Sugar alcohols and prevention of oral diseases - comments and rectifications

Substituting sugar (sucrose and related fermentable saccharides) with low-calorie carbohydrates and sugar alcohols constitutes a well-founded approach to controlling energy intake in the prevention of obesity and certain diseases, and to limiting the occurrence of bacteria-associated diseases such as dental caries. The present concise review discusses selected sugar-substitute applications of alditol-type sugar alcohols and disaccharide polyols. In the former category, erythritol (a tetritol) and xylitol (a pentitol) will receive special attention. Xylitol has been shown to exert interesting biochemical effects―such as formation of ammonia and basic amino acids―in dental biofilm (dental plaque). These nitrogen-associated metabolic features have remained unnoticed because data concerning them were published already in the 1970s in supplements to regular journal volumes. Thus, the present review highlights the oral biologic significance of the xylitol-associated shift observed in the biology of oral biofilm: from carbohydrate dominance to one where nitrogen metabolism plays an important role. This review also comments on the synergy between certain oral health adjuvants (e.g., chlorhexidine and fluoride) and alditols, and on the use of alditols in periodontal treatments (i.e., non-sweet applications of alditols), and provides insights to European Union regulations on sugar substitutes. The article also attempts to rectify defective information regarding these sweeteners, including that contained in a recent Cochrane Xylitol Review. A brief discussion on certain physicochemical aspects of alditols will be provided to facilitate an understanding of the oral biological processes involved. Correspondence to: Kauko K. Mäkinen, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20500 Turku, Finland