가족부의 [일반식품의 유용성 표시, 광고 인정범위 지침]에 자일리톨껌이 충치예방 효 능을 표방하려면 감미료의 함량을 최소로 몇 %이상이어 야 한다 는 조건을 제시하였다. 또한 식품의약품안전청공 고 [제2009-248호]에 의하면 껌 포장지에 산화방지제 표 시를 의무화 하도록 하였고 2009년 12월부터 껌 포장지 에 껌의 첨가물인 산화방지제의 표시가 의무화되었다. 본 연구는 자일리톨 함유의 씹는 껌이 다른 성분이나 요소에 의한 치아 우식 예방 효과가 아니라, 순수한 자일리톨 만 의 효능을 알아보기 위해 증류수에 희석시킨 자일리톨 용 액으로 가글한 후, 자일리톨의 함량에 따라 S. mutans 활 성화에 미치는 영향을 실험하고자 하였다. 15,16) 17) 18) 품을 전혀 음용하거나 씹지 않은 상태에서 통속적인 양치 후 채취한 타액으로 하였고, 비교군은 같은 학생에게서 일정한 자일리톨 함량의 용액을 가글한 후 채취한 타액으 로 정하였다. 실험에 사용할 자일리톨 희석 용액은 시판 되는 껌의 자일리톨 함량과 비슷한,,,,, 로 만들었고 각각의 희석 용액 가글 실험 은 이전 실험으로 인한 영향을 최소화하기 위해 48시간 경과 후 실시하였다. 본 연구에 사용된 100% 자일리톨로 구성된 핀란드산(anisco Sweteners oy, kotka, inland) 을 활용하였다(ig. 1). 2. 배양방법 타액 속의 Streptococcus mutans의 활성을 측정하기 위 하여 entocult SM Strip mutans Kit(Orion iagnostica O., P.O.ox 83, l-02101 spoo, inland)(ig. 2)로 판 정하였다. Kit 내 acitracin Tablet을 배양액이 담긴 용액 속에 넣 어 녹인다. Paraffin Wax를 1분간 측정 환자에게 씹게 한 후 Screening Strip을 구강 내의 혀 위에 올리고 입을 가 볍게 다물게 한 다음 큰 힘을 가하지 않은 상태에서 전체 재료 및 방법 1. 재료 및 연구계획 경주에 거주하는 S대학 학생 가운데 최근 1개월 이내에 항생제를 복용하지 않고, 이틀(48시간)내에 항균 양치액 이나 전문가 불소도포를 받지 않은 19세에서 21세 나이 의 학생 중 치아 우식경험이 있는 학생 7명과 치아 우식 경험이 없는 학생 7명으로 나누어 총 14명을 실험군으로 선발하였다. 선정된 14명에서 대조군은 자일리톨 함유 제 ig. 1. Xylitol 100% powder produced in inland. ig. 2. entocult SM Strip mutans Kit (Orion iagnostica O., inland) ig. 3. ulture medium in incubator.
Journal of ental Hygiene Science Vol. 10, No. 2, pp. 123~129 (2010) 5M Specimen for xperiments ontrol group omparison group xperienced of dental caries a b c d e f g Specimen State of don't apply xylitol solution Inexperienced of dental caries State of applying xylitol solution -1-1 -1-1 -1-1 -1 total -1-1 -1-1 -1-1 -1-1 -1-1 -1-1 -1-1 a-1 b-1 c-1 d-1 e-1 f-1 g-1-1 -1-1 -1-1 -1-1 -1-1 -1-1 -1-1 -1-1 -1-1 -1-1 -1-1 Pellets 14 pcs 84 pcs 98 pcs k 10 š w. k Strip w z 37 o w» 48 w. k x w z 2 w š m w ƒƒ 5ml š 5 ƒ w z w x k 30 z k z w. ü m 48 z m,,,,, ƒ z x w. x w 84 w z(table 1), ³» 48 w (ig. 3). 3. Streptococcus mutans y d (caries activity test) t q t w y y w (ig. 4). y ƒ 0(negative), 1(mild) y, 2(moderate) y, 3(severe) š y. 4. m m w S. mutans y (Table 2, ig. 5~6) SPSS NOV(analysis of variance) w š x Á S. mutans y Student's paired t -test w. 결 과 ƒ 7 w x xylitol x x S. mutans y x. x S. mutans y 7 1 lass2 y ùkþ 6 'JH Standards chart for screening strip.
