Sugar substitutes

Presented by : -
Dr. Piyush Verma
MDS 2nd yr
Dept of Pedodontics

1
 Index
 Introduction
 Sugars
 List of common sugars
 Digestion & absorption of sugars
 Amount of sugars in food products
 Sugar related label claims
 Natural vs. added sugars

 Sugar substitutes
 Need for sugar substitutes
 Ideal requirements
 Nutritive sweeteners
 Non nutritive sweeteners
 Sweeteners derived from plants
 Conclusion
 References
2
 Introduction
Sugar (sucrose) being most acceptable sweetening agent is
considered as the “arch criminal “ in dental caries
initiation

Search for suitable sweetening agent that satisfies all the

characteristics of sugar along with being non- cariogenic is
going on since decades

Till date, no such substitute replaces sugar in all aspects

but cariogenic potential can certainly be reduced

3
What are sugars
Simple carbohydrates or simple sugars 1 or 2 sugar
units
Complex carbohydrates contains hundreds of simple
sugar
Sugars are added to foods during manufacturing,
cooking or at mealtime
Provide 4 kilocalories/gm
Glucose perfect fuel for brain & primary fuel for
muscles

4
Common sugars

5
Digestion & absorption of sugars

6
 Amount of sugar in a food product
Sugar is listed under total
carbohydrate

Includes both naturally

occuring & added sugars

Names in ingredients section

help to identify sugar in a
product

7
On food label, sugars can be
listed by many names

Food high in sugars if one of

these names appears 1st or 2nd in
the ingredients list, several
names appear in list

8
Sugar related label claims
Sugar free – Less than 0.5 gm
sugar/serving

Reduced sugar – sugar content

reduced by atleast 25%

No sugar added -- No sugar or

any ingredient containing sugar
has been added

9
Natural sugars vs. Added sugars

10
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

Nutritive sweeteners – provide some calories

Non nutritive sweeteners – provide zero calories

11
Need for sugar substitutes
Replaces sucrose in the food stuff which are proved to
be highly cariogenic

Required for diabetic patients for tasty diet

12
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

13
Nutritive sweeteners Non nutritive sweeteners

High Fructose Corn syrups Aspartame

Coupling sugars Saccharin

Glucose Cyclamate

Dextose Acesulfame potassium

Lactose Sucralose

Maltose Neotame & Tagatose

Polyols Dulcin

14
Nutritive sweeteners :
 Sugar sweeteners –
 High fructose corn syrups
 Glucose
 Dextrose
 Lactose
 Maltose
 Coupling sugars : glycosylsucrose

 Reduced energy polyols/sugar alcohols

 Sorbitol
 Xylitol
 Maltilol
 Mannitol
 Hydrogenated starch hydrolysates (HSH)
15
High fructose corn syrups (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
 Relative sweetness is comparable to sucrose

16
Role of HFCS in foods
 Baked goods – give a brown crust, enhances
flavour in fruit fillings
 Yogurt – enhances flavor, controls moisture,
regulates tartness
 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 ,flavors remain
17
18
Limitation of HFCS
 Obesity
 White JS, 2008 - A diet high in HFCS can lead to
taking in more calories Obesity

 Zeratsky K et al (2008), Travis J et al (2009) -

indicated a link between increased consumption
of sweetened beverages containing HFCS & obesity

19
HFCS & dental caries
 Rolla G et al, 1985 – Glycosyltransferase uses
sucrose in HFCS to produce extracellular glucans ,
facilitates dental plaque adherence to enamel surface

Frostell et al, 1991 – HFCS donot cause any

production of extracellular polysaccharides in the oral
cavity & cariogenicity is slightly less than that of sucrose

