A number of studies have been conducted to confirm the preventive effect of xylitol on dental caries as a whole or partial alternative to dietary sugars. This study reviewed the oral health effects of xylitol on the prevention mechanism of dental caries, the prevention of dental caries, the inhibition of mother-to-child transmission, and the oral health effects in the elderly based on existing studies on the oral health of xylitol. Carbohydrates and dietary sugars in food are fermented by acid-producing microorganisms in the mouth and produce dental plaque and acid, which cause dental caries. However, most dental decay-causing bacteria cannot produce acids by metabolizing xylitol. Xylitol, stored in cells as a non-metabolizable metabolite by Streptococcus mutans (S. mutans), affects bacterial glucose metabolism and inhibits bacterial growth. Xylitol consumption also reduces the amount of plaque and the population of S. mutans in both plaque and saliva. In addition, xylitol acts in the remineralization process. Xylitol has been confirmed to effectively prevent dental caries, inhibit mother-to-child transmission of MS, prevent dental caries, and increase salivary flow in the elderly. In conclusion, xylitol is an adequate sugar substitute for dental health, from infants to the elderly. For future studies, the researchers recommend reviewing the effects of xylitol on the oral and intestinal microbial environment and the side effects of excessive intake.