Do we need artificial sweeteners to avoid dental caries?

There is growing concern about the ill effects of sugar on the general as well as oral well being, and hence, newer products are being launched in the market as replacements of regular table sugar (sucrose). These products are actually plant extracts that are not metabolised by the oral bacteria and therefore, do not cause dental caries.

Although these artificial sweeteners are a non cariogenic substitute, they cannot completely replace the natural sugars in the diet. The dynamics of sugar intake should be understood to maintain a healthy mouth along with a healthy body.

With the advent of non sugar sweeteners, one may ask that what is the need for being so mindful while consuming sugars, when we have such alternatives?

Certain sugar alcohols are not metabolised to acids by the oral bacteria and hence cannot cause dental caries. However, they are not devoid of other side effects. Certain protein sweeteners like aspartame cannot be metabolised by some individuals and hence the contents of the products should be clearly mentioned on their labels. Other kind of sweeteners like Bulk Sweeteners such as Sorbitol and Xylitol provide extreme sweetness, 200-300 times as sweet as Sucrose (regular tase sugar). These sugar alcohols are non cariogenic and do not cause dental caries. However, these products are also partly metabolised by the small intestines and may induce osmotic diarrhoea.

A highly commercialised and popular non nutritive sweetener Stevia, is an extract from the leaves of Stevia rebaudiana plant which contains Steviol glycosides. This product contains many different genetic variants, however only the rebaudiana variant with high purity Steviol glycosides are considered safe for humans. The FDA does not approve crude leaf extracts and stevia leaves as food additives. The acceptable daily intake is 4 mg/kg body weight.

Stevia has been a subject of debate for quite some time because of its proposed benefits as well as adverse effects. It is considered a diuretic, that is, it accelerates the rate of salt and water elimination in urine and thus might damage the kidneys with prolonged usage.

Some of its products contain sugar alcohols which might cause hypersensitivity reactions in the body such as nausea, vomiting. indigestion, cramping and bloating.

It is also known to reduce the blood sugar levels which is good for patients with diabetes mellitus type 2, however, the products may also contain dextrose and maltodextrin which might adversely affect the blood sugar levels.

Hence, the purest extracts of stevia are considered safe but the commercial blends of the products may also contain other ingredients which might adversely affect health. However, from the oral perspective, these products are unable to cause dental caries alone, their blends may contain other forms of sugars that might be metabolised into acids and initiate the process of demineralisation and hence, lead to dental caries.

Therefore, there cannot be a single alternative that can completely replace sucrose (regular table sugar) and render us caries free and healthy. Every product comes with its known pros and cons. A balance needs to be struck regarding the amount and type of sugars consumed, the time at which they are consumed, the oral hygiene status of the individual and the use of fluorides, in order to maintain a complete state of general as well as oral health. Also, the use of non sugar sweeteners, although not completely forbidden, should be used with caution and with complete knowledge of the particular substance being used.

Enjoy the celebrations this year, with your favourite sweets and indulge in the rich festivities, while still being healthy and caries free.

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