Sugar, Artificial Sweeteners and Tooth Decay - Sweet!

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By Dr. David Leader

There are many options available to sweeten a cup of coffee or a bowl of breakfast cereal. Parents, who are careful enough to read the list of ingredients on a breakfast bar or a cold drink, may be left cross eyed and uninformed when the list hides sweeteners in plain sight. Which sweeteners are natural sugars, which are not, and which are safe for kids?

Pure cane sugar or sucrose is the standard of sweeteners for taste and use in food and beverage. Sucrose provides the taste that people expect in a sweetener. There are various forms of sucrose available: powdered, granulated, cubes and syrup. Sucrose does not change its flavor when hot. That makes it ideal to use in sauces and baked goods. No one is allergic to sucrose. Even diabetics, who are sensitive to sucrose, may eat reasonable amounts.

There are other kinds of sugar. Fructose is very popular. It is less expensive than sucrose. Fructose carries the same caloric price tag as sucrose, 15 calories per teaspoon or 4 grams. Some industry experts recommend fructose for diabetics. Most physicians do not recommend that diabetics eat large amounts of this sugar.

Honey is a solution primarily of water, fructose, and glucose (another kind of sugar). Honey is just as likely to cause tooth decay and weight gain as any other sugar.

All sugars have two problems, they cause tooth decay and carry a high caloric price tag. Each level teaspoon of sucrose weighs 4 grams and carries 15 calories. A 12-ounce can of soda may have 16 teaspoons of sugar or 240 calories. Sugar use over a long period may induce the serious medical condition, diabetes.

Many items contain sugar without listing sucrose, fructose, or sugar by name. Sucrose is known by many names such as dehydrated cane juice, concentrated beet juice, maltose, turbinado sugar, and brown sugar. Fructose appears on ingredient lists as high fructose corn syrup, corn syrup, concentrated pear juice, levulose, and concentrated apple juice.

Read ingredient lists carefully; some products list small amounts of various sugars to hide the true sugar content. For the actual sugar content, divide the number of grams of sugars by 4 to find the number of teaspoons of sugar per serving.

For example, Kellogg’s Frosted Flakes Milk and Cereal bars list sugar as an ingredient three separate times. The label lists four other sugars as well. That is why even though cereal and milled corn top the ingredient list, sugars make up more than half of the 19 grams of carbohydrate per serving.

Many of the refreshments that we drink every day have more sugar than we imagine. For example, Cranberry juice cocktail contains over one level teaspoon of fructose per ounce of liquid; that means that 12 ounces of “cranberry juice” delivers nearly 200 calories and will cause decay as readily as other sources of sugar. Many carbonated soft drinks carry even more sugar per ounce. The super large soft drink that accompanies a burger at many fast food chains may have more calories than the burger.

Some people choose non-sugar sweeteners to avoid the ill effects of sugar. The most well known is saccharine (available in the popular pink “Sweet and Low” packets). Saccharine is an artificial, non-nutritive (no calorie) sweetener. Aspartame (available as “Equal” in blue packets) is a protein that has a sweet and sugary taste. Aspartame is not as stable as sugar or saccharine in heat or solution, so do not use it for baking, and look for expiration dates on soft drinks that contain Equal. Since the disappearance of the artificial sweetener, cyclamate (sold as “Sugar Twin” in yellow packets) from store shelves in the US in 1969, and the implication of saccharine as a cause of bladder cancer, consumers view other artificial sweeteners with a jaundiced eye.

Xylitol, sorbitol, maltitol, mannitol, and sucralose (available in yellow “Splenda” packets) are sugar alcohols. Sugar alcohols are not sugar or alcohol, but resemble both in some ways. They are stable in heat and solution, and taste like sugar. Sugar alcohols have fewer calories than sugar.

Delta Dental of Massachusetts and other dental health agencies promote the use of Xylitol due to its anticariogenic (anti-cavity) effect. In other words, there is scientific evidence that Xylitol (better than other sugar alcohols) prevents tooth decay by killing bacteria that harm teeth.

Stevia is a sweet herb. This “dietary supplement” is available in convenient paper packets with the dosage advice “Add one packet to your food or beverage.” The Food and Drug Administration (FDA) does not consider Stevia safe enough to be sold as a food or food additive. Dietary supplements face a much lower level of scrutiny. The best advice is to stay away from Stevia until its safety can be proven.

How much sweetener is too much? There are two considerations for sugars. Eating or drinking large quantities of sugars will provide extra calories, and some bacteria will cause tooth decay when exposed to sugar. Fight the number of calories by lowering the overall quantity of dietary sugars. Fight cavities by decreasing the frequency of sugar consumption.

When decay-causing bacteria contact sugar, the bacteria will produce acid. The acid eats into teeth and forms cavities. Bacteria will continue to produce acid for twenty minutes after the sugar is gone. That is why babies who sip on formula or mother’s milk for hours at a time or an adult who sips sugary beverages or eats candy all day will develop serious tooth decay. Sticky sweets like dried fruit (raisins and prunes) and chewy fruit snacks (Fruit by the Foot and Fruit Roll Ups) stick to teeth and lengthen the amount of time sugar is available to bacteria. To decrease tooth decay, decrease the number of times per day that sugar is eaten and the length of time sugar stays in the mouth.

Some people believe that artificial sweeteners are not safe. If artificial sweeteners are not safe, then using less is safer. Eating 20 to 50 grams of sugar alcohol per day may have a laxative effect. The exact dose depends on which sugar alcohol and the person using it.

Dentists and dental hygienists receive training on nutrition and the effects of sugar. If you have further questions, please ask your dental health team.

Dr. David Leader is the Chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs.