This document provides an overview of sugar substitutes and their classification. It discusses both nutritive sweeteners like sugar alcohols and non-nutritive artificial sweeteners approved by the FDA. Key points include common sugar substitutes like aspartame, saccharin, sucralose and acesulfame-K and their sweetness relative to sucrose as well as potential health benefits and risks. Natural sweeteners such as stevia, licorice and monellin are also reviewed.

1. sugar substitutes
Presented by:
Dr. swati verma
MDS- Ist year

2. Contents
 Introduction
 Types of sugar substitutes
 Classification
 Ideal requirements
 Sweet score & USDA Food pyramid
 Health benefits of AS
 FDA approved AS –benefits & toxic effects
 Polyalcohols
 Natural sweeteners
 Tooth friendly sweet concept
 References

3. INTRODUCTION
WSRO STATEMENT ,NOV.2011
 Sugar (sucrose) being most acceptable sweetening
agent in use by mankind is considered as the “Arch
Criminal” in dental caries initiation.
 Dental caries occur when acid-producing bacteria,
especially Mutans streptococci, Lactobacilli and
Actinomyces species, populate the sticky coating on
the surface of tooth.
 Frequent consumption of fermentable
carbohydrates, including sucrose, has a role in the
aetiology of dental caries.

4. Sugar substitutes
 Artificial sweeteners are
called as sugar
substitutes
 Added to foods to
provide sweetness
without adding extra
calories
 2 kind of sweeteners
 Nutritive
 Non-nutritive

5. Types of nutritive sweeteners
 Sugar sweeteners
 High fructose corn syrups
 Glucose
 Dextrose
 Lactose
 Maltose
 Honey
 Concentrated fruit juices
 Reduced energy polyols or
sugar alcohols
 Sorbitol
 Xylitol
 Mannitol
 Hydrogenated starch hydrolysates
(HSH)

6. CALORIC
Poly
alcohols/sugar
alcohols.
Xylitol
Sorbitol
lactilol
Hydrogenated
starch
hydrolysate
Lycasin
Palatinit
Coupling sugar
Sorbose
Palatinose
NON CALORIC
Saccharin
Aspartame
Sucralose
Neotame
Cyclamate
Classification

7. A)Natural
• 1. Monellin
• 2. Licorice
• 3. Dihydrochalcone
• 4. Miraculin
B)Artificial
• 1. Aspartame
• 2. Saccharin
• 3. Cyclamate
• 4. Sucralose
Based on their
origin
Pramod Yadav et al. sugar substitutes & health . IOSR
Journal of Dental and Medical Sciences (IOSR-JDMS)

8. Ideal requirements
Should provide sweetness with no unpleasant after taste
Should have little or no calories
Should not be carcinogenic or mutagenic
Should be economical to produce
Should not be degraded by heat when cooked

9. SWEET SCORE
 SWEETS : FREQUENCY X SCORE
 Liquid : _ x 5
Solid : _ x 10
 Slowly dissolving : _ x 15
Total sweet score: — Interpretation sweet score
5 or less: excellent
10: good
15 or more: “watch out” zone
Diet Counselling – A Primordial Level of Prevention of
Dental Caries. Journal of Dental and Medical Sciences
(IOSR-JDMS) Volume 13, Issue 1 Ver. II (Jan. 2014), PP
64-70

10. USdA FOOD PYRAMID

11. Health benefits of AS
 Weight loss
 Dental care
 Diabetes
mellitus
 Cost

12. 5 Artificial
sweeteners
approved by
FDA
Sacchari
n
Aspartam
e
Acesulfa
me K
sucralos
e
Neotam
e

13. SACCHARIN
 Discovered by Remsen &
Fahlberg in 1879
 Oldest of artificial
sweeteners
 200-700 times sweeter
than sucrose
 Available in liquid & tablet
forms as a tabletop
sweetener, has a slightly

14. Benefits
Calorie free
 Pharmacologically inert & is stable under
moist conditions encountered in food
preparations
 Heat stable

15.  Excretes almost without
metabolic alteration, 75% -
90% in urine
 Brand name – Sweet ‘N
Low & Sugar Twin

16. Dental aspects
 Saccharin 0.5%
,when used as a
supplement to a
cariogenic diet , it
significantly reduced
both fissure and
smooth surface caries
in rats, apparently by
interfering with the
growth of S.mutans.

