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a detailed list. Ultimately, these are all forms of sugar that do have a cariogenic insult potential on the teeth.

SUGAR ALCOHOLS

The sugar alcohols or polyols (such as xylitol, sorbitol, mannitol, and maltitol) are used in foods as sweeteners and thickeners. They can be found as a sugar substitute in some “diabetic” foods because they have less of an effect on blood sugar than other sugars. As they are not extremely sweet and as they can cause stomach upset (bloating, diarrhea) when consumed in large amounts, artificial sweeteners are often used and included in the product as well. Sugar alcohols have been demonstrated to be noncariogenic. Polyols used in combination can reduce caries, but xylitol appears to take the lead in effectiveness.4 Most of our dietary sugars and polyols consist of a 6-carbon monosaccharide unit, but xylitol has a unique 5-carbon structure.5 Xylitol disrupts the processes of energy production by Streptococcus mutans, leading to bacterial cell death. With adequate consumption levels of xylitol (6-10 grams daily), bacterial levels are reduced.6 The resulting bacteria exhibit reduced adhesion to the teeth and other reduced virulence properties such as less acid protection. Dosing frequency of xylitol should be a minimum of two times a day. Xylitol can be found in some brands of chewing gum. Thus, xylitol can be beneficial and other sugar alcohols do not promote a cariogenic insult on the teeth.

ARTIFICIAL SWEETENERS

Artificial sweeteners are food additives that add a sweet flavor to foods, but have minimal calories. The artificial sweeteners that are approved for use in the United States are aspartame, sucralose, neotame, acesulfame potassium, and saccharine. Stevia is an approved non-caloric sweetener that is derived naturally. They are used in diet drinks, cereals, sugar-free products such as ice creams and yogurts. Artificial sweeteners also do not promote a cariogenic insult on the teeth. See Table (2) for summary.

educated choices. Our role as health care professionals is to perpetuate accurate information to our patients, colleagues, and friends. A “sweet” treat does not have to cause negative dental consequences.

REFERENCES

1. Marshall, TA. Preventing dental caries associated with sugarsweetened beverages JOURNAL OF THE AMERICAN DENTAL ASSOC> 144(10):1148-1152, 2013. 2. Loesche, WJ. Role of Streptococcus mutans in human dental decay MICROBIOL. REV 50: 353-380, 1986. 3. Orland, FJ. Bacteriology of dental caries:formal discussion, JOURNAL OF DENTAL RESEARCH 43:1045-1047, 1964. 4. LY, K; Milgrom, P; and Rothen, M. Xylitol, Sweeteners and Dental Caries PEDIATRIC DENTISTRY 28: 2 :154-163, 2006. 5. Trahan, L. Xylitol: a review of its action on mutans streptocci and dental plaque –its clinical significance. INT DENT JOURNAL 1995;45 (suppl1): 77-92. 6. Dean, J; Avery, D; and Mcdonald, R. DENTISTRY FOR THE CHILD AND ADOLESCENT (MOSBY ELSEVIER , Missouri, 2011) 177-181. 7. Guideline on xylitol use in caries prevention PEDIATRIC DENTISTRY REFERENCE MANUAL Volume 35, Number 6, 171-173, 2014. 8. Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners. J Acad Nutr Diet. 2102;112:739-758.

AUTHORS Randy Ligh is a private practitioner for Pediatric Dentistry in San Jose, CA, 408/286-6308. Claire Saxton is a clinical dietician at Kaiser Santa Clara Medical Center in Santa Clara, CA, 408/569-1551. Joe Fridgen is a private practitioner for Pediatric Dentistry in San Jose, CA, 408/286-6315.

SUMMARY

The choices for something “sweet” are varied and complex. The effects of different types of sweeteners on our dental health have been discussed and, hopefully, this knowledge will lead us to make informed and

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