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In a randomized double-blinded clinical trial, preschool children used sucrose or xylitol chewing gum regularly for 2 months to study the preventive effect of xylitol on acute otitis media (AOM). Salivary mutans streptococci (sm) levels of the children were measured before the exposure. Those with ≥105sm CFU in 1 mL saliva were considered to have high sm levels (sm+); and those with <105 CFU low sm levels (sm−).This practice-based study aims to evaluate long-term dental effects of the sucrose/xylitol exposure on primary teeth.For analyses, individuals were divided into sub groups according to their study group in the original AOM trial and baseline sm levels. Outcome events owing to dental caries of their all primary teeth were followed from dental records up to 12 years. Survival of teeth caries free was determined by Kaplan–Meier method and analysed statistically by Wilcoxon testing.Survival of primary teeth caries free of children with high sm levels in the sucrose group was significantly shorter compared with all other groups when followed until shedding.Two months’ regular exposure to sucrose was sufficient to induce dental caries in primary teeth of children with elevated sm levels at baseline.