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The Dental Effects and Associated Properties of Natural Sugars, Sugar Substitutes, and Artificial Sweeteners Randy Ligh, DDS SUGAR AND ITS MANY FORMS Sucrose, glucose, lactose, fructose, and dextrose are some of the chemClaire Saxton, MS, RD, CNSC ical names of what we call “sugar.” Simple sugars are monosaccharide and Joe Fridgen, DDS disaccharide forms of carbohydrate, while complex carbohydrates such as There appears to be a lot of misconceptions in the health care arena surrounding sugars. We would like to clarify and bring to light the information that exists surrounding sugars as related to dentistry. Health care professionals will find this information useful to guide patients in making appropriate choices about food, beverages, and chewing gums. Sugar has long had a reputation as a culprit in contributing to dental decay. Dental caries (decay) is a disease with a multifactorial etiology. It is an infectious process during which carbohydrates (sugar) are fermented by oral bacteria and the acid production causes enamel dissolution at the tooth enamel surface.

CARIES PROCESS

We know that a number of oral microorganisms can produce enough acid to demineralize tooth structure. Streptococcus mutans have demonstrated to be one of the major and most virulent caries-producing microorganisms.1 The acids produced by the microorganisms are metabolic by-products of the consumption of carbohydrate.2 Extended periods of low (acidic) pH in the mouth provide a supportive environment for the proliferation of cavity-causing bacteria. The low pH is also responsible for the demineralization and net mineral loss of the teeth leading to irreversible breakdown. Caries requires both the presence of the microorganisms and the availability of carbohydrate.3 Other contributing risk factors include oral hygiene habits, presence of oral appliances or braces, medical conditions, salivary flow and content, medications, and dietary habits.

TABLE 1: OTHER LABELS FOR SUGARS barley malt

dextran

fruit juice concentrate

malt syrup

beet sugar

corn syrup solids

honey

maltodextrin

brown sugar

date sugar

glucose

maltose

cane sugar

dextrose

grape sugar

molasses

caramel

evaporated cane juice

high-fructose corn syrup

nectars

carob syrup

fructose

invert sugar

sucrose

corn syrup

fruit juice

lactose

sorghum syrup turbinado sugar

34 | THE BULLETIN | MAY/JUNE 2014

starch and glycogen are made up of longer chains called polysaccharides. These complex carbohydrates have less of a cariogenic effect. Numerous forms of the simple sugars are used in food manufacturing, and labeling for sugar can be overwhelmingly complex. All forms of sugar can be found in the ingredient lists, but there are many names for sugars that may be difficult to recognize by the consumer. See Table (1) for

TABLE 2: PROPERTIES OF SUGARS AND SUGAR SUBSTITUTES Nutritive value (calories/g)

Cariogenic

Sweetness*

Sucrose

4

Yes

1.0

Glucose

4

Yes

.7

Fructose

4

Yes

1.5

Lactose

4

Yes

.2

Xylitol

2.4

No

1.0

Natural sugars

Sugar substitutes Sugar alcohols/polyols Sorbitol

2.6

No

.6

Mannitol

1.6

No

.5

Maltitol

2.1

No

.9

Aspartame (NutraSweet, Equal)

0.0

No

180

Saccharin (Sweet 'N Low)

0.0

No

300

Sucralose (Splenda)

0.0

No

600

Acesulfame potassium (Sunett)

0.0

No

200

0.0

No

250

Non-nutritive artificial sweeteners

Natural Chrysanthemum Family Herb Stevia (Truvia, PureVia)

*Sucrose (table sugar) is the standard for sweetness comparison and is given the sweetness value of “1.”

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