3. Contents
Introduction
Types of sugar substitutes
Classification
Ideal requirements
Sweet score & USDA Food pyramid
Health benefits of AS
FDA approved AS –benefits & toxic effects
Polyalcohols
Natural sweeteners
Tooth friendly sweet concept
References
4. INTRODUCTION
WSRO STATEMENT ,NOV.2011
Sugar (sucrose) being most acceptable sweetening
agent in use by mankind is considered as the “Arch
Criminal” in dental caries initiation.
Dental caries occur when acid-producing bacteria,
especially Mutans streptococci, Lactobacilli and
Actinomyces species, populate the sticky coating on
the surface of tooth.
Frequent consumption of fermentable
carbohydrates, including sucrose, has a role in the
aetiology of dental caries.
5. Sugar substitutes
Artificial sweeteners are
called as sugar
substitutes
Added to foods to
provide sweetness
without adding extra
calories
2 kind of sweeteners
Nutritive
Non-nutritive
6. Types of nutritive sweeteners
Sugar sweeteners
High fructose corn syrups
Glucose
Dextrose
Lactose
Maltose
Honey
Concentrated fruit juices
Reduced energy polyols or
sugar alcohols
Sorbitol
Xylitol
Mannitol
Hydrogenated starch hydrolysates
(HSH)
8. A)Natural
• 1. Monellin
• 2. Licorice
• 3. Dihydrochalcone
• 4. Miraculin
B)Artificial
• 1. Aspartame
• 2. Saccharin
• 3. Cyclamate
• 4. Sucralose
Based on their
origin
Pramod Yadav et al. sugar substitutes & health . IOSR
Journal of Dental and Medical Sciences (IOSR-JDMS)
9. Ideal requirements
Should provide sweetness with no unpleasant after taste
Should have little or no calories
Should not be carcinogenic or mutagenic
Should be economical to produce
Should not be degraded by heat when cooked
10. SWEET SCORE
SWEETS : FREQUENCY X SCORE
Liquid : _ x 5
Solid : _ x 10
Slowly dissolving : _ x 15
Total sweet score: — Interpretation sweet score
5 or less: excellent
10: good
15 or more: “watch out” zone
Diet Counselling – A Primordial Level of Prevention of
Dental Caries. Journal of Dental and Medical Sciences
(IOSR-JDMS) Volume 13, Issue 1 Ver. II (Jan. 2014), PP
64-70
14. SACCHARIN
Discovered by Remsen &
Fahlberg in 1879
Oldest of artificial
sweeteners
200-700 times sweeter
than sucrose
Available in liquid & tablet
forms as a tabletop
sweetener, has a slightly
16. Excretes almost without
metabolic alteration, 75% -
90% in urine
Brand name – Sweet ‘N
Low & Sugar Twin
17. Dental aspects
Saccharin 0.5%
,when used as a
supplement to a
cariogenic diet , it
significantly reduced
both fissure and
smooth surface caries
in rats, apparently by
interfering with the
growth of S.mutans.
18. Adverse effects
Oral dose of 5-25 gm daily may cause anorexia,
nausea & vomiting
Bladder cancer
FDA , 1972 – Set limits on the use of saccharin
(1gm/day for a 155 lb person)
Reuber MD, 1977 – experimental group of rats
which had 5% saccharin in their diet had higher
incidence of bladder cancer than control group of
rats.
Howe et al, 1977 – conducted a study on
hospitalized patients with bladder cancer. Risk of
bladder cancer was 60% higher among men who
had used saccharin tablets
19. Aspartame
Combination of amino acids
Aspartic acid & Phenylalanine
It is about 180-200 times
sweet as sucrose
Caloric value of 4 cal/gm
Kroger et al (2006)-low calorie sweeteners & other substitutes- a review of
safety issue .vol.5
20. ADI- 50 mg/kg/d
Effective in enhancing acid
fruit flavors & extending sweet
taste as in chewing gums
Brand names – Nutrasweet,
Equal
23. Disadvantages
Risk of fetal abnormalities & mental
retardation if blood levels of phenylalanine
are not carefully maintained below
12mg/100ml, during pregnancy for persons
with PKU (FDA, 1981)
24. Acesulfame K
200 times sweeter than
sucrose
First approved by FDA in
1988 for use as a sweetener
in dry food products .
