Week 7 - Sugars & Sweeteners

Sucrose- disaccharide

Sucrose is the most commonly used tabletop sweetener. - Males generally consume more sucrose than females; teenagers are the greatest consumers. - Low fat foods= more sugar or sugar substitutes - Up to 31% of total sugars consumed are hidden sugars (processed foods)

Disaccharides

Sucrose: regular table sugar, powdered sugar, brown sugar, raw sugar (used in baking) Lactose: milk sugar, used for whipped toppings, commercial baked goods Maltose: malt sugar or syrup, derived from barley, found in malt flavored foods and alcoholic beverages

HFI (hereditary fructose intolerance)

Suffer from nausea, vomit, excessive sweating, malaise, tremors, coma and convulsions. Individuals learn to carefully avoid foods with fructose or sucrose (where fructose is one of the metabolic products). These individuals have very few caries/none

Sorbitol

Sugar alcohol (polyol) occurs naturally in many fruits and berries. Used in chewing gum, toothpaste, frozen desserts and candy With respect to the oral cavity, we are interested in sugar-free gum's claim to be non-cariogenic The plaque pH seldom drops below 5.7 after chewing gum with sorbitol Further studies are required as S.mutans known to metabolize sorbitol. Half as sweet as sucrose. In clients with reduced salivary gland function, it has been shown to be cariogenic with prolonged use.

Uses of Sucrose

Sweetening agent - character of the sweet taste can be varied according to pH and temperature used to make a product. The level of sweetness is important to the acceptance of foods Flavor blender & modifier - can reduce acidic bite and sour taste. (blender :mayonnaise, modifier: pickles) Texture & bodying agent - gives a nice texture which is highly acceptable to consumers. Dispersing & lubricating agent - in dry packed foods, sucrose keeps other ingredients from packing too tightly (better blending during food preparation) caramelization/color agent - provides a desirable flavor and aroma and brown color to baked food products. Bulking agent - maintains appearance and consistency. (if non-caloric sweetener is added other ingredients must be added to compensate for the bulk)

sensation of taste

Taste buds are present and functioning before birth Taste sensation is initiated by the arrival of a stimulus at the taste buds.

Legislation and Sweetener Use

The specific use of a sweetener must be stated before it can be approved for commercial use - If used as a sweetener, safety, teratology, mutagenicity and carcinogenicity are investigated - If anticariogenicity is claimed, such as in the use of xylitol, additional money must be spent in animal/human studies before the claim of anti-caries producing can be claimed.

Nutritive (caloric) sweeteners

include sugar and sugar alcohols

Sugar in Plaque

is a contributory factor in dental caries. Bacteria are essential for caries development, regardless of diet. The action of sugar in caries development is local, not systemic.

Mutans streptococci

is the microorganism having the greatest cariogenic potential in humans.

most popular intense/artificial sweeteners

saccharin, aspartame, acesulfame-K, sucralose.

sweeteners

satisfy taste and provide added energy

Sucrose enhances

the colonization and growth of S.mutans in dental plaque more than other monosaccharides or disaccharides.

Sugar alone is NOT

the sole determinant of the cariogenicity of food. At present, no one sweetener dominates another when considering caries prevention.

sugar refers to

two classifications of carbohydrates: Free-form monosaccharides or simple sugars Disaccharides - two simple sugar molecules linked together

ADA encourages

use of dental sweeteners - Small amounts of artificial sweeteners are used to achieve acceptable levels of sweetness - Cost is 100X greater than equal amounts of sucrose but 90% more economical because the equivalent sweetness is 1000X that of sucrose Used in oral medicines, mouthrinses, dentifrices

Caries promoting activity of carbohydrates

varies based on frequency of intake as well as combination with other foods varying in fat/protein.

Monosaccharides

Glucose: widely used in canned foods and processing (dextrose) Fructose: known as fruit sugar or levulose. Can produce a laxative effect. Is twice as sweet as glucose Galactose- found in dairy products, less sweet than the above.

Stevia

Natural herbal sweetener that is non caloric and is more than 100-300x sweeter than table sugar. - Extracted from leaves of Stevia Rebaudiana Bertoni, a shrub in South America. - Heat stable, nonfermentable, and a flavor enhancer, and possess antiplaque and anticaries qualities. - No allergic reactions to it seem to exist.

Sucralose

Noncaloric sweetener that is 600X sweeter than sucrose- Splenda. Non cariogenic and non nutritive sweetener. - Derived from sucrose - Not broken down or absorbed in the human body, therefore has no calories - Does not promote tooth decay - More than 100 studies, including human research, support the safety of its use

Indicated Prevention

Strategy targets individuals showing early signs of caries - These individuals need immediate interventions as well as more detailed guidance on how to reduce cariogenicity of their current diet - Follow up on a regular basis to promote long term changes

Selective Prevention

Strategy that targets population at risk for caries Examples: adolescents with high intake of soft drinks/snack foods, clients with xerostomia or cariogenic food patterns, diet advice prior to radiation therapy

1990's

Studies suggest that trends in consumption of added sugar may be associated with increased rates of obesity and inadequate intake of essential nutrients - esp. calcium.

