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Dental Studies

Dental considerations in sucralose use.

Mandel ID, Grotz VL. J Clin Dentistry. 2002;13(3):116-118.

Introduction

Dental caries is commonly mediated by oral bacteria that digest fermentable carbohydrates, such as sucrose, glucose, and fructose, resulting in high acid production and altered plaque pH. This causes microscopic demineralization of tooth enamel, with the formation of subsurface carious lesions. With further mineral loss, bacteria penetrate the tooth and cause cavities. Streptococcus mutans is the prime cariogenic organism in this process, and has a special relationship with sucrose, which helps S mutans adhere to the tooth, giving it an advantage over competing organisms.

This central relationship of sucrose to caries initiation is the major reason for interest in sucrose substitutes, like sucralose, which might be hypo- or non-acidogenic
(acid-forming).

This review paper covers the numerous research studies of sucralose and its potential to induce or promote dental caries. The most important of these are as follows:

• In vitro studies of the effect of sucralose on bacterial metabolism
• In vivo animal studies of the effect of sucralose in foods and in solution
• In vivo human studies of the effect of sucralose in common beverages including water, tea, and coffee

In vitro studies

In a study of the effects of sucralose on metabolism in 10 strains of oral bacteria including S mutans, investigators found:

• Sucralose did not support bacterial growth or acid production, providing strong support that sucralose is not cariogenic in vitro

In vivo animal studies

A study of sucralose in rats examined the effects of sucralose on coronal (crown) and root caries. They compared a standard, highly cariogenic diet containing various concentrations of sucrose to the same diet, but with varying concentrations of sucralose, substituting for the sucrose.

• Rats fed the sucralose diet developed significantly fewer dental caries than rats fed the sucrose diet
• Sucralose-fed rats also had 10- to 20-fold lower levels of S mutans

When the rats were desalivated to eliminate the potential protective dental factors in saliva, the incidence (total number) of coronal caries was comparable in the sucrose and sucralose groups, however:

• Coronal caries severity was much lower in the sucralose group
• Root caries developed at a high rate in the sucrose group, but did not develop in the sucralose group

Coronal caries can be expected simply from the presence of the high starch conditions of the diet employed. Therefore, the lack of significant differences in total incidence of coronal caries is not indicative of sucralose cariogenicity, whereas the absence of root caries and the much lower severity of coronal caries indicate that sucralose is not cariogenic in rats.

In a similar study, desalivated rats receiving essential nutrition by gastric lavage were given water with sucrose and fructose or sucralose, bypassing the oral cavity.

• Sucrose and fructose resulted in extensive dental decay
• Sucralose resulted in no dental decay

Additionally, when rats were given a cariogenic diet supplemented by a variety of sweetener solutions

• Sucrose solutions significantly increased the caries scores
• Sucralose solutions had no additional effects
• The combination of fluoride in the nonsugar solutions neither enhanced nor interfered with the caries scores, indicating no negative interaction of sucralose and fluoride

Human studies

The dental effects of sucralose have been evaluated in 3 studies in humans using the widely used in situ plaque pH model methodology. One study compared the effects of 4 aqueous rinses: sucrose (common table sugar), sucralose (SPLENDA^® Brand Sweetener) alone, sucralose with maltodextrin (SPLENDA^® No Calorie Sweetener, Granulated), and sucralose with maltodextrin plus dextrose (SPLENDA^® No Calorie Sweetener, Packets)

• Sucralose alone did not decrease pH values from baseline, and was therefore considered noncariogenic by the investigators
• Sucrose (sugar) resulted in the greatest decrease in pH from baseline
• Both sucralose with maltodextrin and sucralose with maltodextrin plus dextrose decreased pH, but significantly less than did sucrose

Similar results have been observed in 2 other studies, where sugar and sucralose alone, or in combination with the other ingredients present in the retail products, were added to hot coffee or iced tea

• In either coffee or tea, sucralose had no statistically significant effect on dental plaque pH compared to baseline
• Sucrose resulted in the greatest decrease in plaque pH (more acidic). Sucralose with either maltodextrin or maltodextrin plus dextrose increased plaque acidity to a lesser degree than sucrose

Conclusion

• The studies reviewed in this article demonstrate that sucralose does not promote dental caries and fulfills the FDA criteria for noncariogenicity
• Foods sweetened with SPLENDA^® Brand Sweetener (sucralose) may be noncariogenic or have significantly less cariogenicity than foods sweetened with sucrose, depending on the other ingredients in the food
• Both Packet and Granulated SPLENDA^® No Calorie Sweetener are significantly less acidogenic than sugar and, when used to replace sugar, may help in the dietary management of dental caries

The authors conclude that consumption of foods containing sucralose may help improve oral health.