Nutritional and Health Aspects of Sweeteners - Sweeteners: Nutritional Aspects, Applications, and Production Technology - page 339

The mean number of teeth present (NoT) was 24.2, and the mean numbers of sound teeth (ST), illed
teeth (FT), and decayed teeth (DT) were 10.8, 12.1, and 1.1 for men and 9.6, 13.8, and 0.5 for women,
respectively. The consumption of sugar-sweetened beverages (SSBs) was more frequent than other
sugar-containing products and greater in men than in women. Daily use of xylitol chewing gum
was reported by 13% of the men and by 22% of the women. Tooth brushing at least twice daily was
reported by 47% of the men and by 79% of the women; 86% and 96%, respectively, reported daily use
of luoride toothpaste. The frequency of consumption of sugar- and xylitol-containing products and
of tooth brushing, as well as the use of luoride toothpaste, play a role in the dental health of dentate
adults, with the impact being weak on NoT, ST, and FT but stronger on DT, especially concerning
tooth brushing frequency (relative risk = 1.5) and the use of luoride toothpaste (relative risk = 1.8).
The authors concluded that understanding the impact of certain oral health-related behaviors on
dental health in adults may lead to better targeting of oral self-care messages (Tseveenjav et al.
2011).
In an attempt to replace sugar in the diet, certain substances that may possess noncariogenic
or anticariogenic properties have been used. Grenby (1991) analyzed the factors that have to be
considered when developing low-calorie sweeteners to replace sugar in the diet, for the beneit of
dental health. He explained that the choice of low-calorie sweeteners with improved characteristics
is expanding, with particular attention being paid to calorie control, dental health improvement, and
developing an appealing range of foods and drinks. The use of polyol-based gum (i.e., xylitol based)
can reduce the risk of dental caries compared to sucrose-sweetened gum (Makinen et al. 1995).
Sugar alcohols (e.g., sorbitol, mannitol, and xylitol) do not promote tooth decay according to an
authorized health claim in food labeling by the Food and Drug Administration (FDA; 2006). The
Turku Study, which was a controlled dietary intervention in Finnish adults, showed that almost total
substitution of sucrose in the diet with xylitol (a noncariogenic sweetener) resulted in an 85% reduc-
tion in dental caries over a 2-year period (Scheinin et al. 1976). Similarly, nonnutritive sweeteners
do not promote dental caries (American Dietetic Association 1998). Moreover, sucralose does not
promote dental caries according to the FDA (1996). Hence, the agency has authorized a health claim
regarding noncariogenic carbohydrate sweeteners to include sucralose.
d-Xylitol is found in low content as a natural constituent of many fruits and vegetables. It is
a ive-carbon sugar polyol and has been used as a food additive and sweetening agent to replace
sucrose, especially for noninsulin-dependent diabetics (Chen et al. 2010). It has multiple beneicial
health effects, such as the prevention of dental caries and acute otitis media (AOM). In the industry,
it has been produced by the chemical reduction of d-xylose mainly from photosynthetic biomass
hydrolyzates. As an alternative method of chemical reduction, the biosynthesis of d-xylitol has
been focused on the metabolically engineered Saccharomyces cerevisiae and Candida strains. In
order to detect d-xylitol in the production processes, several detection methods have been estab-
lished, such as gas chromatography-based methods, high performance liquid chromatography-
based methods, liquid chromatography-mass spectrometry methods, and capillary electrophoresis
methods. The advantages and disadvantages of these methods are compared in the review of Chen
et al. (2010).
As an effective and safe tooth decay-preventive agent, d-xylitol is used in chewing gums,
mouth rinse (Hildebrandt et al. 2010), and toothpaste (Lif Holgerson et al. 2006; Sano et al. 2007).
Streptococcus mutans is most notably associated with human dental decay, by attachment to the
acquired enamel pellicle and direct interaction with the salivary components.
However, S. mutans cannot utilize d-xylitol. After people take d-xylitol-containing products,
the lactic acid production from fermentation by these strains will be decreased. Saliva with d-xylitol
is more alkaline than that containing other sugar products.
A 40-month double-blind cohort study on the relationship between the use of chewing gum and
dental caries was performed from 1989 to 1993 in Belize, Central America. The results showed that
the d-xylitol-containing gum was effective in reducing caries rates, and the most effective agent was