Nutritional and Health Aspects of Sweeteners - Sweeteners: Nutritional Aspects, Applications, and Production Technology - page 340

a 100% d-xylitol pellet gum (Makinen et al. 1995). Makinen et al. (2001) reported the effect of a
2-month usage of saliva-stimulating pastils containing erythritol or d-xylitol. In the d-xylitol-group,
the mean weight of the total plaque mass was reduced signiicantly; the plaque and salivary levels
of S. mutans and the plaque levels of the total Streptococcus were reduced signiicantly as well
(Makinen et al. 2001). Milgrom et al. (2006) suggested the effective dose of d-xylitol to be between
6.44 and 10.32 g/day.
Regular use of d-xylitol in chewing gums or syrup prevented the incidence of acute otitis media
(AOM) in children (Uhari et al. 1996). d-Xylitol had the ability to reduce the growth of the major
otopathogen of AOM, S. pneumoniae , which caused 30% or more of such attacks, and also sup-
pressed Haemophilus inluenza , another important pathogen implicated in AOM (Kontiokari et al.
1998). The researchers reported that the exposure of epithelial cells, pneumococci, or both to 5%
d-xylitol reduced the adherence of pneumococci. Some researchers implied that the inhibition of
pneumonia growth induced by d-xylitol was mediated via the fructose phosphotransferase system.
However, the mechanism remains a matter of speculation (Tapiainen et al. 2001).
Szöke et al. (2001) explored the effect of after-meal sucrose-free gum chewing on clinical caries.
In this 2-year study, they investigated whether chewing sugar-free gum reduced the development of
dental caries in schoolchildren. The children were split into two groups: the gum group, who were
instructed to chew sugar-free gum for 20 min after eating three times daily, and the control group,
who were not provided with chewing gum. The study showed that chewing gum after meals signii-
cantly reduced the incidence of dental caries. Similarly, Beiswanger et al. (1998) conducted a study
to determine the effect of chewing sugar-free gum on the incidence of dental caries in children. The
children were put into either a control group or a chewing gum group. Those in the gum group had
to chew sugar-free gum for 20 min after each meal. The study concluded that chewing sugar-free
gum after meals greatly reduces the incidence of dental caries.
He et al. (2006) discovered a novel compound (Glycyrrhizol A), from the extraction of licorice
roots, with strong antimicrobial activity against cariogenic bacteria. In a current study, Hu et al.
(2011) developed a method to produce these speciic herbal extracts in large quantities and then
used these extracts to develop a sugar-free lollipop that effectively kills cariogenic bacteria like
S. mutans . Further studies showed that these sugar-free lollipops are safe and their antimicrobial
activity is stable. Two pilot human studies indicate that a brief application of these lollipops (twice a
day for 10 days) led to a marked reduction of cariogenic bacteria in oral cavity among most human
subjects tested. The authors argued that this actual herbal lollipop could be a novel tool to promote
oral health through functional foods (Hu et al. 2011).
In conclusion, one may argue that a combination of measures on the basis of educating the pub-
lic about the dangers of frequent sugar consumption, proper oral hygiene, and luoride use, as well
as public awareness regarding anticariogenic substances, may well contribute to the prevention and
reduction of dental caries.
11.4 preBIOtICS aND DIGeStIVe heaLth
Bulk sweeteners are sugar substitutes used most frequently by the confectionery industry. This
group of sweeteners contains primarily sugar alcohols, which are not broken down in the stomach
or small intestine, and nondigestible carbohydrates, which can be used in foods at levels similar to
that of sucrose (Mela 1997). The term nondigestible refers to the food ingredients being undigested
in the upper gut, with a large portion remaining for fermentation by the indigenous microbiota of
the large intestine. MTL is an example of a bulk sweetener, whereas PDX and resistant starch (RS)
are bulking agents that can substitute for the texture properties of sucrose in confectionery products.
All have been found to be fermented by the indigenous bacteria of the colon (Probert et al. 2004;
Ghoddusi et al. 2007; Arrigoni et al. 2005; Tsukamura et al. 1998).