ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Sugar Substitutes May Reduce Tooth Demineralization in High Caries Patients
Clinical Question In a patient with high risk caries how do dietary sugar substitutes compared to sucrose affect demineralization on teeth surfaces?
Clinical Bottom Line Sugar substitutes have shown to decrease the chances of tooth demineralization when assessing for enamel pH, caries incidence and tooth surface hardness compared to conventional sucrose diets.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23631998Giacaman/2013Patient Group bovine enamel slabsLaboratory study
Key resultsGiacaman showed that there was a noticeable difference between artificial aspartame substitute diet and sucrose when comparing enamel demineralization. When Giacaman was assessing the enamel slabs before and after the experiment, it was evident that there was less surface microhardness and more extracellular polysaccharides on the sucrose culture than the aspartame culture (p<0.05).
#2) 12212881Roos/2002Patient Group Seventeen subjects aged 12- 17Crossover Controlled Clinical Trial
Key resultsRoos concluded that regular coke with sucrose had more acidic environment after a 5, 10, and 20 minute exposure compared to diet coke with aspartame (P = < .001). The pH at the 5 minute mark for coke and diet coke was 5.5 +/- 0.5 and 6.0 +/- 0.7. At 10 minutes it was 5.6 +/- 0.6 and 6.2 +/- 0.7. At 20 minutes it was 5.7 +/- 0.7 and 6.5 +/- 0.5. The acidity level reflects the enamel’s tendency to demineralize. The lower acidic levels from sucrose sodas will lead to a higher chance of demineralization.
#3) 1886826Das/19912000 Rat PupsAnimal Study
Key resultsDas concluded that rats with Streptococcus mutans exposure had a significant decrease in caries when aspartame was introduced to their diet along with sucrose. The rats that were only fed with aspartame had no signs of caries and very low S. mutans count. Caries are directly derived from tooth demineralization.
Evidence Search ("sweetening agents"[Pharmacological Action] OR "sweetening agents"[MeSH Terms] OR ("sweetening"[All Fields] AND "agents"[All Fields]) OR "sweetening agents"[All Fields] OR ("sugar"[All Fields] AND "substitute"[All Fields]) OR "sugar substitute"[All Fields]) AND demineralization[All Fields] AND ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR "caries"[All Fields])
Comments on
The Evidence
There were no systematic reviews or quality meta-analysis studies found over the connection of aspartame and demineralization. The validity was very questionable as this was not a very common study and was mostly from lab experiments. There will need to be more in vivo studies to be analyzed before a definite conclusion can be made.
Applicability Sugar substitutes have become a growing trend in the diets of many people. Clinicians need to realize that the key etiology to oral problems starts with a patient's diet. It is essential that dentists address the use of sugar substitutes over sucrose when patients are highly susceptible to caries if reducing sucrose intake is not possible.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords diet, caries, cavities, demineralization, sugar substitute
ID# 2817
Date of submission: 03/17/2015spacer
E-mail lehd@livemail.uthscsa.edu
Author Huy Le
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Georgiana S. Gross, MPH
Faculty mentor/Co-author e-mail GROSSG@uthscsa.edu
Basic Science Rationale
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