Sugar alcohols, caries incidence, and remineralization of caries lesions: a literature review

Nanostructure of healthy and caries-affected human teeth

Spatially resolved small-angle x-ray scattering based on synchrotron radiation combines the quantitative assessment of nanometer-sized components using scattering with the real-space imaging by means of scanning. The method enables us to study the effect of caries-induced damages on the inorganic and organic nanoscopic components in human teeth. We demonstrate for several 200- to 500-μm-thin tooth slices that the bacterial processes dissolve the ceramic components in enamel and dentin, but the dentinal collagen network remains practically unaffected with respect to its abundance and orientation in early stages of caries and in parts of extended carious lesions. Consequently, we speculate that future caries treatments can be developed reversing the effect of bacterial attacks by means of suitable remineralization of the dentin.

FROM THE CLINICAL EDITOR

In this groundbreaking study of caries pathology using synchrotron-based X-ray scattering, the authors demonstrated that while bacterial processes do dissolve the ceramic components in enamel and dentin; however, the dentinal collagen network remains unaffected, enabling the development of future caries treatments that re-mineralize the dentin.

Sugar alcohol sweeteners as alternatives to sugar with special consideration of xylitol

INTRODUCTION

Dental caries is a diet-associated disease which continues to be a serious health problem in most industrialized and developing countries. Strategies to maximize caries prevention should automatically consider the use of sugar substitutes. It is important that public health authorities are made cognizant of the availability of new polyol-type sugar substitutes.

REVIEW SUMMARY

Clinical studies have shown that xylitol, a natural, physiologic sugar alcohol of the pentitol type, can be used as a safe and effective caries-limiting sweetener. Habitual use of xylitol-containing food and oral hygiene adjuvants has been shown to reduce the growth of dental plaque, to interfere with the growth of caries-associated bacteria, to decrease the incidence of dental caries, and to be associated with remineralization of caries lesions. Numerous public regulatory bodies have endorsed the use of xylitol as a caries-limiting agent. Other sugar alcohols that have been successfully used as sugar substitutes include D-glucitol (sorbitol), which, however, owing to its hexitol nature, normally has no strong effect on the mass and adhesiveness of bacterial plaque and on the growth of mutans streptococci. A tetritol-type alditol, erythritol, has shown potential as a non-cariogenic sugar substitute. Combinations of xylitol and erythritol may reduce the incidence of caries more effectively than either alditol alone.

CONCLUSIONS

Partial sugar substitution with polyols is an important dietary tool in the prevention of dental caries that should be used to enhance existing fluoride-based caries prevention programmes. The most effective method of conveying this information to the public is through a proper health claim for these alditols in food labelling. The present review summarizes clinical and biochemical aspects of the above three dietary polyols and emphasizes the role of sugar substitution as a potential health-promoting strategy.