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. 2010;2010:981072.
doi: 10.1155/2010/981072. Epub 2010 Jan 5.

Sugar Alcohols, Caries Incidence, and Remineralization of Caries Lesions: A Literature Review

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Sugar Alcohols, Caries Incidence, and Remineralization of Caries Lesions: A Literature Review

Kauko K Mäkinen. Int J Dent. .
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Abstract

Remineralization of minor enamel defects is a normal physiological process that is well known to clinicians and researchers in dentistry and oral biology. This process can be facilitated by various dietary and oral hygiene procedures and may also concern dentin caries lesions. Dental caries is reversible if detected and treated sufficiently early. Habitual use of xylitol, a sugar alcohol of the pentitol type, can be associated with significant reduction in caries incidence and with tooth remineralization. Other dietary polyols that can remarkably lower the incidence of caries include erythritol which is a tetritol-type alditol. Based on known molecular parameters of simple dietary alditols, it is conceivable to predict that their efficacy in caries prevention will follow the homologous series, that is, that the number of OH-groups present in the alditol molecule will determine the efficacy as follows: erythritol >/= xylitol > sorbitol. The possible difference between erythritol and xylitol must be confirmed in future clinical trials.

Figures

Figure 1
Figure 1
“How it all began”: a pioneering plaque assessment study carried out in 1970 (a). Effect of dietary carbohydrates and xylitol on the growth of dental plaque after consumption of the shown sweeteners for four days (while the subjects refrained from oral hygiene), mainly in coffee or tea, and in the form of hard candies [11]. The consumption level of each sweetener was about 20 g per day and per subject. The values shown are means ± S.D. of fresh weight of plaque collected from all available tooth surfaces. (b) Inverse relationship between plaque fresh weight and its protein content. Twelve test subjects used xylitol chewing gum five times a day over a period of one month. Plaque from all available surfaces was collected following a 2-day no-oral-hygiene period. Consumption level of xylitol per day and per subject was 6.7 g. Xylitol consumption was associated with reduced plaque mass while the protein content of plaque simultaneously rose from 1.1 ± 0.2 mg to 1.4 ± 0.2 mg per mL of plaque suspension (straight line). Protein and nitrogen analyses should not be claimed to accurately determine the amount of dental plaque in clinical studies involving sugar alcohols.
Figure 2
Figure 2
Relationship between the structural configurations of sorbitol (D-glucitol), D-glucose, and xylitol. The molecular configurations of sorbitol and glucose are relatively similar. Hence, sorbitol can be called a “glucose-polyol”. The configuration of xylitol (a “non-glucose polyol”) markedly differs from the two other configurations. The close similarity of sorbitol with glucose partly explains its plaque-promoting and mutans streptococci-stimulating effects.
Figure 3
Figure 3
A simplified presentation of the competition between water and xylitol molecules for Ca, assumed to play a role in environments involving whole-mouth saliva and plaque fluid. Here, Ca has interacted with six water molecules which constitute the primary hydration layer of the metal ion (the actual number of water molecules surrounding the spherical Ca ion may vary from 4 to 12). The resulting new hydration layer consists of water molecules and xylitol molecules. This leads to stabilization of the salivary Ca phosphate systems [14, 18]. Reproduced with permission [14].
Figure 4
Figure 4
The zigzag structure of xylitol (a) and that of a xylitol-Ca complex (b) assumed to exist also in salivary environments and generally under physiologic conditions in the human body. The double-headed arrow in (a) reflects the special interaction between the oxygen atoms shown. The complex formation can facilitate the transport of Ca through membrane pores and also against weak Ca gradients. This structure may aid in the transport of Ca through the gut wall.
Figure 5
Figure 5
An important sialochemical effect of xylitol diet. Increase of the free amino acid content (in μmol/L, thin line) of whole-mouth saliva after long-term consumption of a xylitol diet, shown in a polar co-ordination diagram [13]. The analysis was carried out on pooled saliva of subjects who had consumed the xylitol diet for 12 to 16.5 months (average consumption level of xylitol: about 65 g/day). The solid black area shows the free amino acid levels in saliva of subjects who consumed a regular sugar-containing diet. The high levels of ammonia and most amino acids (which can in turn serve as sources of further ammonia production) speak for reduced plaque acidity and increased nitrogen metabolism in dental plaque from which a large part of the free amino acid pool of whole-mouth saliva is derived. Non-standard abbreviations: CIT = citrulline; TAU = taurine; PSE = phosphoserine. Reproduced with permission [14].

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