20
Coupling sugars : glycosylsucrose

 General term for oligosaccharides derivatives of

sucrose

 Mixture of monosaccharides, glucosylsucrose,

maltosylsucrose & oligosaccharides

 Obtained when cyclodextrin glucosyltransferase

acts on a mixture of starch & sucrose

 Sweetness is about 50 – 60% that of sucrose 21

Advantages of Coupling sugars
 Relatively cheap
 Resistant to heat
 Suitable for baking & cooking
 pH stable, doesnot cause diarrhea ( Yamada T et al, 1985)
 Acid production is much less as compared to glucose &
sucrose ( Yamada T et al, 1989)
 Permits very little synthesis of insoluble glucan ( Ikeda T
et al, 1992)

22
 Polyalcohols
 Carbohydrates whose chemical
structure partially resembles a sugar &
partially resembles a alcohol

 Occurs naturally in berries

 Most are half as sweet as sucrose

 Slowly & incompletely absorbed from

small intestine

 May cause abdominal gas or GI

discomfort
23
 Classification of polyalcohols

Sorbitol
Xylitol
Mannitol
Maltilol
Erythritol
Lactilol
Isomalt
Hydrogenated starch hydrolysates (Lycasin)

24
 Sorbitol
 Prepared from glucose by hydrogenation.
 About one half as sweet as sucrose.
 Slowly and incompletely absorbed from the
intestine
Following absorption dietary sorbitol is oxidized to
fructose by sorbitol dehydrogenase and further
metabolism is same as fructose.
 1 gm sorbitol 4 calories
 Recommended intake by Food & Agricultural
organization ( WHO) 150mg/kg/day
25
Microbial metabolism of sorbitol:
 Most oral microorganisms lack the enzymatic
makeup to utilize sorbitol.

 An important exception is S.mutans.

 The slow rate of fermentation of sorbitol allows acid

to diffuse out of plaque at a rate of almost equal to
the rate of formation ( Makinen & Virtanen, 1978)

 The utilization of sorbitol by microorganisms

provide them with substrate that may contribute to
their survival but does not directly contribute to 26
Dental aspects of sorbitol

 Birkhead et al ( 1980) – When sorbitol applied to dental

plaque, very little alteration of the pH takes place

 Few clinical trials of sorbitol products indicated a

moderate caries reduction from gum chewing ( Moller &
Poulsen, 1989)

 (Banoczy et al, 1992)- a substantial reduction in DMF

teeth, when sorbitol-containing chocolate was compared
to an equal intake of sucrose containing chocolate
27
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

28
 Xylitol
Pentilol sugar alcohol with 5 carbons

Occurs widely in fruits & vegetables

Has sweetness similar to sucrose & a cooling effect

in mouth

Provides 2.4 cal/g

29
Metabolism of xylitol by oral
microorganisms

 Cariogenic microorganisms do not metabolize

xylitol and consuming xylitol does not decrease
plaque pH.
 Replaces sucrose by a non-metabolized substance
thus prevents acid production by plaque
 Alters the oral flora by starving those organisms
which thrive best on sucrose
 Thus, Xylitol can be described as non-cariogenic
but not anticariogenic 30
 Non-cariogenic mechanism of action of
xylitol
Primary mechanism of action inhibition of glycolytic
cycle

 Bacteria ingest xylitol, they are unable to metabolize it

Reduced lactic acid production

Less challenge to teeth

31
Dose for anticaries effect

 Intake of xylitol has to be at least 5-10g/day in 3-7

consumption period, have an anticaries effect ( Isokangas
et al, 1988 ; Peterson & Razanamihaza, 1999 ; Alanen et al,
2000 ; Makinen et al, 2000 ; Machiulskiene et al, 2001)

32
Mouton et al, 1975 -- Weight of wet fresh plaque was
reduced by about 30-55% in human studies where xylitol was
substituted for sucrose

Scheinin et al, 1975 – 2 yr period study, carried out in Turku,

Finland
 Population consisted of 125 subjects, mean age of 27.6 yrs
 1 group– 35 subjects, receiving normal sucrose containing
diet
 2nd group – 38 subjects, sucrose entirely substituted by
fructose
 3rd group – 52 subjects, sucrose entirely substituted by xylitol
 Reduction in 85% of frank clinical lesions & radiographic
caries were reported for xylitol group, 30% for fructose group
as compared with sucrose 33
Maniatopoulos ,1983 -- 5% xylitol did not increase or
decrease caries when added to a starch diet & did not
depress growth rate

Schoolchildren in the Ylivieska study (Isokangas et al.,

1988) were randomly divided into two test groups

xylitol gum Control group

which chewed no gum.

