The amount and frequency of consumption of sweeteners are increasing at an alarming rate, particularly in children. This article focuses on the impact that sugars have on the oral cavity. As such, the effects range from changes in microorganisms to alterations in tooth structure.
Sugar & Caries
A sugar dose refers to one gram of sugar in drinking water or food (usually liquid). It is known as a daily dose if you are consuming a certain number of grams each day. Sugar impacts caries by stimulating plaque formation, promoting acid production, weakening teeth enamel, and inhibiting host defenses (oral flora) against pathogens. In general, the more frequent the exposure to sugar, the greater the risk of developing caries. Sugars can also lead to tooth decay through their effect on the microbiota of the mouth (bacterial overgrowth).
A high carbohydrate diet will increase the total bacterial count in the mouth and the presence of putative mutants streptococci. Thus, the bacteria associated with caries may increase while lactobacilli decrease. However, the relationship between these two groups is complex. Most studies show that mutants’ streptococcal levels decrease when carbohydrates are consumed. Some authors suggest that this decline is due to a reduction in the level of carbohydrate uptake rather than a change in the composition of the bacterial community. These reports allude to the possibility that there is no cause-effect link between elevated carbohydrate consumption and an increase in the incidence of caries.
There is some evidence that diets low in fermentable carbohydrates such as sucrose and fructose can act synergistically with fluoride to reduce the occurrence of root caries.
Fluoride and Sugars
The association between fluorides and sugars has been studied long ago. Fluoride decreases the solubility of calcium hydroxide, which inhibits demineralization. However, when the pH drops, CaF2 dissociates into free ions causing precipitation of calcium. It is hypothesized that this process occurs on enamel surfaces that have absorbed excessive amounts of dietary acids and where sufficient amounts of calcium are absent. Although fluoride and sucrose appear to work together in reducing caries, sucrose may interfere with the effectiveness of fluoride by competing for the available binding sites on hydroxyapatite and altering its crystal structure.
The role of fluoride in sugar metabolism remains unclear. There are several mechanisms by which fluoride might influence the development of dental caries. One proposed mechanism suggests that fluoride prevents or retards the adherence of Streptococcus mutants to salivary pellicles, thereby decreasing colonization in situ. Another hypothesis proposes that intracellular fluoride ions inhibit glycolysis in S.mutans.
Tooth Decay & Diabetes
Diabetes is classified either as Type I or II diabetes. Both types are characterized by chronic insulin deficiency resulting from pancreas dysfunction. People with diabetes who exhibit signs and symptoms of metabolic syndrome have been shown to have higher incidences of dental caries compared to people with diabetes without metabolic syndrome. This was confirmed within six months after diagnosis of DMII. These patients had a much higher prevalence of untreated proximal dentine lesions than healthy controls. The mean lesion score in people with diabetes was 1.47 times greater than in non-diabetics at baseline.
Artificial sweeteners are considered harmful to the human body because they could alter gut microflora and result in many digestive disorders. But people have different opinions about Artificial Sweeteners. Some claimed that there’s no difference in blood glucose control between regular sugar and alternative sweeteners. Others believed that Artificial Sweeteners would help people avoid dental problems.