Used in yogurt,
refrigerated desserts,syrups.
26. Advantages
Calorie free
No evidence of
carcinogenicity,
mutagenicity, cytotoxicity &
teratogenicity
Excellent shelf life so it is
used in candies,canned
food and alcoholic
beverages
Disadvantages
Headache
27. Sucralose
Discovered in 1976
Non- nutritive, non caloric
derivative of sucrose
6oo times sweeter than sucrose
Sold under the trade name
SPLENDA
Widely used throughout the
world in tea, coffee, carbonated
& non- carbonated beverages,
chewing gums etc.
ADI- 5 mg/kg/d
31. Sorbitol
Occurs naturally in cherries,
plums ,pears, apples.
Prepared from glucose by
high pressure hydrogenation
or by electrolytic reduction.
• 1 gm sorbitol yields 4 calories
• Recommended intake by Food
& Agricultural organization (
WHO) 150mg/kg/day
oxidoreductase
Sorbitol
fructose
32. Advantage
Can be used by only 5-10% of bacteria in
plaque – less acid production ( Kalfas et al,
1990)
Disadvantage
Too much sorbitol consumption ( >20-30gm)
can cause diarrhoea. It act as a laxative
because of osmotic transfer of water into the
bowel.
33. Xylitol
Obtained commercially from
birch trees.
Naturally in fruits and
vegetables (strawberries,
raspberries, plums), oats,
certain mushrooms.
Commonly used by diabetic
patients.
High dosage causes
diarrhoea.
The recommended dose for
34. A study conducted in Turku, Finland,
evaluated the effectiveness of xylitol on
dental plaque reduction in 1970.
xylitol has been widely researched and
globally accepted as a natural sweetener
approved by the US Food and Drug
Administration (FDA) and the American
Academy of Pediatric Dentistry.
36. xylitol is incorporated into the cells of MS
as xylitol-5-phosphate, through the
phosphoenolpyruvate phosphotransferase
system. This results in inhibition of both
growth and acid production.
Nayak et al.(2014)The effect of xylitol on dental
caries
and oral flora. Clinical, Cosmetic and Investigational
37. MECHANISM OF ACTION
Xylitol reduces the levels of mutans streptococci in plaque and saliva by
disrupting their energy production processes, leading to cell death.
It reduces the adhesion of these microorganisms to the teeth surface
and also reduces their acid production potential.
promotes mineralization by increasing the salivary flow when used as
chewing gum
Xylitol alcohol has been shown to impact growth of nasopharyngeal
bacteria such as S. pneumonia and S. mitis, and hence has a role to
play in nasopharyngeal pneumonia
38. Oral health benefits
Decreases incidence of caries by ng salivary
flow
Reducing
Cariogenic bacteria
Plaque level
Xerostomia
Gingival inflammation
Erosion
39. Milgrom et al.studied the effect of habitual
consumption of
xylitol gummy bear snacks (11.7 g/d) in reducing
cariogenic
microorganisms in school-going children. And found
significant reduction in S. mutans and S. sobrinus.
Murthykumar reported in 2013 that xylitol in milk
demonstrated a beneficial anticaries effect and is
well accepted by both children and adults.
Shikhar kumar et al (2013) concluded that Children
consuming the sugar-free (xylitol) chewing gum
showed a marked increase in the pH of saliva.
40.
41.
42. Lactilol
Sugar alcohol used as a
replacement bulk sweetener
for low calorie foods
40% as sweet as sucrose
Provides 2.4 cal/g
Used in sugar-free candies,
cookies (biscuits), chocolate,
and ice cream
43. Advantages
Highly stable, can be used in baking
Promotes colon health as a prebiotic
Laxative and is used to prevent or treat
constipation
Disadvantages
Cramping, flatulence & diarrhoea
44. High fructose corn syrup(HFCS)
Mixture of glucose & fructose
Produced from corn syrup
2 most common types
HFCS 42 = 42% fructose, 58%
glucose
HFCS 55 = 55% fructose, 45%
glucose
45. ROLE OF HFCS
Baked goods – give a brown
crust, enhances flavour in fruit
fillings
Yogurt – enhances flavor,
controls moisture.