Concluded that xylitol gum, used two to three times/day

in combination with basic fluoride prevention, constitutes
a strong instrument in caries prevention.
34
Soderling et al( 1989) compared effects of sorbitol,
xylitol & a mixture of sorbitol & xylitol in chewing
gums, in adults. Plaque & salivary levels of S Mutans
increased in Sorbitol group but decreased in 2
groups using Xylitol.

Svanberg & Birkhead ( 1991) – Reduced level of MS

in saliva when 10-20% xylitol was added to fluoride
dentifrice

35
When xylitol consumed frequently & for a long period ,
metabolism of dental plaque found to be altered less
acid production Aguirre Zero et al (1993)

Alanen et al, 2000 (Estonia) -- demonstrated that a

supervised use of both xylitol containing candy & chewing
gums reduced caries incidence in school children
compared with corresponding control group

Habitual xylitol consumption by mothers over years may

reduce mother-child transmission of MS Soldering et al
(2001)

36
Advantages of xylitol
 Non-cariogenic
 Has been used by diabetics– metabolism is insulin independent
(Forster, 1974)
 Can be used as a source of energy in intravenous nutrition as
tissues can use xylitol under postoperative & post traumatic
conditions (Georgieff et al, 1985)

Disadvantages of xylitol
 Absorption is slow & incomplete
 Osmotic diarrhoea in high doses– 30-60 gm
37
 Lycasin
They are used as bulk
sweeteners in confectionery
products.

75-90% of sweetness of
sucrose

Provides 3.0 cal/g

38
 Lycasin is a hydrogenated starch hydrolysate.

 Produced from
 potato or
 corn starch
 by partial acid or enzyme hydrolysis and subsequent
hydrogenation at high pressure and high temperature.

 Thus the final product contains a mixture of hydrogenated

mono-, di-, tri- and tetrasaccharides and higher chain
length hydrogenated saccharides.
39
 Reynolds et al, 1972-- Its caloric value is similar to that of
other carbohydrates but like sorbitol its metabolism is
slow when compared to that of glucose

Frostell et al, 1974-- The effect of substituting sucrose by

Lycasin in candy on the caries prevalence of primary
teeth of children was tested and found 25% overall caries
reduction

40
Infed & Muhlemann, 1978 – Hard sugared
confectionery sweetened with Lycasin with a high
content of maltilol & a low content of higher
saccharides cause a relatively small decrease in plaque
pH

Grenby TH et al, 1988 – included Lycasin in diets fed

to caries active Osborne-Mendel rats for periods upto
8 weeks. Reduction in caries scores were 72%

41
Advantage of Lycasin
 Metabolism is slow – less caries

Disadvantages of lycasin
 Headache
 Bitter metallic after taste

42
Maltitol and
Mannitol

 Maltitol is a 12-carbon polyol,

produced by hydrogenation of
maltose. Cannot be metabolized by
most oral micro-organisms.

 Provides 2.1 cal/g

43
 Birkhead et al, 1979 – Maltilol lozenges eaten 4 times a
day for 3 months did not affect plaque formation, acid
production or no. of S.mutans & lactobacilli in plaque

 Ooshima T et al, 1992 - The effect of maltitol on caries

development in experimental rats. Maltitol induced no
significant dental caries in rats and replacement of the
dietary sucrose content with maltitol resulted in a trend
towards caries reduction in rats.

 Thabius et al, 2010– noted when maltilol gums were

chewed for 7 days, 7 times a day for 5 minutes between
regular meals, caries incidence was reduced
44
Mannitol , like sorbitol, is a hexitol.
 50% as sweet as sucrose

It is industrially prepared by hydrogenation of invert

sugar, sucrose or monosaccharides.

