Special needs populations such as the mentally disabled or developmentally disabled present a unique challenge for the dental professionals providing dental treatment. Among those challenges is oral health promotion through primary prevention of dental caries and periodontal disease. There are many barriers to adequate oral care for these special needs patients that include cost, physical limitations, low levels of perceived need and lack of dental knowledge by residents and staff, if the person resides in an institution. Primary prevention to maintain oral comfort and function for these patients is a priority to support their quality of life. Typical oral health problems of these patients include hyposalivation, root-surface caries, poor oral hygiene, a high prevalence of periodontal disease and dental caries. The purpose of this paper is to review information for the inclusion of xylitol in primary preventive regimens as an adjunct for the prevention of oral diseases for special needs patients.