Keep your nose clean

Nasal and upper respiratory benefits of xylitol use

by Susan Clark, RDHEF

Dr. Matti Uhari is one of the world's leading xylitol researchers. He works in the department of pediatrics at the University of Oulu in Finland. Knowing that xylitol inhibits the growth of Streptococci mutans in the mouth, he then hypothesized that xylitol could also affect the growth of other nasopharyngeal bacterial flora, an important factor when considering respiratory infections. He studied this in vitro by adding xylitol to a medium and observed that 1% and 5% xylitol markedly reduced the growth of alpha-hemolytic streptococci, including Streptococcus pneumoniae. If xylitol reduced the growth of Streptococcus pneumoniae in the nasopharynx, he concluded that xylitol could also reduce the carriage of this pathogen and thus have clinical significance in the prevention of pneumococcal diseases.

Finnish researchers also found that xylitol decreased ear infections. They looked at what happened when the bacteria in the nose were exposed to xylitol. Dr. Uhari's group reported their findings in the British Medical Journal in 1996 and in Pediatrics in 1988. They showed that ear infections in children could be reduced by up to 40% with eight to nine grams of oral xylitol every day.

Building on the studies of Dr. Uhari and other researchers, Dr. Lon Jones, a board certified osteopathic physician based in Plainview, Texas, developed a xylitol-based nasal spray. Since these studies suggested that it was possible to create better upper respiratory health using a natural product such as xylitol, he began administering it to his granddaughter who had chronic ear infections. He administered the xylitol-based nasal wash after every diaper change and observed her ear infections ceased. Dr. Jones then had 10 children in his practice use the nasal wash in the same manner. Over the next 11 months of regular use of this xylitol-based spray, these 10 children experienced a 93% reduction in ear infections.

Bacteria usually cause an ear infection, but a virus can also be the culprit. They begin in the back of the nose, when fluid builds up in the area behind the eardrum, and then becomes infected. The bacteria that live on the mucus travel down into the eustachian tube that leads into the middle ear and cause otitis media in children.

In older people, and while properly termed lower respiratory infections, bacteria and viruses that are able to get airborne in the nose are aspirated to cause bronchitis and pneumonia. When working effectively, any fluid that enters this area leaves quickly through the eustachian tube, which connects the middle ear to the back of the nose and throat. However, if the eustachian tube is blocked – which is common during colds, sinus infections, and even allergy seasons – it traps the fluid in the middle ear. Germs like to grow in dark, warm, and wet places, so a fluid-filled middle ear becomes the perfect breeding ground. As the infection worsens, so may the inflammation in and behind the eardrum, resulting in pain.

Babies are particularly susceptible to ear infections because their eustachian tubes are short (about 1/2 inch) and horizontal. As they grow to adulthood, their tubes triple in length and become vertical, so fluid can drain more easily. Ear infections are one of the most common childhood illnesses. Be sure to include questions on the health history with children in your practice about ear infections and asthma. These conditions are now considered risks factors for early childhood caries.

In 1999, Dr. Jones patented using xylitol in nasal application and formulated the product that became known as Xlear Nasal Spray. This nasal spray line contains xylitol, purified water, salt, and grapefruit seed extract as a preservative. It contains no drugs, has no side effects, is safe for all ages, and is completely non-habit forming. Its principal ingredient is xylitol. It functions to wash bacteria and pollutants, while soothing and moisturizing the nasal passageway.

The nasal spray works in three ways:

• First, it decreases the adherence of harmful bacteria to the cells in the nose.
• Secondly, the concentration of xylitol stimulates our own defensive washing of the nose.
• Thirdly, the xylitol decreases the concentration of salt in the airway surface fluid.

If you could look with a microscope inside your nose, you would see all of the pollutants and infecting agents stuck in mucus that coats and protects your airway. The mucus would be moving slowly, toward the back of the nose. The mucus is secreted by special cells, scattered among those lining your airway and swept by microscopic hairs called cilia that extend into the airway from the other cells in the airway. Between these ciliated and mucus-secreting cells and the mucus layer is the airway surface fluid that provides some space for the cilia to help trap and propel bacteria and pollutants out of the nose.

