1. Presented by : - Dr. Piyush Verma MDS 2 nd yr Dept of Pedodontics 1

2. 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

3. 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

4. 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

5. Common sugars 5

6. Digestion & absorption of sugars 6

7. 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

8. On food label, sugars can be listed by many names Food high in sugars if one of these names appears 1 st or 2 nd in the ingredients list, several names appear in list 8

9. 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

10. Natural sugars vs. Added sugars 10

11. 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

12. 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

13. 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

14. 14 Nutritive sweetenersNon nutritive sweeteners High Fructose Corn syrups Aspartame Coupling sugars Saccharin Glucose Cyclamate Dextose Acesulfame potassium Lactose Sucralose Maltose Neotame & Tagatose Polyols Dulcin

15. 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

16. 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

17. 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 consistent & stable for product’s shelf life 17

18. 18

19. 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

20. 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

21. 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

22. 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

23. 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

24. Classification of polyalcohols Sorbitol Xylitol Mannitol Maltilol Erythritol Lactilol Isomalt Hydrogenated starch hydrolysates (Lycasin) 24

25. 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

26. 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 their cariogenicity ( Cornick & Bowen, 1980) 26

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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  2 nd group – 38 subjects, sucrose entirely substituted by fructose  3 rd 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

34. 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

35. 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

36. 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

37. 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

38. Lycasin  They are used as bulk sweeteners in confectionery products.  75-90% of sweetness of sucrose  Provides 3.0 cal/g 38

39.  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

40. 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

41. 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

42. Advantage of Lycasin  Metabolism is slow – less caries Disadvantages of lycasin  Headache  Bitter metallic after taste 42

43. 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

44.  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

45.  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

46. 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

47. 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

48. 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  Cannot be metabolized by oral bacteria 48

49. 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

50. 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

51. 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

52. 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

53. 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

54. 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  Brand names – Nutrasweet, Equal 54

55.  (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

56. 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

57. 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

58. 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

59. 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

60. 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

61. Benefits  Calorie free  Pharmcologically inert & is stable under moist conditions encountered in food preparations  Heat stable 61

62. 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

63. 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

64. 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

65. 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

66. 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

67. Currently banned in USA by FDA Still on hold in several Latin American & European countries & restricted in use in Canada 67

68. 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

69. 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

70. 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

71. 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 S. mutans growth when added to xylitol. 71

72. 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

73. 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

74.  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

75. Advantages  Rapidly metabolized & excreted  Heat stable  Nutritive value – 0 calories  Doesnot contribute to tooth decay 75

76. 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

77. Other sweeteners derived from plants 77

78. 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

79. 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

80. 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

81. 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

82. 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

83. 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 sweetening agent 83

84. 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

85. 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

86. 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  In some cases samples became putrified 86

87. 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

88. 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

89. Metabolism & energy production of sugar substitutes Sugar substitutes Ingestion Large intestine Fermentation Short chain fatty acid Enzymatic degradation Energy production 89 Oku T et al. Digestion, absorption, fermentation & metabolism of sugar substitutes. Pure Appl Chem, 2002; 74(7): 1253-61

90. FDA approved sweeteners High Fructose Corn syrups (HFCS) Aspartame Saccharin Acesulfame K Neotame & Tagatose Sucralose Polyols Stevia 90

91. FDA disapproved sweeteners Cyclamate Dulcin 91

92. 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

93. References Gordon Nikiforuk, Understanding Dental caries, Etiology & mechanisms, Vol 1 Newbrun, Cariology, 1 st edition Fejerskov, Dental caries, The disease & its clinical management Shobha Tandon, Textbook of pedodontics, 2 nd edition MS Muthu, Pediatric Dentistry, 2 nd edition 93

94. 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

95. 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