25 April 2022

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Role of sugars and other sweeteners in the maintenance of the dental health

Authors: Giuliana Bontà, Guglielmo Campus, Laura Strohmenger, Maria Grazia Cagetti

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Diet could affect the homeostasis of hard dental tissues through sugars and other fermentable carbohydrates intake. This substances are metabolized into acids by the action of the cariogenic plaque bacteria and cause a decrease in pH with the loss of mineral salts from the enamel and dentin. Frequent intake of sugars also creates a favorable environment for multiplication of acidic bacteria.

Caries is a disease caused by the dissolution of the tooth mineral tissues produced by the acid derived from bacterial metabolism of carbohydrates. The two bacterial species mainly involved in this phenomena are oral streptococci, in particular Streptococcus mutans, and lactobacilli.

The European Food Safety Authority (EFSA) has defined the reference values for nutrition supplements that need to be taken to enjoy good health for different ages and gender. As regard sugars, the European Authority affirms that frequent consumption of high sugary foods increases the risk of tooth decay and contributes to body weight increase.

MATERIALS AND METHODS
The present review of the literature took into consideration the scientific papers selected from PubMed database without any time limit, using the keywords “carbohydrates, polyols, intensive sweeteners, stevia, dental caries” used as single words and in association with each other.

RESULTS
Sugars are present in foods in two forms: those naturally contained in foods such as fruit, honey and dairy products and those added to foods during processing to alter their flavor or consistency. Sweeteners can be classified into carbohydrates, sugar alcohols and high intensity sweeteners. While mono and disaccharides are fermented by cariogenic bacteria with production of acids that increase caries risk, sugar alcohols inhibit the metabolic activity of cariogenic microorganisms. No effect on caries is reported for high intensity sweeteners.

The duration of exposure and the persistence of sugary foods in the oral cavity cause prolonged periods of acid production and consequent demineralization. The life of different foods in the oral cavity can vary considerably.

DISCUSSION AND CONCLUSIONS
Simple carbohydrates are an important source of nutrition for the body; however, their excessive consumption increases the risk of developing systemic and oral pathologies. Sugar substitutes, natural or synthesized, can help to reduce the incidence of caries in adults and children. However, their use is subjected to certain restrictions.

CLINICAL SIGNIFICANCE
Diet has a primary role in maintaining the health of the entire body, including the oral cavity. It is a common tendency to select foods following the emotions of pleasure or rejection that they pass through smell, sight and taste. Research indicates that sweet is the taste first known by infants, however, the use of free sugars must be limited both in terms of quantity and frequency of intake.