Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-27T09:28:59.238Z Has data issue: false hasContentIssue false
  • English
  • Français

Sugar, alternative sweeteners and meal frequency in relation to caries prevention: new perspectives

Published online by Cambridge University Press:  09 March 2007

Daniel Kandelman
Daniel Kandelman
Affiliation:
Department of Oral Health, Faculty of Dental Medicine, University of Montreal, CP 6128, Succursale Centre-Ville, Montreal, Quebec H3C 3J7, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

In the last 20 years, mainly due to optimum fluoride exposure, and practice of good oral hygiene procedures, an important reduction in caries has been observed, despite the fact that sugar consumption was maintained and/or was increasing during the same lapse of time. A sugar-caries relationship cannot be established in most of the industrialized countries and the dietary factor is not as preponderant in the caries process as it used to be two decades ago. The factors which seem to contribute the most significantly to the cariogenicity of the diet are the frequency of carbohydrate ingestion and eating patterns. The relative cariogenicity of food is not correlated with the amount of carbohydrate it contains. Even if sucrose remains the most important sugar consumed in sweets, beverages and confectionery products, all fermentable-carbohydrate foods can be involved in the caries process. The use of chewing gum and other xylitol-containing products have resulted in defined reduction in caries and represent interesting alternatives for high-caries-risk populations. Caries risk and oral health assessments as well as the evaluation of oral hygiene procedures and fluoride exposure should become essential tools in dietary counselling. People who receive optimum fluoride exposure and follow regular oral hygiene measures can safely use dietary carbohydrates, preferably during meals and two to three times daily in snacks or drinks.

Keywords

SugarSweetenersMeal frequencyCaries
Type
Research Article
Information
British Journal of Nutrition , Volume 77 , Issue S1 , April 1997 , pp. S121 - S128
Copyright
Copyright © The Nutrition Society 1997

