Biochemical effects of and bacteriological response to sugar substitutes in the oral environment.

The problems of the biochemical effects of sugar substitutes and bacteriologic response to such substitutes in the oral cavity may fill a whole book. Therefore, considerable restrictions in the presentation are necessary. Noncaloric sweeteners and additives are not utilized by the oral microorganisms for metabolism and acid production and are therefore of minor interest in this connection. This presentation mainly concerns sugar alcohols and related substances, primarily sorbitol, xylitol and Lycasin. Monosaccharides and other saccharides are not dealt with in this presentation even if some of them are of considerable interest; for example fructose, invert sugar and others. Sugar alcohols are used as substitutes because they cannot be utilized by the vast majority of oral organisms for fermentation, acid production or production of polysaccharides. There is a risk that the oral flora will adapt to these products and that such a substitute, which is originally nonacidogenic, may subsequently be utilized for fermentation and may even induce dental caries.