Provides 1.6 cal/g

45
Deshpande E et al, 2008 -- The impact of mannitol
containing chewing gums on dental caries mannitol
containing chewing gum can be used as part of normal oral
hygiene to prevent dental caries.

Lee EJ et al, 2009 – investigated the preventive effect of

chewing gum containing mannitol, xylitol, gum base, and
sugar on remineralization. Mannitol and xylitol gums were
more effective in remineralization than sugar gum.

46
Advantages of mannitol & maltilol
 Reduced-calorie sweetener
 Non hygroscopic
 Provides sweetness with a clean, cool pleasant taste
 May be a useful alternative sweetener for people with
diabetes
 Does not contribute to the formation of dental caries

47
Erythritol
 Sugar alcohol found naturally in pears, lemons, mushrooms &
fermented foods

 60-70% as sweet as sucrose

 Produced commercially since 199o, can be used in foods same way as

other polyols

 Provides 0.2 cal/g

 Completely absorbed from GIT & excreted unchanged in urine

( Munro, 1998)

 Unlikely to have a laxative effect

48
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

49
Benefits of lactilol
 Highly stable, can be used in baking
 Promotes colon health as a prebiotic
 Laxative and is used to prevent or treat constipation

Drawbacks of lactilol
 Cramping, flatulence & diarrhoea

50
Isomalt
 Type of sugar alcohol, used primarily for its sugar-like physical
properties

 Sweetness potency 50% that of sucrose

 Provides 2.0 cal/g

 Doesnot promote tooth decay

 Carries a risk of gastric distress, including flatulence and diarrhea,

when consumed in large quantities

 Advised to not be consumed in quantities larger than about 50 gm

per day for adults and 25 gm for children.
51
Polyols digestive issues
 Polyols are not efficiently absorbed & metabolized by
humans

 When consumed in large quantities, unabsorbed &

unmetabolized materials can have a variety of effects when
they reach intestine

 Symptoms may range from

 Borborygms
 Flatulence
 Abdominal pain
 Diarrhoea
52
Non-nutritive sweeteners
 Compounds are many time sweeter than sucrose

 Provide sweetness with little or no caloric value

 Compounds are added to confections & food products in

such small amounts that they cannot provide bulking
properties of sucrose

 Successfully used in gelatin desserts, pudding, dessert

toppings, soft drinks, chewing gum, mouthwashes etc.

 Not fermented to acid by oral bacteria, cannot lower pH

of plaque 53
 Aspartame
 Combination of amino acids Aspartic acid
& Phenylalanine

 It is about 180-200 times sweet as sucrose

 Caloric value of 4 cal/gm, similar to

proteins & carbohydrates

 Consumed in small amounts, so negligible

caloric contribution

 Effective in enhancing acid fruit flavors &

extending sweet taste as in chewing gums

54
 (FDA, 1981) -- Aspartame and products must carry a
notice that the products contain phenylanine, this
helps the persons with phenyl ketonuria to limit their
intake of phenyl alanine

55
Dental aspects of aspartame

 Bowen WH, 1975 – aspartame reduced smooth surface

caries

 Olson, 1977 – presence of 0.045 & 0.09% aspartame in a

growth medium reduced adherence of S. mutans to
nichrome wires when incubated with sucrose for 5 days

 Lout RK et al, 1988 – tested cariogenicity of frequent

aspartame (0.05%) and sorbitol (20%) rinsing in
laboratory rats. Rinsing with 0.05% aspartame or sorbitol
did not potentiate caries activity.
56
Das S et al, 1991 – tested aspartame for its
cariogenicity alone & in the presence of sucrose, in
rats. In animals fed aspartame only, there was no
caries. The S. mutans counts were high in the
animals receiving sucrose diets with and without
aspartame

Abbas S et al, 2008 – the effect of aspartame on the

antimicrobial activity of CHX against S.mutans
Concluded At conc. of 4%,8%,12% & 16%, aspartame
did not significantly inhibit the antibacterial activity of
0.2% CHX.
57
Advantage of aspartame
 Addition to foods result in sweetness equivalent to that
obtained from sucrose & reduce calories by over 95%

