Potential cariogenicity of and parental attitudes towards sucrose substitutes

Abstract

Introduction: Sucrose substitutes are added more and more often to food and drinks. So far, researches have focused on their effects on control of body weight and blood glucose level. Very few studies have been carried out to investigate their effect on dental caries and people’s attitudes towards their use. Objectives: This study aimed to evaluate the in-vitro cariogenicity of isomaltulose, D-tagatose, stevioside and sucralose on human tooth infected with multi-species biofilm. Another aim was to describe the knowledge and attitudes of parents of kindergarten children in Hong Kong regarding sucrose substitutes. Methods: Five groups of human tooth blocks were placed in artificial mouth model for two weeks with a multi-species biofilm in the presence of 5% isomaltulose, 5% D-tagatose, 1% stevioside and 1% sucralose, or 5% sucrose. The bacteria forming the biofilm were Streptococcus mutans, Streptococcus sobrinus, Lactobacillus acidophilus and Lactobacillus rhamnosus. In addition, acidity of the mixed bacterial suspension in the different media after 10 min, 30 min, every hour in the first 8 hours, and 24 hours was measured by a pH meter. Depths of the artificial caries lesions in enamel and dentine were measured by micro-computed tomography. Besides the laboratory studies, a survey was conducted on a sample of kindergarten children and their parents in Hong Kong. Dental caries experience of children was measured by the dmft index. Parental attitudes towards and knowledge of sucrose substitutes were collected from a structured questionnaire and in-depth interviews. Results: The 24-hour pH curves showed less acid was produced when isomaltulose, stevioside and sucralose were used as the substrate compared to when sucrose was used. The respective mean depths of demineralized lesions in dentine of the isomaltulose, stevioside and sucralose groups were 99.4±35.0µm, 57.3±40.1 µm, 41.6±45.2 µm, which were significantly smaller than those of the D-tagatose group and the sucrose group, 160.1±66.6 µm and 201.4±67.8 µm, respectively. A total of 655 parents (543 mothers and 112 fathers) participated in this study and 26 parents completed an interview. Although 41% of the parents preferred to choose sugar-free products for their children, most parents were cautious. More than 80% of the parents agreed that frequent intake of sucrose containing food and beverages could cause dental caries, while only 36% of the parents thought the replacement of sucrose by substitutes might be effective in reducing dental caries in young children. Parents’ most common concern for sucrose substitutes was about safety (91%). Conclusion: Isomaltulose, stevioside and sucralose are less cariogenic than sucrose and have good potentials for use in dental caries prevention by substituting sucrose. The in-vitro cariogenicity of D-tagatose is comparable to sucrose. Most parents of kindergarten children in Hong Kong only have relatively superficial knowledge on sucrose substitutes and they worry about the safety and health effects of these products.