Saccharin

- 200-700x sweeter than sucrose. Non-nutritive and non cariogenic. - "Sweet N Low" - Compatible with most foods - Major disadvantage is its metallic aftertaste. - In 1977, it was deemed carcinogenic - the FDA tried to have it classified as a drug so it would be available by prescription only. - In 2000-2001, the proposal was withdrawn -due to lack of evidence.

Acesulfame - K

- A non-nutritive sweetener that is 200X sweeter than sucrose - Pleasant taste with no aftertaste - Derivative of acetoacetic acid - Noncariogenic - Found in toothpastes, mouthwashes, pharmaceuticals, instant coffee and tea, gum - Not shown to have toxic side effects (FDA) - Withstand high temps- ideal for baking and cooking.

1980's

- Both in the U.S. and in the United Kingdom, the consumption of sugars was not found to play a direct role in the development of cardiovascular disease, hypertension, diabetes and obesity. - However, all regulatory bodies do suggest that the intake of sucrose be limited.

Mannitol

- Occurs naturally in seaweed - Derived from the sugar mannose - Metabolized very slowly by oral microorganisms - Virtually no cariogenic potential - Used in toothpastes, mouthrinses, used as a dusting agent for chewing gum, bulking agent in powdered foods. - Naturally occurring Polyol

Polyols

- recognized as having a low potential of producing dental caries - With respect to caries prevention, the main use of polyols (esp. sorbitol and xylitol) is in gum. - Note that the caries preventive effect is believed to be the act of mastication rather than the sugar substitute.

Can take up to....

10 years and $20M to market an entirely new sweetener - If the sweetener is classified as a drug, dosage statements and package inserts carrying warnings of complications, contraindications and drug interactions must be included - Public safety is paramount - many food additives were originally intended for fabric and food coloration (safety was a secondary issue)

Aspartame

160-220X sweeter than sucrose and is the most frequently used non caloric sweetener - Trade name "NutraSweet" and "Equal" - No unpleasant aftertaste - Dipeptide of two naturally occurring amino acids: phenylalanine (some people have an allergy and can die from consumption) and aspartic acid - Not found in nature Approved for use as a free-flowing sugar substitute for table use, cold cereals, drink mixes A flavor enhancer A flavor extender - lengthens the period of flavor for chewing gum by 5 to 7X. - NONCARIOGENIC - Individuals with PKU (phenylketonuria) should avoid aspartame because of phenylalanine content Phenylketonuria=increase of amino acids in the blood that can be harmful.

Vipeholm - Sweden

Conducted at a mental institution in southern Sweden. - Adult patients on a nutritionally adequate diet were observed for several years and found to develop caries at a slow rate. - Patients were divided into seven groups to compare cariogenicity as related to changes in frequency and consistency of carbohydrate intake. - Caries incidence increased significantly when sucrose rich foods were ingested between meals. - The frequency and consistency of foods was also considered - sticky or adhesive forms of food maintained higher sugar levels in the mouth for longer periods of time, thus causing more caries development. - This study also demonstrated that increasing the average consumption of sugar had little increase in caries provided the additional sugar was consumed at mealtime in a solution form.

Xylitol

Has the same sweetness as sucrose Has received lots of attention by the dental profession and its anti-caries effect. Is derived from birch trees, corn cobs, oats, bananas, strawberries and select mushrooms. Appearance and texture is similar to sucrose 10X the cost of sucrose Clinical, salivary chemistry and microbiologic evidence suggests that xylitol is the best sucrose substitute with respect to caries prevention. Used in chewing gum, mints, mouthrinses, some dentifrices. - nonacidogenic, noncariogenic - Decreases bacterial metabolism and produces a less dramatic drop on pH in dental plaque. - Reduces the volume and amount of supragingival plq due to a reduced production of extracellular polysaccharides and biofilm matrix. - Promotes the selection of xylitol-resistant mutans streptococci - Stimulates salivary secretion - 5g of Xylitol per day to have an effect on S.mutans

Disadvantages of sucrose use

High osmolarity - the high concentration used in canning causes shrinkage and wrinkling of foods. Hygroscopic - absorbs moisture making food difficult to freeze-dry. Chars @ high temperatures Supports bacterial growth - increases potential for bacterial contamination and spoilage.

Hopewood House - Australia

Orphanage of up to 82 children at any given time - From its beginning, sugar and other refined carbohydrates were excluded from the diet. -Carbohydrates came in the form of whole meal bread, soybeans, wheat germ, oats, rice, potatoes and some molasses. - The menu also included dairy products, nuts, fruits and raw vegetables. - A survey of the Hopewood children (Age 5-11) versus the state-school children revealed a greatly reduced caries incidence in the Hopewood children. - Hopewood children had poor oral hygiene with 75% suffering from gingivitis. - Once the children left the orphanage, their diets changed and an increase in DMFT was noted. Therefore, no permanent resistance to caries development had been acquired.

Foods containing

cooked starch and sucrose enhance caries potential. AVOID these foods/beverages in between meals for caries prev.

Processed high starch snacks

produce as much acid in dental plaque as sucrose alone but at a slower rate.

Non-nutritive sweeteners

offer no energy; can sweeten with little volume

10 to 15Kg per person

per year is the suggested threshold level of sugar content above which a food is highly cariogenic. Factors other than sugar consumption (such as OH, professional care, fluoride use) must be taken into account in explaining variation in caries prevalence.