Disadvantages of aspartame
 Unstable at high heat, should not be used in cooking &
baking ( FDA, 1981)
 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)

58
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 bitter after
taste

 Excretes almost quantitatively without

metabolic alteration, 75% - 90% of it in urine

 Brand name – Sweet ‘N Low & Sugar Twin 59

Dental aspects of saccharin

 Strasser PH et al , 1980 -- Saccharin (0.5%) when used as

a supplement of cariogenic diet (56% sucrose),
significantly reduced both pit & fissure & smooth surface
caries in rats, by interfering with growth of S. mutans

 Tanzer JM et al, 1984-- Caries reduction were associated

with initially reduced recovery of S. mutans soon after
saccharin supplementation begins

 Kohn JS et al, 1990 -- Saccharin has an inhibitory effect

on Glycolytic Enzymes in Cell-Free Extracts of S.mutans
60
Benefits

 Calorie free

 Pharmcologically inert & is stable under moist conditions

encountered in food preparations

 Heat stable

61
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
155lb person)
 Reuber MD, 1977 – experimental group of rats which had 5%
saccharin in their diet had higher incidence of bladder cancer
than control rats
 Howe et al, 1977 -- Study on hospitalized patients with
bladder cancer & neighborhood controls, risk of bladder cancer
was 60% higher among men who had used saccharin tablets
 Banned in Canada & USA
62
 Walker et al, 1982 -- No association was found between
the use of saccharin & risk of bladder cancer

 Salant A et al , 1989 – Bladder tumors found in rats were

related to a mechanism in rats not found in humans

 No longer listed as potential cancer causing agent, warning

label has been removed

63
Cyclamate

 30 times as sweet as sucrose

 Economic, 10 cents worth of cyclamate would provide

same sweetening effect attained by $ 1 worth of sucrose

 In 1969, 17 million pounds of cyclamate were

consumed in USA in beverages, dietetic foods & table
products

64
Legator et al, 1969 – In man, cyclamate is converted to
cyclohexylamine by microorganisms in lower intestinal tract ,
can produce vasoconstrictor & hypertensive effects by its effect
on sympathetic nervous system

Legator et al, 1971 – Straight line relationship exists between

dose concentrations & chromosomal aberrations in bone
marrow & sperm cells in rats

 Similar chromosomal breaks observed in human leucocytes,

skin & cancer cells in vitro

65
Stone R et al , 1975 -- Reported, cyclamate
induce bladder cancer in rats when embedded
with cholesterol in their bladders

Russell J et al, 1992 -- compared pH changes in

plaque after rinsing with sucrose & sugar free
cyclamate containing solutions. Plaque pH value
fall below 5.7 for 1 hr after rinsing with sucrose
solution, no mean pH value was below 5.8 with
sugar free solution of cyclamate
66
Currently banned in USA by FDA

Still on hold in several Latin American & European

countries & restricted in use in Canada

67
Acesulfame
Potassium ( Ace K)
 Combination of organic acid &
potassium
 200 times sweeter than sugar
 First approved by FDA in 1988
as a table top sweetener
 It was then approved for use in
beverages by FDA, 1988
 Approved for general use in
foods, but not in meat & poultry
in December 2003 by FDA
 Brand names – Sunett & Sweet
one
68
Frostell G et al, 1989 – Acesulfame K inhibits the growth
of S. mutans to decrease acid formation from sucrose

Advantages
 Calorie free
 No evidence of carcinogenicity, mutagenicity,
cytotoxicity & teratogenicity
 Excellent shelf life
 Rapid & almost complete absorption

Disadvantages
 Slightly bitter after taste
69
Sucralose
 Non- nutritive, non caloric derivative
of sucrose

 600 times sweeter than sucrose

 Non metabolized by body

 Widely used throughout the world in

tea, coffee, carbonated & non-
carbonated beverages, chewing gums
etc.
 Brand name - Splenda 70
Dental aspects of sucralose

Bowen WH et al , 1992 – determined the effects of

sucralose, xylitol, and sorbitol on remineralization of
caries lesions in rats. Animals receiving sucralose,
xylitol, sorbitol, or distilled water had fewer lesions

Mandel ID et al, 2002 -- studied the effect of sucralose-

containing solutions on human plaque pH.
Demonstrated that sucralose is non-cariogenic.

