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The Effects of Sugar and Sugar Substitutes on Dental Caries

Sweetness in Practice Contributor - Mar 30, 2016
dental-health blog

Studies have found a direct correlation between the intake of dietary sugars and dental caries.1 In fact, the correlation is so strong that the Academy of Nutrition and Dietetics states, “Nutrition is an integral component of oral health.”2 Diet has a direct impact on the health of the tooth by impacting the amount, pH, and makeup of the saliva as well as the pH of plaque.3 Sugars, once broken down by salivary amylase, provide substrate for oral bacteria, which can then lower the pH of the plaque and saliva and, thereby, start demineralizing the tooth.4 Nutritionally, the chief public health actions to reduce the risk of caries are embracing a balanced diet and following the dietary guidelines and dietary reference intakes.5

When it comes to tooth health, sugar has a bad reputation - for good reason. While the damaging relationship between excess dietary sugar and dental caries is widely known among dental professionals, the potentially positive impact of sugar substitutes on dental caries may be less well known.

It is important to note that all sugar substitutes may not be created equally when it comes to oral health: while it’s likely that most sugar substitutes are less prone to cause dental caries than sugar,6 it is even possible that some may also offer protective benefits that may improve long-term oral health.7 Being able to guide our patients toward sweetener options that can offer added protection against dental caries may give them a leg up in improving their dental health.

Fortunately, substituting sugar with a natural sweetener such as a stevia-based sweetener, may help. Emerging science suggests that sweeteners made from stevia, such as zero-calorie Truvía® Natural Sweetener, may actually have the potential to help protect against dental caries.8 Stevia, as well as sucralose and saccharin, have been shown in an in vitro study to contain antibacterial properties that appear to interfere with oral bacterial metabolism, making them less cariogenic than sucrose.9

Erythritol is another sweetener that should be given consideration when it comes to improved oral health. This sweetener is not converted into acids by bacteria in the mouth, and therefore will not promote tooth decay.[10] In fact, the FDA has authorized the use of a health claim highlighting that noncariogenic carbohydrate sweeteners, such as erythritol, do not promote dental caries.11 Research shows that erythritol may even do a better job of lowering the risk of dental caries compared to the sugar alcohol xylitol, which has previously been promoted as beneficial to oral health.12 Although both of these sweeteners demonstrated dental benefits over the three year study, erythritol usage showed the greater reduction in dental caries.13 Erythritol is sold on its own as granules and is also an ingredient in Truvía® Natural Sweetener.

When it comes to improving the oral health of your patients, recommending that they cut down on added sugars is an important step. In addition, we can educate our patients on using sweetener alternatives that can help maintain the flavors of the foods they love while also offering dental benefits. A sweetener like Truvía® Natural Sweetener, which is composed of erythritol and stevia leaf extract, may help to reduce the risk of dental caries and tooth decay when used in replacement of added sugars. Using Truvía® Natural Sweetener can help your patients enjoy the foods they desire, while also promoting positive oral health.

To learn more about how Truvía® sweetener can play a useful role in a healthy balanced diet, click here. »


  1. Touger-Decker R, van Loveren, C. “Sugars and Dental Caries.” Am J Clin Nutr October 2003 vol. 78 no. 4 881S-892S. Accessed on 16 Mar 2016. Retrieved from http://ajcn.nutrition.org/content/78/4/881S.full

  2. American Dietetic Association. May 2003. Position Paper: Oral Health and Nutrition. J Am Diet Assoc 2003;5:615–25.

  3. Touger-Decker R, van Loveren, C.

  4. Touger-Decker R, van Loveren, C.

  5. Touger-Decker R, van Loveren, C.

  6. Giacaman RA, et al. Cariogenic potential of commercial sweeteners in an experimental biofilm caries model on enamel. Archives of Oral Biology (2013), http://dx.doi.org/10.1016/j.archoralbio.2013.03.00...

  7. Contreras S. Anticariogenic properties and effects on periodontal structures of Stevia rebaudiana Bertoni. Narrative review. J Oral Res 2013; 2(3): 158-166. Accessed on 16 Mar 2016. Retrieved from doi: 10.17126/JORALRES.2013.034

  8. Contreras S.

  9. Giacaman RA, et al.

  10. Runnel R, et al. Effect of three-year consumption of erythritol, xylitol and sorbitol candies on various plaque and salivary caries-related variables. J of Dentistry 2013: 1236-1244. http://dx.doi.org/10.1016/j.jdent.2013.09.007

  11. U.S. Food and Drug Administration. Code of Federal Regulations Title 21. Vol 2. Revised 1 Apr 2015. Accessed on 12 Feb 2016. Retrieved from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/...

  12. Honkala, S., Runnel, R., et al. Effect of Erythritol and Xylitol on Dental Caries Prevention in Children. Caries Research, 2014;48, 482-490. doi: 10.1159000358399

  13. Honkala, S., Runnel, R., et al.