Non-sugar sweeteners

Xiang Loong

Linked to Diet Control

Types of non-sugar sweeteners

1. Caloric sweeteners

(a) Xylitol
(b) Sorbitol
(c) LycasinI

(d) Maltitol

(e) Mannitol

caloric sweetenernon caloric sweetener
Examples of Caloric Sweeteners. Taken and

2. Non Caloric Sweeteners

(a) Acesulfame-K
Acesulfame KAcesulfame K

(b) Aspartame

Non-sugar sweeteners - Cariologyaspartame

(c) Cyclamate


(d) Saccharin
Non-sugar sweeteners - Cariology

(Diagrams of structures of molecules from:

(Lingström et al., 2003, p.331)


Chewing Gums

Chewing gum is a type of confection made of rubber and has both recreational and medical uses. It is often used
as a means of delivering substances such as:

1. Calcium

2. Bicarbonate

3. Carbamide

4. Chlorhexidine

5. Fluoride

6. Xylitol

These substances protect the oral environment and mediate common oral diseases, to improve oral health and reduce caries. In addition, xylitol and calcium lactate are able to enhance the reminineralization of the enamel surfaces on the teeth, allowing this protective layer to be regenerated. (Burt, 2006; Ly, Milgrom, & Rothen, 2008, p.553- 554)

The sugar substitutes in chewing gum are sometimes called polyols or ‘sugar alcohols’ because their chemical structure is close to that of both sugar and alcohol. Polyols do not promote caries because they are ether metabolised very slowly, or not at all in dental plaque. (Burt, 2006)

Non-sugar sweeteners - Cariology
Diagram taken from:


How does Xylitol exert its therapeutic effects?

1. It is not fermented by oral micro-organisms

2. It inhibits the growth of mutans streptococci by interfering with glycolysis when glucose is used as a source of energy

3. It weakens the caries-inductive properties of dental plaque colonizing newly erupting tooth surfaces

4. It is able to loosen the plaque and mutans streptococci binding to the tooth surfaces

(Vadeboncoeur, Trahan, Mouton, & Mayrand, 1983; Wåler & Rölla, 1983; Isokangas, Makinen, Tiekso, Alanen, 1993; Van Loveren, 2004, p,287)


Evidence of the protective effects of polyols

Clinical trials have been conducted to show that the consumption of sorbitol or xylitol-sweetened gums between or after-meals has a preventive effect on the occurrence of dental caries, in comparison with controls without gum use. (Van Loveren, 2004, p.289)

In another experiment, three groups of voluntary dental students and dental personnel consumed a diet sweetened with sucrose, fructose, or xylitol for a period of 25 months. No new carious lesions were found in the xylitol group while a 47% reduction in caries was found in the fructose group. (Lingström, et al., 2003, p.333)

However, it has been shown that sorbitol is less effective than xylitol in controlling caries due to the fact that large amounts of sorbitol in drinks can still be slowly fermented by mutans streptococci. Excessive intake of chewing gums containing sorbitol will also lead to the increase in acid production and the number of sorbitol-fermenting micro-organisms. Manufacturers still prefer using sorbitol as it is much cheaper than xylitol.

An in vitro study suggested that both sorbitol and xylitol can be broken down by certain strains of lactobacilli, thereby reducing pH sufficiently to demineralize enamel. However, even if this does happen in humans, however, a person would have to eat much more sorbitol than is found in two sticks of gum to reduce plaque pH to cariogenic levels.
(Burt, 2006, p.192)



1. Burt, B. A. (2006). The use of sorbitol- and xylitol-sweetened chewing gum in caries control. J Am Dent Assoc, 137(2), 190-196.

2. Isokangas, P., Makinen, K. K., Tiekso, J., & Alanen, P. (1993). Long-term effect of xylitol chewing gum in the prevention of dental caries: a follow-up 5 years after termination of a preventive program. Caries Res, 27, 495-498.

3. Lingstrom, P., Holm, A. K., Mejare, I., Twetman, S., Soder, B., Norlund, A., et al. (2003). Dietary factors in the prevention of dental caries: a systematic review. Acta Odontol Scand, 61(6), 331-340.

4. Ly, K. A., Milgrom, P., & Rothen, M. (2008). The potential of dental-protective chewing gum in oral health interventions. J Am Dent Assoc, 139(5), 553-563.

5. Vadeboncoeur, C., Trahan, L., Mouton, C., & Mayrand, D. (1983). Effect of xylitol on the growth and glycolysis of acidogenic oral bacteria. J Dent Res, 62(8), 882-884.

6. Van Loveren, C. (2004). Sugar alcohols: what is the evidence for caries-preventive and caries-therapeutic effects? Caries Res, 38(3), 286-293.

7. Waler, S. M., & Rolla, G. (1983). Effect of xylitol on dental plaque in vivo during carbohydrate challenge. Scand J Dent Res, 91(4), 256-259.


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