17. Adverse effects
 Oral dose of 5-25 gm daily may cause anorexia,
nausea & vomiting
 Bladder cancer
 FDA , 1972 – Set limits on the use of saccharin
(1gm/day for a 155 lb person)
 Reuber MD, 1977 – experimental group of rats
which had 5% saccharin in their diet had higher
incidence of bladder cancer than control group of
rats.
 Howe et al, 1977 – conducted a study on
hospitalized patients with bladder cancer. Risk of
bladder cancer was 60% higher among men who
had used saccharin tablets

18. Aspartame
 Combination of amino acids
Aspartic acid & Phenylalanine
 It is about 180-200 times
sweet as sucrose
 Caloric value of 4 cal/gm
Kroger et al (2006)-low calorie sweeteners & other substitutes- a review of
safety issue .vol.5

19.  ADI- 50 mg/kg/d
 Effective in enhancing acid
fruit flavors & extending sweet
taste as in chewing gums
Brand names – Nutrasweet,
Equal

20. Food containing Aspartame

21. Toxic effects
Acute
 Headache
 dry mouth
 dizziness
 mood change
 nausea
 Vomiting
 thrombocytopenia
Chronic
Lymphomas
Liver dysfunction
Whitehouse et al.(2008)the potential toxicity of artificial sweeteners-
vol.56.No.6

22. Disadvantages
Risk of fetal abnormalities & mental
retardation if blood levels of phenylalanine
are not carefully maintained below
12mg/100ml, during pregnancy for persons
with PKU (FDA, 1981)

23. Acesulfame K
200 times sweeter than
sucrose
 First approved by FDA in
1988 for use as a sweetener
in dry food products .
Used in yogurt,
refrigerated desserts,syrups.

24. ADI- 15 mg/kg/d
Brand names – Sunett &
Sweet one

25. Advantages
 Calorie free
 No evidence of
carcinogenicity,
mutagenicity, cytotoxicity &
teratogenicity
 Excellent shelf life so it is
used in candies,canned
food and alcoholic
beverages
 Disadvantages
 Headache

26. Sucralose
 Discovered in 1976
 Non- nutritive, non caloric
derivative of sucrose
 6oo times sweeter than sucrose
 Sold under the trade name
SPLENDA
 Widely used throughout the
world in tea, coffee, carbonated
& non- carbonated beverages,
chewing gums etc.
 ADI- 5 mg/kg/d

27.  Advantages
 Non-cariogenic
 Nutritive value is zero calories
 Disadvantages
 Diarrhoea
 Dizziness
 Stomach pain

28. NEOTAME
 Newest of the low calorie sweeteners
 8000 times sweeter than sucrose
 ADI- 2 mg/kg/d
• Found in baked foods, soft drinks, chewing gum,
frosting, frozen desserts, jams, jellies, gelatins,
puddings, processed fruits, toppings, and syrups.
TOXIC EFFECTS
• Headache
• Hepatotoxicity at high doses

29. Polyalcohols

30. Sorbitol
 Occurs naturally in cherries,
plums ,pears, apples.
 Prepared from glucose by
high pressure hydrogenation
or by electrolytic reduction.
• 1 gm sorbitol yields 4 calories
• Recommended intake by Food
& Agricultural organization (
WHO) 150mg/kg/day
oxidoreductase
 Sorbitol
fructose

31.  Advantage
 Can be used by only 5-10% of bacteria in
plaque – less acid production ( Kalfas et al,
1990)
 Disadvantage
 Too much sorbitol consumption ( >20-30gm)
can cause diarrhoea. It act as a laxative
because of osmotic transfer of water into the
bowel.

32. Xylitol
 Obtained commercially from
birch trees.
 Naturally in fruits and
vegetables (strawberries,
raspberries, plums), oats,
certain mushrooms.
 Commonly used by diabetic
patients.
 High dosage causes
diarrhoea.
 The recommended dose for

33.  A study conducted in Turku, Finland,
evaluated the effectiveness of xylitol on
dental plaque reduction in 1970.
 xylitol has been widely researched and
globally accepted as a natural sweetener
approved by the US Food and Drug
Administration (FDA) and the American
Academy of Pediatric Dentistry.

34. Guideline on Xylitol Use in Caries Prevention.by

35. xylitol is incorporated into the cells of MS
as xylitol-5-phosphate, through the
phosphoenolpyruvate phosphotransferase
system. This results in inhibition of both
growth and acid production.
Nayak et al.(2014)The effect of xylitol on dental
caries
and oral flora. Clinical, Cosmetic and Investigational

36. MECHANISM OF ACTION
Xylitol reduces the levels of mutans streptococci in plaque and saliva by
disrupting their energy production processes, leading to cell death.
It reduces the adhesion of these microorganisms to the teeth surface
and also reduces their acid production potential.
promotes mineralization by increasing the salivary flow when used as
chewing gum
Xylitol alcohol has been shown to impact growth of nasopharyngeal
bacteria such as S. pneumonia and S. mitis, and hence has a role to
play in nasopharyngeal pneumonia

37. Oral health benefits
 Decreases incidence of caries by ng salivary
flow
 Reducing
 Cariogenic bacteria
 Plaque level
 Xerostomia
 Gingival inflammation
 Erosion

38.  Milgrom et al.studied the effect of habitual
consumption of
xylitol gummy bear snacks (11.7 g/d) in reducing
cariogenic
microorganisms in school-going children. And found
significant reduction in S. mutans and S. sobrinus.
 Murthykumar reported in 2013 that xylitol in milk
demonstrated a beneficial anticaries effect and is
well accepted by both children and adults.
 Shikhar kumar et al (2013) concluded that Children
consuming the sugar-free (xylitol) chewing gum
showed a marked increase in the pH of saliva.

