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Kathy Kolasa: Sugar substitutes help fight cavities

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Kathy Kolasa

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Wednesday, August 28, 2019

Q: “I know that eating a diet high in sugar and sweets can lead to cavities, but are sugar substitutes actually better for your teeth? If so, what do you recommend?” AS, Ayden

A: We are fortunate to have a dental school at ECU, and Emory Byrd, a third-year student, wanted you to know a bit more about oral health and nutrition.

Dental caries, also called cavities, is one of the most prevalent chronic diseases in the United States. You are smart to explore ways to minimize your risk of cavities and improve your oral health AND your overall health. This is especially true because chronic oral infections have been linked to diabetes, heart and lung disease, stroke and low birthweight or premature birth in pregnant women. This means that having poor oral health can make these health conditions worse.

Before we discuss how sugar substitutes affect your teeth, let me remind readers how sugar causes cavities. Sugar is the leading cause of cavities because it provides fuel for the bacteria in your mouth, especially for cavity-causing S. mutans. These bacteria are a major component of plaque and live in your mouth as part of the oral microbiome. The microbiome is the collection of various microorganisms, both good and bad, that call the mouth “home.” The bacteria S. mutans digest the sugars that you eat into acid, which dissolves the tooth’s strong outer enamel and eventually causes tooth decay.

The good news is that artificial sweeteners do not have the same cavity risk as regular sugar. The bacteria in your mouth do not break down these sweeteners like acesulfame potassium, aspartame, saccharin, sucralose, neotame, sugar alcohols and blends of these. Even better, xylitol, a sugar alcohol found naturally in some fruits and vegetables (and added to some foods) can prevent cavities by reducing dental plaque formation and suppressing decay-causing bacteria.

Although the name may be confusing, sugar alcohols do not contain ethanol, the compound found in alcoholic beverages. Sugar alcohols are very similar to regular sugar but have a slightly different chemical formula. Cavity-causing bacteria like S. mutans can’t get energy from xylitol and eventually die. As a result, not as much plaque is formed and less enamel demineralization occurs.

Xylitol can be found naturally in some fruits and vegetables such as strawberries, raspberries, mushrooms and cauliflower. It is used as a sweetener in some gums, candy, lozenges, mints, suckers, jams, toothpastes and mouth rinses that you can find in the grocery store. Brands such as Trident and Dr. John’s Healthy Sweets offer sugar-free products sweetened by xylitol that are tooth-friendly alternatives to traditional sweets.

Xylitol can also be purchased in a crystallized form that looks very similar to sugar, which can be used in place of sugar when making baked goods or other sweet treats at home. Although it can typically be swapped in a 1 to 1 ratio, xylitol can react to heat and moisture in slightly different ways than sugar. You may need to modify a favorite recipe to get the results you want. Crystallized xylitol can be found in-store at Walmart or Sam’s Club and can also be purchased online through websites like Amazon or Thrive Market.

As with anything, it is better to consume xylitol in moderation because consuming too much can cause gas, bloating and other digestive problems. Although there is no recommended daily dose, adults can consume 20-70 grams or 0.7-2.4 ounces per day without a side effect. Children, however, might get an upset stomach if they eat more than 10-20 grams or 0.35-0.7 ounces. If digestive problems occur, just use less.

For cavity prevention, studies show that doses of 5-6 grams or 0.17-0.21 ounces split into three doses throughout the day may reduce the risk of cavities, especially if consumed after eating a meal high in starches or sugars. Of course, the best way to prevent cavities and keep your mouth healthy is by brushing twice a day with toothpaste that contains fluoride and flossing once a day.

It is important to note that xylitol is toxic to dogs and other animals, so be sure to keep it out of reach of your furry friends!

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