Sugar Substitutes

Non-cariogenic Sweeteners
Dr.Ghada Maghaireh BDS,MS,ABOD

Non-cariogenic Sweeteners

Sugar in sticky foods consumed between meals is associated with high caries activity. These findings stimulated research on hypoacidogenic and non-acidogenic sugar substitutes that do not cause pH falls in dental plaque. The usefulness of sugar substitute has to be looked upon not only from a cariological but also from nutritional, toxicological, economic and technical point of view.

Non-cariogenic Sweeteners

The most important issues to consider when evaluating a non-sugar sweetener in relation to dental caries are: 1. Metabolism by oral microorganisms and dental plaque. 2. The influence on cariogenic microorganisms.

3. The risk of microbial adaptation to the

sweetener.

Types of Sugar Substitutes

Sugar substitutes can be separated into two major groups: (I) Intense sweeteners (II) Bulk sweeteners

Intense Sweetener

There are many natural and synthesized intense sweeteners. Some have very intense sweet taste, up to several thousands as sweet as sucrose. Glyrrihizin, monellin, thumatin and mirakulin are examples of naturally occurring intense sweeteners.

The sweeteners alitam and aspartame are based on amino acids or peptides.

Intense Sweetener

Acesulfame-K, cyklamate, saccharin and sucralose are chemically synthesized sweeteners. Intense sweeteners are used in a variety of food products, dentifrices and in sweetening drops and tablets for use in food, coffee, tea, etc. Currently about 30% of the carbonated beverages consumed in USA sweetened with aspartame.

Intense Sweetener

Intense sweeteners are not metabolized to acids by oral microorganisms. Limitations of those sweeteners include poor taste quality, instability and lack of volume. It is important also to remember that other ingredients, such as citric acid or phosphoric acid may cause dental erosion. In some products, the naturally occurring sugar may cause caries (e.g. fruit-flavored soft drinks).

Safety Concerns of Intense Sweeteners

Few side-effects of intense sweeteners have been reported in human. The food label must declare if a product contains a sweetener. In the case of aspartame, the label must also say that the product contains a source of phenylalanine, because some individuals are unable to metabolize this amino acid (i.e. those with phenylketonuria).

Bulk Sweeteners

An example of bulk sweeteners are sugar alcohols such as sorbitol and xylitol. They are currently used in confectionary, chewing gum, chocolate, jellies and other sweets.

They are only partially absorbed in the small intestine and pass to the colon where they may cause osmotic diarrhea. They are not recommended in children under 3 years of age and may cause stomach problems if they used in sugar-free medicine if the daily intake is high.

Sorbitol

Sorbitol is a six-carbon sugar alcohol that can not be utilized by the microorganisms that dominate in the dental plaque. However, majority of strains of mutans streptococci and lactobacilli do ferment sorbitol which may limit its value as a non-cariogenic sugar substitute.

There are fundamentals differences between the fermentation of sucrose and that that of sorbitol by S. mutans.

Sorbitol

First, the fermentation of sorbitol proceeds at slow rate and the final pH dose not reach such low levels seen with glucose or sucrose. Secondly, sorbitol is metabolized by enzymes which are synthesized only when the bacteria is exposed to sorbitol for a sufficient period. Thirdly, fermentation of sorbitol yields considerable amounts of ethanol and formate but a small proportion of lactic acid.

Sorbitol

Many studies found that plaque pH drops only marginally and that a critical pH of less than 5.7 is very seldom obtained in dental plaque following sorbitol consumption. It has been concluded that the potential hypoacidogenic properties of sorbitol do not pose a cariogenic threat to the majority of people.

Xylitol

Xylitol is a sugar alcohol with five carbons that is not fermented by oral microorganisms. Xylitol dose not lower the pH of the dental plaque. Xylitol has a bacteriostatic effect on mutans streptococci.

Xylitol has the ability to reduce the population of mutans streptococci.

Other Bulk Sweeteners

Lycasin, maltitol and mannitol.

Studies have indicated that these sweeteners have a low cariogenic potential. Lycasin is a hydrogenated starch hydrolysate.
Various types have been manufactured by most lycacin products contain over 50% maltitol and low proportion of carbohydrates.

Other Bulk Sweeteners

Maltitol is a 12-carbon sugar. Maltitol can be metabolized by mutans streptococci, Actinomyces and Lactobacilli at a slow rate.

Maltitol dose not significantly lower plaque pH.

Other Bulk Sweeteners

Mannitol, like sorbitol, is a six-carbon sugar alcohol. Lactobacilli and mutans ferment mannitol. streptococci can

Mannitol gives only a small or no decrease in plaque pH compared with sucrose .

Use of non-sugar sweeteners for caries prevention

The most important goal of preventive dentistry is to reduce the consumption of sweet products to a minimum which may be difficult to achieve. Use of intense and bulk sweeteners can be accepted from toxicological and nutritional point of view in certain risk products that are used very frequently (e.g. chewing gum, confectionery, medicine and beverages).

In chewing gums and confectionery, the caries-reducing effect can be expected to be 20-40% depending on the intake frequency of the sugar-free products and the caries activity.