 Hogan A, 2010 – studied the effect of mixture of Splenda

and Xylitol on the Growth of Streptococcus mutans.
Concluded Splenda, resulted in a greater inhibition of 71
Advantages
 Non-cariogenic
 Calorie free
 Heat stable
 Can be used in baking
 No health concerns has been reported
 Nutritive value – 0 calories

Disadvantages
 Diarrhoea
 Dizziness
 Stomach pain

72
Neotame & Tagatose
 Neotame
 Newest of the low calorie sweeteners

 Approved by FDA in 2002 as general purpose sweetener

 Approx 7000 times sweeter than sucrose

 Intense non-nutritive sweetener not fermentable by the

oral micro biota

 Possess a crisp, clean taste with no detectable aftertaste

73
Tagatose
 Low calorie sweetener derived from lactose
 Recently approved by FDA in 2001
Improves blood sugar control in diabetics
 Donner TW et al, 1999 -- have benefits treating
non-insulin dependent diabetes as it attenuates
rise of serum glucose after oral glucose intake
 Levin GV et al, 2002 -- Excessive consumption
can lead to mild intestinal discomfort, flatulence &
diarrhea

74
Advantages
 Rapidly metabolized & excreted
 Heat stable
 Nutritive value – 0 calories
Doesnot contribute to tooth decay

75
Dulcin
 First synthesized in 1883
 250 times as sweet as sucrose
 Was once employed as a noncaloric sweetening
agent
 Kandelman D et al, 1890 -- Dulcin was toxic to
experimental animals after prolonged consumption
because of amino-phenol produced in vivo
 Prohibited in USA & UK

76
Other sweeteners derived from plants

77
Stevia Rebaudiana ( Stevia)

 Made from extract of stevia plant

( perennial shrub from South Africa)

 Upto 300 times sweeter than sucrose

 Not absorbed by the body

 Calorie free, non-cariogenic

 Heat stable

 Brand names – Pure Via, Truvia

78
Sichani MM et al, 2012 – studied the effects of extract
of stevia rebaudiana leaves on S.mutans growth.
Concluded that acetone & ethanol extracts of
S.rebaudiana leaves showed highest activity against S.
mutans

Further research on this plant , its pharmacological &

its uses in foods implications is still going on

79
Advantages of Stevia
 Cheap and is more economical to produce sugar from it
 Helps to make a control over diabetes
 Make a control on the blood pressure
 Heat stable

80
Agave ( Nectar/ syrup)

 Made from the extract of wild agave

 25% sweeter than sugar

 56 calories/tablespoon

 Low glycemic index – Absorbed slowly

 Heat stable

 Brand name -Xagave

81
Advantages of agave
 Sweeter than regular sugar
 Has low glycemic index
 can be used in recipe including baked goods &
desserts
 Doesnot affect the flavor of beverages
 Dissolves easily

82
Licorice ( Ammoniated
Glycerhizin)

 Well known flavoring agent obtained from

roots of a small shrub grown in Central Asia
& Europe

 50 times as sweet as sucrose

 Has excellent foaming, flavoring

reinforcement properties

 Used in beverages, desserts, dentifrices &

pharmaceutical preparations

 Its licorice flavor restricts its use as a 83

King AG, 2006 -- natural products isolated from licorice
root, inhibit the bacteria associated with dental cavities.

Peters MC et al, 2010 – determined the clinical effect if

licorice root extract lollipop at reduction of S.mutans.
Concluded twice daily use of herbal licorice lollipop
for 22 days, significantly reduced relative percentage of
S.mutans

Mentes JC et al, 2012 – examined effect of herbal

lollipop containing licorice on S.mutans. There was a
trend toward reduction of S. mutans with consumption
of more lollipops during the 21-day period.

