• We all like a little sugar

Sweet enough?

Sweetness is a wonderful thing. We love it from an early age and often into old age! It is a treat and a temptation, but its appeal can mask a darker side. When it comes to dental health, sweetness can be a 'wolf in sheep's clothing', ready to wreak havoc.

Sweetness is a wonderful thing. We love it from an early age and often into old age! It is a treat and a temptation, but its appeal can mask a darker side. When it comes to dental health, sweetness can be a 'wolf in sheep's clothing', ready to wreak havoc. 


The effects of sugar on dentition are widely acknowledged and its impact on health and weight is becoming more and more topical. In 2013 a study at Newcastle University was commissioned by the World Health Organisation[1] to research into "the effects of sugars on our oral health"[2]. The outcome of the study was the recommendation of a global initiative for a reduction in sweet additives to reduce tooth decay. The study suggested reducing the current WHO recommended intake of 'free sugars' of less than 10% of calorie intake (which in itself helps to lower tooth decay levels), to less than 5%, which would bring the increased benefit of reducing dental cavity risk throughout life. Free sugars include those added to foods and those found in fruit juice, syrups etc.


Sugar substitutes have of course been around a long time and given the effect that sugar has on dentition, it is hardly surprising that many chewing gums offer a sugar free recipe, substituting the sugar with sweeteners. But chewing gum has other attractions besides being a confectionery. The British Dental Health Foundation[3] point out that the acid attack on teeth which can take place after eating can be reduced by chewing sugar-free gum, increasing saliva to help defend against the attack.


Sweeteners have various origins -- both artificial and natural. One sweetener, xylitol, can be derived from a number of sources, including birch bark, and not only imparts a sweet taste, but can bring added value with its use. It has been the subject of considerable research, including the 'Turku Sugr Studies'[4] in the 1970s, followed by research into its effect on dental caries prevention undertaken on a school-based study in Finland in the 1980s[5]. By 1999 research by Hujoel P.P. et al[6] concluded that: "for long-term caries-preventive effects to be maximized, habitual xylitol gum-chewing should be started at least one year before permanent teeth erupt". By 1993 researchers Maguire, A. and Rugg-Gunn, A.J. asked whether, as a caries preventative, xylitol was a "magic bullet"[7] while in 2011, a two-year randomised clinical trial was carried out involving 'Six months of high-dose xylitol in high-risk caries subjects'.[8] This latter study concluded that: 


"The use of a chewing gum containing a high dose of xylitol for a period of 6 months has been shown to produce a long-term effect on caries development in high caries-risk children".


Xyliol has also been found to have an influence in the 'probability' of transmission between mother and child of mutans streptococci, pointing to a reduction in that probability when the mother consumed xylitol[9].


Caries prevention in children and young people is a very important concern and xylitol has also been observed to reduce "plaque formation and bacterial adherence (ie it is antimicrobial), inhibit enamel demineralization (ie, reduces acid production) and has a direct inhibitory effect on MS [mutans streptococci] levels" [10].


Given xylitol's attractions, the potential dental benefits of chewing gum that contains xylitol are worthy of consideration. The encouragement of good oral health and hygiene and the reduction of sugar are important considerations in the battle against decay and they can also contribute to combating other problems too. In 2013 the NHS Dental Contract Reform Programme cited "improving oral health" as one of its two goals and in February 2014 NHS England made a 'call to action' regarding future dental services and a framework that "Encourages a preventative approach to good oral health, including the promotion of self care by patients and a better appreciation of good oral health generally"[11].


Chewing gum that contains xylitol may therefore be a valuable and attractive resource when encouraging patients to take a more active role in their oral health. But what if a patient has additional oral health needs too, such as halitosis? Fortunately, CB12 Boost chewing gum not only contains xylitol, but also fluoride and zinc. This combination, together with a mint flavour, helps to neutralise bad breath when complemented with CB12 oral care agent, offering extra benefits to both halitosis and non-halitosis sufferers.


The philosopher Aristotle referred to the saying "change in all things is sweet"[12]. In terms of patients improving their oral health care routines, such a change - whether regarding a product, routine or both - can only be beneficial. Where it can offer the potential to enhance not only overall dental health, but help with other more specific difficulties too such as halitosis, the taste of change may well be sweet.  

[1] Moynihan, P.J, Kelly S.A.M. Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines. Pub: Journal of Dental Research. January 2014. Vol. 93, no. 1 8-18

[2] University of Newcastle:  www.ncl.ac.uk/press/news/legacy/2013/12/callforactiononcuttingsugar.html

[3] http://www.dentalhealth.org/tell-me-about/topic/caring-for-teeth/sugar-free-chewing-gum

[4] Scheinin A, Mäkinen KK, Ylitalo K.. Turku sugar studies. V. Final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man. Acta Odontol Scand. 1976;34(4):179-216. & Scheinin A, Mäkinen KK, Tammisalo E, Rekola M. Turku sugar studies XVIII. Incidence of dental caries in relation to 1-year consumption of xylitol chewing gum. Acta Odontol Scand. 1975;33(5):269-78.

[5] Isokangas P1, Tiekso J, Alanen P, Mäkinen KK. Long-term effect of xylitol chewing gum on dental caries. Community Dent Oral Epidemiol. 1989 Aug;17(4):200-3.

[6] Hujoel, P.P., Mäkinen, K.K., Bennett, C.A., Isotupa, K.P., Isokangas, P.J., Allen, P. and Makinen, P.-L. The Optimum time to Initiate Habitual Xlitol Gum-chewing for Obtaining Long-term Caries Prevention. Pub: J Dent Res 1999 78(3): 797-803.

[7] Maguire, A. & Rugg-Gunn, A J. Xylitol and caries prevention — is it a magic bullet? British Dental Journal 194, 429 - 436 (2003) 

[8] Campus, G., Cagetti, M.G., Sale, S., Petruzzi, M., Solinas, G., Strohmenger, L., Lingström, P. Six months of high-dose xylitol in high-risk caries subjects – a 2-year randomized, clinical trial. Pub: Clin Oral Investig. Apr 2013; 17(3): 785–791.. Clin Oral Investigations. Apr 2013; 17(3): 785–791. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607712/.

[9] Söderling, E. Isokangas, P, Pienihäkkinen, K . Tenuvuo, J. Influence of maternal xylitol consumption on acquisitionof mutans streptococci by infants. J Dent Res. 2000 Mar; 79(3): 882-7. Also: Söderling, E., Isokangas, P., Pienihäkkinen, K., Tenuvuo, J., Alanen, P. Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow up.  Caries Res. 2001 May-Jun; 35(3): 173-7

[10] Policy on the Use of Xylitol in Caries Prevention. American Academy of Pediatric Dentistry. Originating Council: Council on Clinical Affairs.  Revised 2010. www.aapd.org/media/Policies_Guidelines/P_Xylitol.pdf

[11] http://www.england.nhs.uk/wp-content/uploads/2014/02/imp-dent-care.pdf - ‘Improving Dental Care and Oral Health – a call to action’, page 11.

[12] Nicomachean Ethics (c. 325 BC) . Bk VII. 14