References

REFERENCES

Bär, A. (1988). Caries prevention with xylitol. World Review of Nutrition and Dietetics 55, 183–209.CrossRefGoogle ScholarPubMed
Birkhed, D. (1994). Cariologic aspects of xylitol and its use in chewing-gum: a review. Acta Odontologica Scandinavica 52, 116–127.CrossRefGoogle ScholarPubMed
Bowen, W. H., Amsbaugh, S. M., Monell-Torrens, S., Brunelle, J., Kuzmiak Jones, H. & Cole, M. F. (1980). A method to assess cariogenic potential of food-stuffs. Journal of the American Dental Association 100, 677–681.CrossRefGoogle Scholar
Bowen, W. H., Amsbaugh, S. M., Monell-Torrens, S. & Brunelle, J. (1983). Effects of varying intervals between meals on dental caries in rats. Caries Research 17, 466–471.CrossRefGoogle ScholarPubMed
Burt, B. A., Eklund, S. A., Morgan, K. J., Larkin, F. E., Guire, K. E., Brown, L. O. & Weintraub, J. A. (1988). The effects of sugars intake and frequency of ingestion on dental caries increment in a three year longitudinal study. Journal of Dental Research 67, 1422–1429.CrossRefGoogle Scholar
Burton, V. J., Rob, M. I., Craig, G. G. & Lawson, J. S. (1984). Changes in the caries experience of 12 years old Sydney schoolchildren between 1963 and 1982. Medical Journal of Australia 140, 405–407.CrossRefGoogle Scholar
De Paola, P. F., Soparkar, P. M., Tavares, M., Allukian, M. Jr & Peferson, H. (1982). A dental survey of Massachusetts school children. Journal of Dental Research 61, 1356–1360.Google Scholar
Edgar, W. M., Bibby, B. G., Mundorff, S. & Rowley, J. (1975). Acid production in plaques after eating snacks: modifying factors in foods. Journal of the American Dental Association 90, 418–425.CrossRefGoogle ScholarPubMed
Edwardsson, S., Birkhed, D. & Majare, B. (1977). Acid production from lycasin, maltitol, sorbitol and xylitol by oral streptococci and lactobacilli. Acta Odontologica Scandinavica 35, 257–263.CrossRefGoogle ScholarPubMed
Federation Dentaire Internationale (1982). World Health Organization global goals for oral health by the year 2000. International Dental Journal 32, 74–77.Google Scholar
Firestone, A. R., Schmid, R. & Mulhemann, H. R. (1982). Cariogenic effects of cooked wheat starch alone or with sucrose and frequency controlled feedings in rats. Archives of Oral Biology 27, 759–763.CrossRefGoogle ScholarPubMed
Gustafsson, B., Quensel, C. E., Lanke, L., Lundquist, C., Grahnen, H., Gonow, B. E. & Krasse, B. (1954). The Vipeholm dental caries study: the effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontologica Scandinavica 11, 232–363.CrossRefGoogle Scholar
Imfeld, T. H. (1977). Evaluation of the cariogenicity of confectionery by intraoral wire telemetry. Helvetia Odontologica Acta 21, 1–28.Google Scholar
Isokangas, P., Alanen, P., Tiesko, J. & Mäkinen, K. K. (1988). Xylitol chewing gum in caries prevention: a field study in children. Journal of the American Dental Association 11, 315–320.CrossRefGoogle Scholar
Kandelman, D., Bär, A. & Hefti, A. (1988). Collaborative WHO xylitol field study in French Polynesia. I. Baseline prevalence and 32 months caries increment. Caries Research 22, 55–62.CrossRefGoogle ScholarPubMed
Kandelman, D. & Gagnon, G. (1990). A 24-month clinical study of the incidence and progression of dental caries in relation to consumption of chewing-gum containing xylitol in school preventive programs. Journal of Dental Research 69, 1771–1775.CrossRefGoogle ScholarPubMed
Kaskhet, S., Van Houte, J., Lopez, L. R. & Stocks, S. (1991). Lack of correlation between food retention on the human dentition and consumer perception of food stickiness. Journal of Dental Research 70, 1314–1319.CrossRefGoogle Scholar
King, J. D., Mellanby, M., Stones, H. H. & Green, H. N. (1955). The effect of sugar supplement on dental caries. Medical Research Council Special Report Series no. 288, London: H. M. Stationery Office.Google Scholar
König, K. G. (1990). Changes in the prevalence of dental caries: how much can be attributed to changes in diet? Caries Research 24, Suppl. 1, 16–18.CrossRefGoogle Scholar
König, K. G., Schmid, P. & Schmid, R. (1968). An apparatus for frequency controlled feeding of small rodents and its use in dental caries experiments. Archives of Oral Biology 13, 13–26.CrossRefGoogle ScholarPubMed
Lanke, S. L. (1957). Influence on salivary sugar of certain propeaies of foodstuffs and individual oral conditions. Acta Odontologica Scandinavica 15, Suppl. 23, 1–156.Google Scholar
Linke, H. A. B. (1986). Sugar alcohols and dental health. World Review of Nutrition and Dietetics 47, 134–162.CrossRefGoogle ScholarPubMed
Linke, H. A. B., Arav, L., Chiv, P. M. & Moss, S. J. (1989). Oral clearance and acid production of foods containing either cooked starch or carbohydrate sweeteners. Caries Research 23, 430 Abstr.Google Scholar