Sauces & condiments –
enhances flavor & balance
Canned & frozen fruit – Protect
the firm texture of canned fruit,
reduces freezer burns on frozen
fruits
Beverages – Provide greater
stability than sucrose in acidic
carbonated sodas .
46. Toxic effects
Fat deposits in liver
Narrowing of blood vessel
Triggers asthma, food allergies
and damages immune system
Accelerates the ageing process
Mercury poisoning as HFCS
contains mercury.
Dr.mercola- Bad to the Last Drop: Refiners Squeeze
Dangerous Additives from Corn
48. Stevioside
Found in leaves of stevia rebaudiana.
Calorie free, non-cariogenic
300 times sweeter than sucrose
Brand name – pure via, truvia
49. Miraculin
Shrub grown in West Africa
produces berries that have
property of causing sour
substances to taste sweet
Active ingredient
(miraculin)is a glycoprotein
with a molecular weight of
about 44,000
50. Effective in sweetening citrus fruits,berries,yogurt etc.
Trade name- miralin miracle fruit drops
51. Licorice (ammoniated glycyrrhizin)
Derived from licorice root( glycyrrhiza glabra)
50 times as sweet as sucrose
Used as expectorant & pharmaceutical vehicles
Reduce the solubility of enamel & prevent fall in
pH during incubation of saliva-glucose mixtures
52. Monellin
Red berries growing in
grape like cluster.
Serendipity berries
3000 times sweeter than
sucrose
Loses its sweetness
within about a day, if left
standing at room
temperature
53. Tooth friendly sweet concept
Started in switzerland in 1989.
To provide consumers with easy guidance to
toothfriendly products, the Toothfriendly ("Happy
Tooth") label was created.
Lollipops
mints
chewing gums
Pastilles
54. Tooth friendly bubble gum
concept was presented by
BENEO with palatinose .
These chewing gums are
derived from sugar beet
low glycemic response which
is approved by EHA.
Reduced stickiness
55. References
Pediatric dentistry priciples & practice- MS muthu 2nd
edition
Cariology –Ernst newburn ,1st edition
Textbook of pediatric dentistry- Nikhil marwah -2nd
edition
Roshan NM, Sakeenabi M. Practical problems in use
of sugar substitutes in preventive dentistry. JISPPD
2011;1(1): 1-8
Bray GA et al. Consumption of high fructose corn
syrup in beverages may play a role in the epidemic of
obesity. Am J Clin Nutr 2004;79:537-43
Kroger M. Low calorie sweetners & other sugar
substitutes: A review of safety issues. Comprehensive
56. AAPD. Policy on the use of xylitol in caries
prevention. Reference manual; 34(6): 45-47
Whitehouse et al. The Potential Toxicity of
Artificial Sweeteners. American Association of
Occupational Health Nurses Journal. 2008;
56(6),251-259.
Raben Anne et al. Sucrose compared with
artificial sweeteners. The Americal journal of
Clinical Nutrition. 2002; 76,721–729.
57. Matsukubo and Takazoe: Sucrose substitutes and
their role in caries prevention, International Dental
Journal (2006) Vol. 56/No.3.
Pramod Yadav et al. sugar substitutes & health .
IOSR Journal of Dental and Medical Sciences (IOSR-
JDMS) Volume 13, Issue 8 Ver. III (Aug. 2014).
Oku T et al. Digestion, absorption, fermentation &
metabolism of sugar substitutes. Pure Appl Chem,
2002; 74(7): 1253-61
• Guideline on Xylitol Use in Caries Prevention.by
AAPD (2011)
58. Kumar, et al.: Effects of xylitol on salivary and
dental plaque pH in children. JISPPD OCT-DEC
2013 ,vol.31.issue 4 .
• Nayak et al.(2014)The effect of xylitol on dental
caries
and oral flora. Clinical, Cosmetic and
Investigational Dentistry
• Diet Counselling – A Primordial Level of
Prevention of Dental Caries.Journal of Dental and
Medical Sciences (IOSR-JDMS) Volume 13,