84
Miraculin ( Miracle fruit)
 Shrub grown in West Africa produces
berries that have property of causing sour
foods to taste sweet

 Active ingredient (miraculin)is a

glycoprotein with a molecular weight of
about 42,000

 Macromolecules participate in taste

modification & taste perception

 Because manufacturers were unable to

document claims of efficacy in weight
control, miraculin has been withdrawn from
market in USA 85
Monellin ( Serendipity
berries)

 Grape like red berry clusters of

serendipity plant indigenous to Africa

 Intensely sweet, 3000 times as sweet as

sucrose, Sweetest natural product known

 Sweet sensation persists in mouth for

unusual length of time

 Loses its sweetness within about a day, if

left standing at room temperature
86
Dihydrochalcone sweeteners

 Bitter substances present in citrus fruits, eg: naringin in

grapefruits, neohespiridin in oranges

 Bitterness is replaced by sweet taste by hydrogenation in an

alkaline solution

 Sweetness is relatively slow in onset & lingering

 Stable over a broad range of temperature in aquous solution

& in acids at room temperature

 Useful in fruit & carbonated beverage products 87

Dental aspects

 Gustafsson et al, 1968 – Naringin (0.2%) when used as a

dietary supplement, significantly reduced caries in hamsters

 Stralfos A et al, 1970 – No significant inhibition in caries was

found

 Thomson et al, 1989 -- when it was fed to rats, causes

significant reduction in caries

88
Metabolism & energy production of sugar
substitutes
Sugar substitutes

Ingestion

Large intestine

Fermentation

Short chain fatty acid

Enzymatic degradation

Energy production
Oku T et al. Digestion, absorption, fermentation & metabolism of sugar substitutes.
Pure Appl Chem, 2002; 74(7): 1253-61 89
FDA approved sweeteners
High Fructose Corn syrups (HFCS)
Aspartame
Saccharin
Acesulfame K
Neotame & Tagatose
Sucralose
Polyols
Stevia

90
FDA disapproved sweeteners
Cyclamate
Dulcin

91
Conclusion
Although a fascinating variety of sweet chemicals exist
most have no practical use because they do not satisfy
all of the ideal requirement of sugar substitutes
Availability of variety of safe
sweeteners is of benefit to consumers because it
enables food manufacturers to formulate a variety of
good-tasting sweet foods & beverages that are safe for
the teeth & lower in calorie content than sugar-
sweetened foods

92
References
Gordon Nikiforuk, Understanding Dental caries,
Etiology & mechanisms, Vol 1
Newbrun, Cariology, 1st edition
Fejerskov, Dental caries, The disease & its clinical
management
Shobha Tandon, Textbook of pedodontics, 2nd
edition
MS Muthu, Pediatric Dentistry, 2nd edition

93
Grenby TH. Dental effects of Lycasin in the diet of
laboratory rats. Caries Res 1988;22(5):288-96.
Roshan NM, Sakeenabi M. Practical problems in use of
sugar substitutes in preventive dentistry. JISPPD 2011;1(1):
1-8
Marshall TA et al. Dental caries & beverage consumption
in young children. Pediatrics 2003;112:e184
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
reviews in food science & food safety 2006(5): 35-47
94
Peters MC et al. Clinical reduction of S.mutans in pre-
school children using a novel liquorice root extract
lollipop: a pilot study . European archives of Pediatr
Dent 2010; 11(6):274-278
Sichani MM et al. Effect of different extracts of stevia
rebaudiana leaves on S.mutans growth. J. Med. Plants
Res 2012; 6(32): 4731-434
AAPD. Policy on the use of xylitol in caries prevention.
Reference manual; 34(6): 45-47
Oku T et al. Digestion, absorption, fermentation &
metabolism of sugar substitutes. Pure Appl Chem,
2002; 74(7): 1253-61

95