A Comparative Evaluation of Xylitol, Sorbitol, and Isomalt-containing Candies and Their Effects on Salivary pH and Salivary Flow Rate in Children Aged 6-12 Years: An Ex Vivo Study.

BACKGROUND: Dental caries is one of the most widespread oral health problems in children, often resulting from the interaction between dietary sugars, oral bacteria, and salivary factors. Saliva plays a key role in protecting teeth by neutralizing acids and supporting remineralization. However, when children consume sugary foods and drinks-particularly those with sucrose-it can cause the salivary pH to drop, increasing the risk of tooth decay. Sugar substitutes such as xylitol, sorbitol, and isomalt are widely used in preventive dental care, but their effects on children's salivary pH and flow rate remain poorly understood. AIM: This study aimed to evaluate and compare the effects of candies containing xylitol, sorbitol, and isomalt on salivary pH and salivary flow rate in children aged 6-12 years using an ex vivo model. MATERIALS AND METHODS: A total of 100 healthy children were randomly divided into four equal groups (n = 25): xylitol, sorbitol, isomalt, and control. Salivary samples were collected at four time points: before and after consuming a sweetened beverage, after the intervention (candy or water rinse), and 15 minutes postintervention. Salivary pH was measured using a calibrated digital pH meter, and flow rate was assessed by weighing collected saliva with a portable electronic scale. Children were kept under standard conditions to minimize variability, and a double-blinded approach was used. Data were analyzed using SPSS v25 and STATA v15, with statistical significance set at p < 0.05. RESULTS: All three polyol groups showed a significant improvement in salivary pH and flow rate after intervention when compared to the control group. Xylitol demonstrated the strongest ability to restore and buffer salivary pH, followed by isomalt and sorbitol. Sorbitol, however, produced the highest increase in salivary flow. At 15 minutes postintervention, pH levels in the polyol groups returned close to baseline, whereas the control group's pH remained low. CONCLUSION: Xylitol-containing candies proved to be the most effective overall, improving both salivary pH and flow-critical factors in reducing the risk of caries. Sorbitol and isomalt also showed beneficial effects, particularly in stimulating saliva. These findings support the targeted use of sugar-free polyol candies as part of caries-prevention strategies in children.