This paper examines how the limited exposure of the professional dental community in the United States to the potential caries reduction benefits of xylitol, and the absence of vehicles for xylitol that could be recommended in private practice settings or applied in public health programs, has retarded xylitol's adoption. Few papers appeared in the English language literature prior to the last two decades but now a greater number are appearing. Current work at the University of Washington has led to a series of randomized controlled trials more clearly establishing dosing and frequency guidelines and increased interest in use of xylitol products for caries prevention. Steps to develop effective alternative vehicles for the delivery of xylitol particularly useful for young children and institutional settings in America, and their bioequivalency, are explored.