41. Lactilol
 Sugar alcohol used as a
replacement bulk sweetener
for low calorie foods
 40% as sweet as sucrose
 Provides 2.4 cal/g
 Used in sugar-free candies,
cookies (biscuits), chocolate,
and ice cream

42. Advantages
 Highly stable, can be used in baking
 Promotes colon health as a prebiotic
 Laxative and is used to prevent or treat
constipation
Disadvantages
 Cramping, flatulence & diarrhoea

43. High fructose corn syrup(HFCS)
 Mixture of glucose & fructose
 Produced from corn syrup
 2 most common types
 HFCS 42 = 42% fructose, 58%
glucose
 HFCS 55 = 55% fructose, 45%
glucose

44. ROLE OF HFCS
 Baked goods – give a brown
crust, enhances flavour in fruit
fillings
 Yogurt – enhances flavor,
controls moisture.
 Sauces & condiments –
enhances flavor & balance
 Canned & frozen fruit – Protect
the firm texture of canned fruit,
reduces freezer burns on frozen
fruits
 Beverages – Provide greater
stability than sucrose in acidic
carbonated sodas .

45. Toxic effects
 Fat deposits in liver
 Narrowing of blood vessel
 Triggers asthma, food allergies
and damages immune system
 Accelerates the ageing process
 Mercury poisoning as HFCS
contains mercury.
Dr.mercola- Bad to the Last Drop: Refiners Squeeze
Dangerous Additives from Corn

46. Natural sweeteners

47. Stevioside
 Found in leaves of stevia rebaudiana.
 Calorie free, non-cariogenic
 300 times sweeter than sucrose
 Brand name – pure via, truvia

48. Miraculin
Shrub grown in West Africa
produces berries that have
property of causing sour
substances to taste sweet
 Active ingredient
(miraculin)is a glycoprotein
with a molecular weight of
about 44,000

49.  Effective in sweetening citrus fruits,berries,yogurt etc.
 Trade name- miralin miracle fruit drops

50. Licorice (ammoniated glycyrrhizin)
 Derived from licorice root( glycyrrhiza glabra)
 50 times as sweet as sucrose
 Used as expectorant & pharmaceutical vehicles
 Reduce the solubility of enamel & prevent fall in
pH during incubation of saliva-glucose mixtures

51. Monellin
 Red berries growing in
grape like cluster.
 Serendipity berries
 3000 times sweeter than
sucrose
 Loses its sweetness
within about a day, if left
standing at room
temperature

52. Tooth friendly sweet concept
 Started in switzerland in 1989.
 To provide consumers with easy guidance to
toothfriendly products, the Toothfriendly ("Happy
Tooth") label was created.
 Lollipops
 mints
 chewing gums
 Pastilles

53.  Tooth friendly bubble gum
concept was presented by
BENEO with palatinose .
 These chewing gums are
derived from sugar beet
 low glycemic response which
is approved by EHA.
 Reduced stickiness

54. References
 Pediatric dentistry priciples & practice- MS muthu 2nd
edition
 Cariology –Ernst newburn ,1st edition
 Textbook of pediatric dentistry- Nikhil marwah -2nd
edition
 Roshan NM, Sakeenabi M. Practical problems in use
of sugar substitutes in preventive dentistry. JISPPD
2011;1(1): 1-8
 Bray GA et al. Consumption of high fructose corn
syrup in beverages may play a role in the epidemic of
obesity. Am J Clin Nutr 2004;79:537-43
 Kroger M. Low calorie sweetners & other sugar
substitutes: A review of safety issues. Comprehensive

55.  AAPD. Policy on the use of xylitol in caries
prevention. Reference manual; 34(6): 45-47
 Whitehouse et al. The Potential Toxicity of
Artificial Sweeteners. American Association of
Occupational Health Nurses Journal. 2008;
56(6),251-259.
 Raben Anne et al. Sucrose compared with
artificial sweeteners. The Americal journal of
Clinical Nutrition. 2002; 76,721–729.

56.  Matsukubo and Takazoe: Sucrose substitutes and
their role in caries prevention, International Dental
Journal (2006) Vol. 56/No.3.
 Pramod Yadav et al. sugar substitutes & health .
IOSR Journal of Dental and Medical Sciences (IOSR-
JDMS) Volume 13, Issue 8 Ver. III (Aug. 2014).
 Oku T et al. Digestion, absorption, fermentation &
metabolism of sugar substitutes. Pure Appl Chem,
2002; 74(7): 1253-61
• Guideline on Xylitol Use in Caries Prevention.by
AAPD (2011)

57.  Kumar, et al.: Effects of xylitol on salivary and
dental plaque pH in children. JISPPD OCT-DEC
2013 ,vol.31.issue 4 .
• Nayak et al.(2014)The effect of xylitol on dental
caries
and oral flora. Clinical, Cosmetic and
Investigational Dentistry
• Diet Counselling – A Primordial Level of
Prevention of Dental Caries.Journal of Dental and
Medical Sciences (IOSR-JDMS) Volume 13,