Role of Sugar and Sugar Substitutes in Dental Caries: A Review

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Author(s): Gupta P, Gupta N, Pawar AP, Birajdar SS, Natt AS, and SinghHP
Publication name: ISRN Dent. 2013 Dec 29;2013:519421
Publication year: 2013

Abstract

Dental caries is a chronic disease which can affect us at any age. The term “caries” denotes both the disease process and its consequences, that is, the damage caused by the disease process. Dental caries has a multifactorial aetiology in which there is interplay of three principal factors: the host (saliva and teeth), the microflora (plaque), and the substrate (diet), and a fourth factor: time. The role of sugar (and other fermentable carbohydrates such as highly refined flour) as a risk factor in the initiation and progression of dental caries is overwhelming. Whether this initial demineralization proceeds to clinically detectable caries or whether the lesion is remineralized by plaque minerals depends on a number of factors, of which the amount and frequency of further sugars consumption are of utmost importance. This paper reviews the role of sugar and sugar substitutes in dental caries.

Summary

This review paper summarises the impact of sugar and low calorie sweeteners on dental health and concludes that low calorie sweeteners such as aspartame, acesulfame-K, cyclamate, saccharin, sucralose and steviol glycosides are not cariogenic ingredients.

When evaluating a non-sugar sweetener in relation to dental caries, it is important to consider the potential for metabolism by oral microorganisms and dental plaque, the influence of consumption on cariogenic microorganisms, and the risk of microbial adaptation to the sweetener. Low calorie sweeteners do not cause pH falls in dental plaque and are not metabolized to acids by oral microorganisms; thus they cannot cause dental caries. However, it is important to remember that other ingredients in some low calorie sweetened food products such as carbohydrates and/ or naturally occurring sugars in some foods or drinks may still cause caries.

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