I recently had a question from a dental hygienist regarding the increased prevalence of artificial sweeteners in our food supply and what recommendations one might make regarding these. This struck me as an incredibly great question, so let’s dive into it:
First, let’s differentiate between nonnutritive sweeteners or intense sweeteners and nutritive sweeteners or bulk sweeteners. Nonnutritive sweeteners, provide no caloric value, and require very little volume to achieve sweetness, such as aspartame and saccharine. Comparatively nutritive sweeteners have less calories than ‘real sugar’, sucrose, but still contain calories like xylitol and sorbitol.
Both nonnutritive and nutritive sweeteners are not readily metabolized by oral microorganisms, therefore individually they are not considered cariogenic, or thought to generate cavities. However, these sweeteners may be in food sources that have other ingredients that could contribute to dental erosion, such as phosphoric acid in many common sodas both the regular or diet sugar substitute containing versions.
Nutritive sweeteners, specifically xylitol, do have research to support their role as non-cariogenic, specifically the role of xylitol containing chewing gums. However, sugar alcohols like xylitol and sorbitol are only partially absorbed in the small intestine and could induce diarrhea, especially in larger quantities. And it is recommended for children 3 years of age or younger to avoid food and beverages continuing these, for this reason.
While now we can understand that sugar substitutes might play a role in dental health, specifically on cariogenesis, we must look holistically from the nutritional, economic, and realistic perspective. From a nutrition angle, we know sugar substitutes could offer lower calorie options for those wanting to be in a caloric deficit, but have some sweeter foods. We also know that that sucrose containing foods can be part of a balanced diet, and removing or replacing all sucrose containing foods with artificial sweeteners, could impact the adequacy of our nutrition, and potentially have impacts on our not only our gut microbiome but the potential adaptations of our oral microbiota. Additionally, from an economic view, sugar substitutes often cost more than traditional sugar, and may have limitations in the way they are used in baking or cooking. Lastly, from a realistic implementation perspective, sugar substitutes simply taste different than sugar. In some items, this may be really noticeable like our favorite dessert, but in some things it may be preferable or even unnoticeable such as an xylitol chewing gum compared to a traditional sugar containing gum.
Take into consideration these facts, along with what your routine diet looks like, and consult with your healthcare team including your dentist, dietitian, primary care provider for support on balancing your dental, nutrition, and physical health.
And while today we’ve discussed sugar substitutes that have been on the market for decades, in our next article we will discuss sugar substitutes that many describe as more ‘natural’ such as stevia and monk fruit. Stay tuned for more!
References:
Gupta P, Gupta N, Pawar AP, Birajdar SS, Natt AS, Singh HP. Role of sugar and sugar substitutes in dental caries: a review. ISRN Dent. 2013 Dec 29;2013:519421. doi: 10.1155/2013/519421. PMID: 24490079; PMCID: PMC3893787.
Roberts MW, Wright JT. Nonnutritive, low caloric substitutes for food sugars: clinical implications for addressing the incidence of dental caries and overweight/obesity. Int J Dent. 2012;2012:625701. doi: 10.1155/2012/625701. Epub 2012 Feb 22. PMID: 22505906; PMCID: PMC3296175.
