Preventive lecture #4

Outline: 
Classification of non sugar sweeteners.
The effect of chewing gum.
Tooth Friendly sweets.
Prevention of dental caries by diet control.
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Classification of non sugar sweeteners-:
non sugar sweeteners were developed to overcome the problems that are associated with sugars with regard to medical conditions of a person" diabetes". And to add the sweet taste of sugars to food without the damaging effect of adding actual sugars.

classified primarily into two groups : 
1. bulk sweeteners. 
2. Intense sweeteners.

bulk sweeteners are about the same sweetness of sugars gram-for-gram.
1 gram of bulk sweeteners have the same taste/ sweetness of 1 gram of actual sugars.    
Bulk sweeteners provide calories, and it is cariogenic but fermented by the bacteria at a slow rate that makes it virtually non-cariogenic.

 Side effects of bulk sweeteners: 
Osmotic diarrhea, because they are only partially absorbed in the small intestines, and that's why they are not recommended for very young patient 3 years and below.

Intense sweeteners are many, many times sweeter than sucrose, provide 0 calories and it's non-cariogenic as bacteria cannot ferment it, meaning that it cannot be metabolized by our oral bacteria. 

Non sugar sweeteners approved in the UK:
Bulk sweeteners-: 
- Xylitol. 
- Sorbitol. 
- Malitol.
- Lactinol.
- Mannitol.
- Tylenol.   

Intense sweeteners-: 
- Saccharin
- Aspartame
- Acesulfame K (ace K)

Such sweeteners can be seen in; oral Meds, tooth pastes, chewing gum, and sweets. " Sorbitol and Malitol" these two have the same props, and used similarly as mentioned here but manufacturers prefer Sorbitol over Malitol due to low cast, more profit equation. 

Xylitol is a naturally occurring sugar, found in fruits and veggies, as well as produced in the human body. 
strawberries are high in Xylitol, and the commercial type Xylitol is actually derived from Corn. 
Turco study group that consumed Xylitol had an 85% reduction in dental caries as opposed to groups that consumed sucrose and fructose. 
Xylitol posses an anti-cariogenic property; basically Xylitol affects the ability of bacteria to stick to the tooth surface, this affects the number of Strep. mutans that can adhere to the tooth surface. 

Xylitol is present in chewing gum, certain sweets, and is used in the pediatric department in perinatal health care.  

In 1879 Saccharin -which is an intense sweetener- was accidentally discovered Constantine Fahlberg. 

Saccharin is 300 times sweeter than sucrose, after consumption a bitter taste develops in the mouth, it is used in soft drinks and 
table top sweeteners. 

Acesulfame K is 100 times sweeter than sucrose, found in certain types of yogurt and yogurt drinks.

 Aspartame is mostly added into soft drinks. It is a dipeptide, made of aspartic acid and phenyl-alanine. And it is digested as a protein. Certain patient cannot digest it and this is one of it's disadvantages. 

The effect of chewing gum? Sugared and sugarless. 

1.Sugared gum vs. no gum at all? The group with no gum had less caries than the group consuming sugared gum. 

2.Sugared gum vs. sugarless gum? There was a substantial reduction in caries in the group consuming sugarless gum. 

Gum induces salivary flow, and with sugarless gum there was a decrease in caries activity. 

3.Sugarless gum vs. no gum at all? Caries development was decreased in groups taking sugarless gum, so there is a definitive benefit for sugarless gum over no gum at all. 

But, which type of sugars? 
Xylitol is superior when it comes to reducing dental carries in both dentitions; primary and permanent. 

Xylitol is superior to Sorbitol in reducing caries activity in both dentitions.  
Chewing 10 times/day is better than 3/day in terms of reducing caries activity. 

Children who had Xylitol gum were actually with lower levels of Strep. mutans than those who hadn't.

Tooth Friendly sweets-: 

Are considered non cariogenic sweets and are substitutes for ordinary sugars in various sweets/ foods. And they contain the combination of bulk sweeteners, Xylitol and Sorbitol previously talked about. 

Examples: 
Smints 
Chupa-Chups 
 
Although tooth friendly sugars are effective they have received some criticism, higher consumption of these sugars induce osmotic diarrhea, and getting used to the sweet taste not knowing the difference between sugarless and actual sugary foods. To children after all it is all sugars and it is all what they need regardless of where the sweetness is coming from.

Prevention of dental caries by diet control-: 

The role of diet involves a modification of behavior which is difficult, and the idea is to start earlier, as a child patient.
Involves a reduction in the non-milk, extrinsic sugars.
A healthy diet constitutes-:General guidelines for a healthy diet.

- eating a variety of foods.
- get minerals and nutrients. 
- eating the right amount.
- get foods plenty in starch and fibers.  
- eating the right amount of fruits and veggies, the recommended amount is 5 servings a day at every meal and between meals. 
- get the right amount of fat not more. 
- don’t have sugary foods and drinks often. 

The effect of diet on teeth health arises more importantly when the teeth erupt. 

Non-milk extrinsic sugar shouldn't provide more than 10% of the source of energy in the diet which is 60 grams/ day. 

an example of 60 grams/ day: 

1. Coca-Cola 35grams of sugar.  
2. Kit Kat 29.3grams of sugar.

Asil Marahle.