The non-cariogenic effects of aspartame: A systematic review and meta-analysis.

OBJECTIVES

This systematic review and meta-analysis evaluated the cariogenicity of aspartame and explored mechanisms of action.

DATA, SOURCES, AND STUDY SELECTION: A literature search was conducted across PubMed, Web of Science, Scopus, and CENTRAL on February 16th, 2024 (registered with PROSPERO CRD42024513463). Eligible studies evaluated the cariogenicity of aspartame in humans, animals, and dental samples compared to sucrose or other controls. Random effects meta-analysis was conducted on caries incidence, acidogenicity, oral bacterial composition, and mineralization for preclinical and clinical trials. Certainty was assessed using the GRADE framework.

CONCLUSION

Four studies in bovine blocks, seven preclinical trials in rats, and two clinical studies were identified. In clinical studies aspartame was less acidogenic than sucrose (standardized mean difference [95 % confidence interval]: 3.07 [-0.97, 7.10], very low certainty), and similar to water (-0.51 [-1.51, 0.48], low certainty). Preclinical studies indicated aspartame did not promote caries development (-0.01 [-0.31, 0.30], low certainty), reduced caries compared to sucrose (-2.51 [-3.50, -1.52], moderate certainty), but had minimal impact when added to sucrose (-0.53 [-1.29, 0.23], very low certainty), except when assessed in sulcal caries (-0.86 [-1.70, -0.02]). Aspartame had minimal effect on bacterial composition. Studies on bovine blocks indicated aspartame was less acidogenic and erosive than sucrose. While aspartame is a non-cariogenic alternative to sucrose, there is limited evidence supporting anti-cariogenicity. The reduction in caries observed with aspartame use is likely due to its role in minimizing sugar intake rather than biological activity. More long-term studies in humans are needed to fully assess aspartame's impact on oral health.

CLINICAL SIGNIFICANCE

Replacement of sugar with aspartame may help maintain healthy oral pH in humans. Animals fed aspartame instead of sugar consistently develop fewer caries, and lab tests indicate aspartame lessens oral acids and dental erosion compared to sugar.