The thin layer of airway surface fluid is also the home of several protein substances called defensins. These antimicrobial substances help trap and kill foreign bacteria that are constantly being deposited in the lungs. When it is working properly, it is a very effective cleaning mechanism.

Xylitol helps the defensins because it has low transepithelial permeability, and is poorly metabolized by several bacteria, so it can lower the airway surface liquid salt concentration. Bacteria lose their ability to adhere to sinus tissue, thus allowing the body to more easily clear them away.

Irritants, toxins, allergens, and dust accumulating in the nasal passages cause the cilia to become disorganized. This underscores the cilia's natural defense system to work properly. The mucus is dry and does not hold on effectively to the bacteria or other pollutants. When a person's natural defense is blocked, and when harmful bacteria make their home in the upper respiratory passages, they breed and multiply, leading to upper respiratory infection and disease, ear infections, sinusitis, and asthma.

Using a nasal spray with xylitol on a daily basis helps your body rinse away infection-causing bacteria and hydrates the nasal passage and sinuses. In addition, unlike prescription remedies, this daily use will never damage tissues, nor result in antibiotic resistance.

Irritants in the back of the nose trigger asthma and allergies as well. Again, the immune system's response to get rid of these irritants is to wash them out. It does this by stimulating the release of histamine.

According to the American Academy of Allergy, Asthma, and Immunology, histamine accomplishes four steps in the nasal passageway.

• Opens small blood vessels under the cells lining the nasal cavity. By doing this, it provides the water for the washing, it replenishes and increases the airway surface fluid with its defensins, and optimizes the water available for the mucus to be wet, sticky, and moveable. Thus, histamine helps the nose get cleaned out faster and easier.
• Increases the mucus to pick up more pollutants.
• Increases sneezing
• Constricts the bronchi, closing down the airway to protect the lungs.

A child's immune response to pollutants in the nose is a runny nose. Traditionally, antihistamines were developed to block histamines, induce rhino rhea, and shrink swollen membranes to allow easier draining of sinuses and the eustachian tube. What they do in effect is turn off nasopharyngeal washing by drying the membranes. Antihistamines block histamine – the "water" is never turned on. Decongestants close down the leaking blood vessels, turning off the water, and do not respond to the pollution in the nasopharynx.

An open nasal airway helps to avoid mouth breathing and is essential for proper orthopedic and orthodontic development. I have already discussed chronic middle ear infections, sinusitis, and upper respiratory infections. Mouth breathing can particularly affect the growing face.

Tongue thrust and digit sucking are harmful to the developing child as well. There is a direct relationship between the degree of mouth breathing and the severity of the malocclusion. This picture shows the results of open mouth breathing, tongue thrust, and digit sucking. Open mouth posturing can cause dental and cosmetic problems too.

Infants instinctively are 100% nasal breathers at birth. When babies are born, their sinus passageways are not connected to the throat like children and adults. This helps them to nurse without aspirating milk. They can only breathe through their nose, so when their nose is stuffy, they will be very uncomfortable

The largest increments of growth occur during the earliest years of life. Consequently, if a child has chronic nasal obstruction, it is essential to correct the problem as soon as possible.

The decision is clear. Regular cleansing of the nasal passage is an important step to preventing illness. Using a nasal spray with xylitol is an effective tool for washing the nose and flushing away harmful bacteria and pollutants that might otherwise lead to sinusitis, ear infections, and upper respiratory disease.

So remember, keep your nose clean.

Susan Clark, RDHEF, is a key opinion leader, speaker, and author of "Exploring Dental Hygiene, Finding the Hidden Rewards." She is the West Coast Region Product Educator for Xlear Inc. She is also actively involved with her local component and California Dental Hygienists' Association and the California HY-PAC committee. You can visit her web site at www.sgclark.net orcontact her at [email protected].