Sugar Alcohols, Caries Incidence, and Remineralization of Caries Lesions: A Literature Review

Abstract

Remineralization of minor enamel defects is a normal physiological process that is well known to clinicians and researchers in dentistry and oral biology. This process can be facilitated by various dietary and oral hygiene procedures and may also concern dentin caries lesions. Dental caries is reversible if detected and treated sufficiently early. Habitual use of xylitol, a sugar alcohol of the pentitol type, can be associated with significant reduction in caries incidence and with tooth remineralization. Other dietary polyols that can remarkably lower the incidence of caries include erythritol which is a tetritol-type alditol. Based on known molecular parameters of simple dietary alditols, it is conceivable to predict that their efficacy in caries prevention will follow the homologous series, that is, that the number of OH-groups present in the alditol molecule will determine the efficacy as follows: erythritol ≥ xylitol > sorbitol. The possible difference between erythritol and xylitol must be confirmed in future clinical trials.

Use of Polyols in Oral Biology Research

“…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.…”

“…Most studies have shown that D-glucitol and D-mannitol, owing to their hexitol nature, support the growth of MS and dental plaque. Erythritol in turn has been shown to reduce the growth of MS almost to the same extent as xylitol (Mäkinen et al, 2005), although published information is still scant (reviewed in Mäkinen, 2010). Recently, Yao et al (2009) reported in a Chinese study that the growth and acid production of S. mutans were higher in low (2% and less) concentrations of erythritol than in similar concentrations of xylitol, while they were lower at higher (<8%) erythritol levels than at corresponding xylitol levels.…”

“…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.…”

Death of a pastry chef

“…Previous studies have shown the implication of personal and professional factors in the development of sugar caries, such as manipulation of sugars, frequent tasting of sweet dishes, sieving of icing sugar, etc. [4][5][6][7] Local infectious complications (maxillary sinusitis) may have played a direct role in the cause of death of the first celebrity chef. …”