5M ffect of xylitol solution on salivary levels of S. mutans at baseline and 24 hours follow up ontrol group omparison group xperience of Specimen dental caries xperienced Inexperienced xperienced Inexperienced ctivity of SM State of don't apply xylitol solution a 3 b 3 c 2 d 3 e 3 f 3 g 3 a-1 3 b-1 2 c-1 2 d-1 2 e-1 3 f-1 3 g-1 2 State of applying xylitol solution 3 3 3 1 0 0 3 2 2 0 0 0 2 3 2 1 1 0 3 3 0 2 2 1 2 2 1 0 0 0 3 2 3 0 0 0 3 1 2 0 0 0-1 3 3 3 0 0 0-1 2 2 2 0 0 0-1 2 2 2 0 0 0-1 3 1 0 1 0 1-1 3 3 1 0 0 0-1 3 3 3 0 0 0-1 3 2 1 0 0 0 lass3 š y x SM y 7 4 lass2 y ùkþ 3 lass3 š y. 'JH omparison of S. mutans activity state between Person which do not experience caries and Person which experience caries. 5M S. mutans activity's t-test analysis of experienced of dental caries between inexperienced of dental caries at state of don't apply xylitol solution ¾ xperienced of dental caries Inexperienced of dental caries Mean 2.857143 2.428571 ispersion 0.142857 0.285714 Number 7 7 Pearson correlation 0.353553 coefficients Hypothesis verage 0 differences egree of freedom 6 P(T<=t) 0.03907 t critical value 1.94318 one-tailed tests lass2 k 1ml 10 5 ~10 6 ³ w lass3 k 1ml 10 6 ³ w d (Table 3). m w SM y x m w ƒ û (Table 4). 'JH omparison of S. mutans activity state of applying xylitol solution between state of don't apply xylitol solution.
Journal of ental Hygiene Science Vol. 10, No. 2, pp. 123~129 (2010) 5M S. mutans activity's NOV of change in xylitol content I J I-J Standard error Sig.42857*.85714* 2.14286* 2.28571* 2.57143* -.42857*.42857* 1.71429* 1.85714* 2.14286* -.85714* -.42857* 1.28571* 1.42857* 1.71429* -2.14286* -1.71429* -1.28571*.14286*.42857* -2.28571* -1.85714* -1.42857* -.14286*.28571* -2.57143* -2.14286* -1.71429* -.42857* -.28571*.285.001.285.029.012.029.999.001.012.999.979.979 95% onfidence interval Max. Min. -.7701 -.3415.9442 1.0871 1.3728-1.6272 -.7701.5156.6585.9442-2.0558-1.6272.0871.2299.5156-3.3415-2.9129-2.4844-1.0558 -.7701-3.4844-3.0558-2.6272-1.3415 -.9129-3.7701-3.3415-2.9129-1.6272-1.4844 1.6272 2.0558 3.3415 3.4844 3.7701.7701 1.6272 2.9129 3.0558 3.3415.3415.7701 2.4844 2.6272 2.9129 -.9442 -.5156 -.0871 1.3415 1.6272-1.0871 -.6585 -.2299 1.0558 1.4844-1.3728 -.9442 -.5156.7701.9129 *.<.05 고 찰 e j e t v (plaque). w É»ƒ û, v j š ³ w û ù w w e ww e w. m Ë k ƒ š ü yƒ ù ü j ³ x w 19) ek k ü S. mutans ƒ ùkû š š š 20,21). w m Ë 3 w S. mutans ƒ š Ë m w z šwš 22). x m e 23). e w» w xk Ë, xk Ë, k,, ƒ s, ij, t q š 24), p m w Ë, m e dw 25). w w S. mutans ƒ Ë Ë š e y w m Ë e z w t w š t t š. m w w Ë e z t yw ƒ w»ƒ w l w» w x w. x xylitol w ƒ w 35% S. mutans y ƒ ù, Xylitol w ƒ w S. mutans y ƒ S. mutans y w e. w x Xylitol w ƒ w 29% S. mutans y ƒ ù Xylitol w ƒ w 95% S. mutans y ƒ ùkû. m Ë»
ƒ t» w. z m z ƒ S. mutans y e w x m ƒ w ù q. 요 약 m w Ë ù w e z ƒ, w m z» w k m ƒ w z, m w S. Mutans y y e w xwš w. w 1~2w e x x m SM y w. k x w z 2 w š m w ƒƒ 10 ml š 5 ƒ w z w x k 30 z k z w. w ü m 48 z m 30, 50, 60, 70, 80 š ƒ z xw. 1. m x w k e Á x y. 2. e x m z w e. 3. e x m w ƒ w 35% S. mutans y ƒ š, m w ƒ w S. mutans y ƒ (p<0.05). 4. e x m w ƒ w 29% S. mutans y ƒ š, m w ƒ w 95% S. mutans y ƒ (p<0.05). Ë m z w e w m w e x Á S. mutans y z ƒ. 참고문헌 1. Van Loveren : Sugar alcohols: what is the evidence for caries-preventive and caries-therapeutic effects? aries Res 38(3): 286-293, 2004. 2. Trahan L: Xylitol: a review of its action on mutans streptococci and dental plaque-its clinical significance. Int ent J 45(1): 77-92, 1995. 