Increasingly,
sweeteners are being used in the diets of caries-prone individuals to reduce
sugar intake. Such substitution deprives the bacteria in the
dental plaque of the
sugars many of them use to produce the
acids that cause demineralization of tooth tissue and development of the caries lesion.
Sweeteners are particularly effective replacements for
dietary sugars because they also stimulate the flow of saliva which can, through several mechanisms, prevent demineralization and even bring about remineralization of already demineralized enamel, dentine or cementum. More saliva means that more of its
nitrogen-containing substances will reach the
dental plaque where they can be degraded by plaque bacteria and thus produce base and the alkaline conditions that are conducive to a shift from
tooth demineralization to
tooth remineralization. At the same time, the additional saliva brings to the plaque more
calcium and
phosphate ions, the necessary ingredients for the remineralization process. At alkaline pH, saliva also provides a source of easily solubilized
calcium phosphate that, in association with salivary
carbohydrate protein, becomes part of the
dental plaque. Because it is dissolved by
acid more easily than is the
calcium phosphate of the tooth, plaque
calcium phosphate acts as a substitute for the tooth tissues when periods of
acid attack occur following
sugar ingestion. It is proposed that diagnostic tests be developed that can conveniently determine the
acid-base and demineralization-remineralization potentials of different dental plaques and that these tests be used to determine the extent to which
sugars in the diets of caries-active individuals be replaced with
sweeteners.