It is well known that lots of sugar over time can increase the chance of cavities. What about “sugar free” products? What about a diet Coke? Is that as bad as the original? Here are some of the options out there today: Saccharin, Equal, Splenda, Stevia, Susta, Xylitol, Sorbitol, Mannitol, etc. Most people use diet or sugar free products to reduce calories–to diet. Some avoid sugar due to medical conditions like diabetes. What about dental caries?

Sucrose (table sugar) is made up of two molecules, glucose and fructose:

The bacteria that contribute to cavities feed off sugars to produce tooth damaging acids. However, other carbohydrates can be just as bad, or worse. Why? Well, a cracker stuck between the teeth can break down into sugars. The fact it is there for a longer time can make the situation worse. After a sugar “attack” the ph around the teeth goes down (more acid) for about 30 minutes or so. If you can brush within that time, or even just rinse out with water, that will help. The fluoride in the toothpaste helps as well. Will switching to a sugar free product help? Well, maybe.

Xylitol:

Most of the information out there seems to be on the caloric content of these products not the cariogenic potential. More people are concerned with loosing weight than preventing cavities. The one product where there seems to be a good deal of solid research is Xylitol. It’s good in small quantities. You may see this in some chewing gum. There is actually a beneficial effect of Xylitol. See my post here on that: Chewing Gum, Good or Bad? I recommend Xylitol products to my patients based on the research.

As far as all the others, well, it is my summation to say I think there is far less potential for cavity formation with sugar substitutes, but the potential is still there to a lesser degree. Just because you switch to a diet coke will not mean you’ll never get a cavity. Sucrose may be the worst, but bacteria can find a way to metabolize different compounds in some way. So, if you want to loose weight or have diabetic concerns, you will definitely consider the alternatives to sucrose. The reduced cariogenic potential of the substitutes may be beneficial as well. Be aware that certain products like colas, have other ingredients, like phosphoric acid (to enhance flavor), that may also lower ph.

I will not go into a long dissertation about all the products and their chemical structures, but here is a reasonably good link for info on that: Sugar Substitutes and Artificial Sweeteners

Journal of the American Dental Association Article: Are sugar substitutes also anticariogenic?

Pediatric Dentist