3. Isokangas P et al.: Long-term effect of xylitol chewing gum in the prevention of dental caries: a follow-up 5 years after termination of a prevention program. aries Res 27(6): 495-498, 1993 4. Mkinen KK: Xylitol-based caries prevention: is there enough evidence for the existence of a specific xylitol effect? Oral is 4(4): 226-230, 1998. 5. oykendall L: lassification and identification of the viridans streptococci. lin Microbial Rev 2(3): 315-328, 1989. 6. Loesche WJ: Role of Streptococcus mutans in human dental decay. Microbiol Rev 50(4): 353-380, 1986. 7. Van Palenstein Helderman WH, Ijsseldijk M, Huis in 't Veld JH.: selective medium for the two major subgroups of the bacterium Streptococcus mutans isolated from human dental plaque and saliva. rch Oral iol 28(7): 599-603, 1983. 8. Isokangas P et al.: Xylitol chewing gum in caries prevention: a field study in children. J m ent ssoc 117(2): 315-320, 1988. 9. Kandelman, agnon : 24month clinical study of the incidence and progression of dental caries in relation to consumption of chewing gum containing xylitol in school preventive programs. J ent Res 69(11): 1771-1775, 1990. 10. armes et al.: ield trials of preventive egimens in Thailand and rench Polynesia. Int ent J 35(1): 66-72, 1985. 11. Mkinen KK et al.: Xylitol chewing gums and caries rates: a 40-month cohort study. J ent Res, 74(12): 1904-1913, 1995. 12. Scheinin et al.: Turku sugar studies. Incidence of dental caries in relation to 1-year consumption of xylitol chewing gum. cta Odontol Scand 33(5): 269-278, 1975. 13. Han SK et al.: Prevention of dental caries by xylitol gum in pre-school children during 12-months. J Korean cad Pediatr ent 31(2):159-168, 2004. 14. Park JH: The anticariogenic effects of xylitol on mutans streptococci in children with mixed dentition. J Korean cad Pediatr ent 34(4):632-638, 2007. 15. quirre-zero O, Zero T, Proskin HM: ffect of chewing xylitol chewing gum on salivary flow rate and the acidogenic potential of dental plaque. aries Res 27(1): 55-59, 1993. 16. dgar WM, Highham SM, manning RH: Saliva stimulation and caries prevention. dv ent Res 89(2): 239-245, 1994. 17. Honkala S, Honkala : Use of xylitol among inish schoolchildren. cta Odontal Scand, 57(6): 306-309, 1999. 18. Lee SJ, Paik J, Han MR: ffect of xylitol on bread properties. Korean J. ood & Nutr. 21(1): 56-63, 2008. 19. armes et al.: ield trials of preventive regimens in Thailand and rench Polynesia. Int ent J 35(1): 66-72, 1985. 20. Isokangas P et al.: ental caries and mutans streptococci in the approximal areas of molars affected by habitual use of xylitol chewing gum. aries Res 25(6): 444-448, 1991. 21. utio JT: ffect of xylitol chewing gum on salivary streptococci mutans in preschool children. J ent hild 69(1): 81-86, 2002. 22. irkhed et al.: ffects of 3 months frequent consumption of hydrogenated starch hydrolysate(lycasin), maltitol, sorbitol
Journal of ental Hygiene Science Vol. 10, No. 2, pp. 123~129 (2010) and xylitol on human dental plaque. cta Odontol Scand 37(2): 103-115, 1979. 23. Hujoel PP et al.: The optimum time to initiate habitual xylitol gum-chewing for obtaining long-tern caries prevention. J ent Res 78(3): 797-803, 1999. 24. Pauli J. Isokangas, Kauko P. Isotupa, Kauko K. Makinen, Pirkko-Liisa Makinen, Harry R. Page Jr, Peter llen, hristopher ennett : Stabilisation of rampant caries: polyol gums and arrest of dentine caries in two long-term cohort studies in young subjects. Int ent J 45(1): 93-107, 1995. 25. Kandelman, agnon : 24month clinical study of the incidence and progression of dental caries in relation to consumption of chewing gum containing xylitol in school preventive programs. J ent Res 69(11): 1771-1775, 1990. (Received ebruary 25, 2010; Revised pril 20, 2010; ccepted pril 24, 2010)