Mänen, K. K. (1992). Dietary prevention of dental caries by xylitol - clinical effectiveness and safety. Journal of Applied Nutrition 44, 16–28.Google Scholar
Mäkinen, K. K., Bennett, C. A., Hujoel, P. P., Isokangas, P. J., Isotupa, K. P., Pape, H. R. J. & Mäkinen, P. L. (1995). Xylitol chewing gums and caries rates: a 40-month cohort study. Journal of Dental Research 74, 1904–1913.CrossRefGoogle Scholar
Mäkinen, K. K. & Scheinin, A. (1982). Xylitol and dental caries. Annals of Research in Nutrition 2, 133–150.CrossRefGoogle ScholarPubMed
Martinsson, T. (1972). Socio-economic investigation of school children with high and low caries frequency. III. A dietary study based on information given by the children. Odontology Review 23, 93–114.Google Scholar
Miller, W. D. (1890). Cited by König, K. (Editor) (1973). The Microorganisms of the Human Mouth. Basel: S Karger.Google Scholar
Mühlemann, H. R., Schmid, R., Noguchi, T., Imfeld, T. & Hirsch, R. S. (1977). Some dental effects of xylitol under laboratory and in vivo conditions. Caries Research 11, 263–276.CrossRefGoogle ScholarPubMed
Mundorff, S. A., Featherstone, J. D. B., Bibby, B. G., Curzon, M. E. J., Einsenberg, A. D. & Espeland, M. A. (1990). Cariogenic potential of foods. 1. Caries in the rat model. Caries Research 24, 344–355.CrossRefGoogle ScholarPubMed
Newbrun, E. & Frostell, G. (1978). Sugar restriction and substitution for caries prevention. Curies Research 12, Suppl. 1, 65–73.CrossRefGoogle ScholarPubMed
O'Mullane, D. (1989). Fluoride - its role in caries prevention. Good Dietary Practice News 1, 2.Google Scholar
Rugg-Gunn, A. J. (1989). Diet and dental caries. In Prevention of Dental Disease, 2nd ed., pp. 9–11 [Murray, J. J. editor]. Oxford. Oxford University Press.Google Scholar
Rugg-Gunn, A. J. & Edgar, W. M. (1984). Sugar and dental caries: a review of the evidence. Community Dental Health 1, 85–92.Google ScholarPubMed
Rugg-Gunn, A. J., Hackett, A. F., Appleton, D. R., Jenkins, G. N. & Erstoe, J. E. (1984). Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent school children. Archives of Oral Biology 29, 983–992.CrossRefGoogle ScholarPubMed
Sardo-Infirri, J. & Barmes, I. E. (1979). Epidemiology of oral diseases - differences in national problems. International Dental Journal 29, 183–190.Google Scholar
Scheinin, A., Mäkinen, K. K. & Ylitalo, K. (1975). Turku sugar studies. V. Final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man. Acta Odontologica Scandinavica 33, 67–104.Google Scholar
Scheinin, A., Mäkinen, K. K., Tammisalo, E. & Rekola, M. (1975). Turku sugar studies. XVIII. Incidence of dental caries in relation to 1-year consumption of xylitol chewing gum. Acta Odontologica Scandinuvica 33, 269–278.CrossRefGoogle ScholarPubMed
Scheinen, A., Banoczy, J., Szöke, J., Esztari, I., Pienihäkkinen, K. & Scheinin, A. (1985). Collaborative WHO xylitol field studies in Hungary. I. Three-year caries activity in institutionalized children. Acta Odontologica Scandinavica 43, 327–347.CrossRefGoogle Scholar
Shaw, J. H. (1973). Influence of experimental diets on carious lesions in the occlusal sulci and on the smooth surfaces of the molars of caries-susceptible rats. Journal of Dental Research 52, 291–299.CrossRefGoogle ScholarPubMed
Sognaes, R. F. (1948). Analysis of wartime reduction of dental caries in European children. American Journal of Diseases in Children 75, 792–821.CrossRefGoogle Scholar
Sreebny, L. M. (1983). Cereal availability and dental caries. Community Dentistry and Oral Epidemioloy 11, 148–155.CrossRefGoogle ScholarPubMed
Sundin, B., Granath, L. & Birkhed, D. (1992). Variations of posterior approximal caries incidence with consumption of sweets, with regard to other caries-related factors in 15–18 year olds. Community Dentistry and Oral Epidemiology 20, 76–80.CrossRefGoogle ScholarPubMed
Tanzer, J. M. (1995). Xylitol chewing gum and dental caries. International Dental Journal 45, Suppl. 1, 65–76.Google ScholarPubMed
Trahan, L. (1995). Xylitol: a review of its action on mutans streptococci and dental plaque - its clinical significance. International Dental Journal 45, Suppl. 1, 77–92.Google ScholarPubMed
Von Der Fehr, F. R., Löe, H. & Theilade, E. (1970). Experimental caries in man. Caries Research 4, 131–148.CrossRefGoogle ScholarPubMed
Weiss, R. & Trithart, A. H. (1960). Between-meal eating habits and dental caries experience in pre-school children. American Journal of Public Health 50, 1097–1104.CrossRefGoogle Scholar
Woodward, M. & Walker, A. R. P. (1994). Sugar consumption and dental caries, evidence from 90 countries. British Dental Journal 176, 297–302.CrossRefGoogle ScholarPubMed