Sugar Alcohol Sweeteners as Alternatives to Sugar with Special Consideration of Xylitol

Abstract

Introduction: Dental caries is a diet-associated disease which continues to be a serious health problem in most industrialized and developing countries. Strategies to maximize caries prevention should automatically consider the use of sugar substitutes. It is important that public health authorities are made cognizant of the availability of new polyol-type sugar substitutes. Review Summary: Clinical studies have shown that xylitol, a natural, physiologic sugar alcohol of the pentitol type, can be used as a safe and effective caries-limiting sweetener. Habitual use of xylitol-containing food and oral hygiene adjuvants has been shown to reduce the growth of dental plaque, to interfere with the growth of caries-associated bacteria, to decrease the incidence of dental caries, and to be associated with remineralization of caries lesions. Numerous public regulatory bodies have endorsed the use of xylitol as a caries-limiting agent. Other sugar alcohols that have been successfully used as sugar substitutes include D-glucitol (sorbitol), which, however, owing to its hexitol nature, normally has no strong effect on the mass and adhesiveness of bacterial plaque and on the growth of mutans streptococci. A tetritol-type alditol, erythritol, has shown potential as a non-cariogenic sugar substitute. Combinations of xylitol and erythritol may reduce the incidence of caries more effectively than either alditol alone. Conclusions: Partial sugar substitution with polyols is an important dietary tool in the prevention of dental caries that should be used to enhance existing fluoride-based caries prevention programmes. The most effective method of conveying this information to the public is through a proper health claim for these alditols in food labelling. The present review summarizes clinical and biochemical aspects of the above three dietary polyols and emphasizes the role of sugar substitution as a potential health-promoting strategy.

Sugar alcohols—their role in the modern world of sweeteners: a review

“…Sugar alcohols (polyols or polyhydric alcohols) are low digestible carbohydrates, which are obtained by substituting and aldehyde group with a hydroxyl one [1,2]. As most of sugar alcohols are produced from their corresponding aldose sugars, they are also called alditols [3]. Among sugar alcohols can be listed hydrogenated monosaccharides (sorbitol, mannitol), hydrogenated disaccharides (isomalt, maltitol, lactitol) and mixtures of hydrogenated mono-diand/or oligosaccharides (hydrogenated starch hydrolysates) [1,2,4].…”

Use of Polyols in Oral Biology Research

“…Regarding oral pathological processes such as dental caries and periodontal disease, decisive factors that can lead to different polyol effects in disease prevention include the length of intervention, the daily amount of alditol used, and the frequency of use per day (Mäkinen, 2011). Therefore, new attempts to design alditol-based caries trials (Bader et al, 2010) are welcome but will not provide final answers if the consumption level of the alditol, the frequency of alditol use, or the overall duration of intervention, are defective.…”

“…Biochemical consequences in dental plaque after ingestion of alditols 3.1 Stabilization of the Ca(II) phosphate system by alditols; effect on protein stability Complex formation between carbohydrates and metal cations is a well-studied bioinorganic research area. Complexation of Ca(II) with alditols, such as erythritol and xylitol, may play a role in the remineralization of caries lesions-an interesting possibility that has been discussed elsewhere (Mäkinen, 2010(Mäkinen, , 2011. In the present review, another oral biologic effect of alditols will be recalled: stabilization of the Ca(II) phosphate system of the oral cavity.…”

“…The study by Duane (2010) demonstrated that children receiving 4.24 g xylitol daily (in five chewing episodes) in the form of chewing gum showed reduced bacterial counts even when the gum contained hexose-based polyols. This study also emphasizes a point that has received serious attention owing to occasional implementation of clinical trials whose very design has nullified the anticipated xylitol effects already in advance (Mäkinen, 2010(Mäkinen, , 2011. Some points of concern Fluoride was administered in milk or drinking water and xylitol (maximum daily intake 20 g per subject) was consumed in the form of confectioneries.…”

“…The structures shown include some alditols whose oral biologic effects have not been studied but which, based on their detailed chemical configuration, warrant future investigation as potential chemical effectors of dental plaque. Several text books and research papers have elucidated the chemistry and physiology of alditols in detail (Carr & Krantz, 1945;Lohmar, 1962;Touster & Shaw, 1962;Mills, 1974;Angyal et al, 1974;Gekko & Satake, 1981;Georgieff et al, 1985;Mäkinen, 2000Mäkinen, , 2010Mäkinen, , 2011. There is an ever-growing body of research describing the medical, pharmaceutical, nutritional, technical, cosmetic, and other applications of alditols.…”