Maltitol In Sugar-Free Confectionery: Boosting Oral Health Benefits

Introduction

Polyols such as sorbitol, maltitol, mannitol and xylitol are hydrogenated carbohydrates which can be found naturally in some fruits and vegetables. They provide a sweet taste, but are different from normal sugar.

A definite advantage of polyols over normal table sugar is their calorie content; table sugars contain 4 kcal/g while polyols only contain 2.4 kcal/g. They are therefore used as sugar replacers in food, oral care and pharmaceuticals products.

What Is Dental Caries?

Dental caries is an infection that causes demineralisation of the hard tissues of the teeth caused by acid, which is produced from the fermentation of carbohydrates by dental plaque bacteria.

Produced in sufficient amounts, the acid causes the oral pH value to drop below 5.7 and subsequently dissolves the tooth enamel. If the acidification of the tooth surface is sustained over time, remineralisation of the enamel cannot occur and a cavity is created, leading to oral health issues.

Dental Plaque—One Of The Principal Contributors To Tooth Decay

Dental plaque resident microbiota comprises mainly ‘safe’ bacteria, but it can also accommodate some potential pathogens; both conditions can be compatible with health.

Potential pathogenic bacteria in dental plaque are mainly mutans streptococci and lactobacilli, which are capable of demineralising enamel. They can be found naturally in dental plaque. With a conventional diet, these potentially cariogenic (tooth decay- causing) bacteria do not produce a lot of acid, and the processes of demineralisation-remineralisation are in equilibrium.

The development of tooth decay occurs when several conditions are met, such as demineralisation of the tooth, cariogenic bacterial overload in the dental plaque, and also when the pH of saliva is low, i.e. acidic.

Sweetpearl Maltitol ® Consumption Does Not Contribute To Dental Plaque Acidification

Figure 1: pH-telemetry record of maltitol SweetPearl® and sucrose control solutions (Macioce et al., 2011).

Using the pH-telemetry method, an assay carried out on European and Chinese volunteers without any differences between the two ethnic populations (Macioce et al., 2011; figure 1) showed that SweetPearl® maltitol consumption does not lead to acidification of the dental plaque, nor does it cause a decrease of its pH value below the critical 5.7. It can therefore help manufacturers claim “Tooth-friendly International” on the label.

Maltitol Sweetpearl® Has A Positive Effect On Saliva Parameters Involved In Oral Health

Saliva contributes to tooth decay through its biological activities such as enzymatic fermentation of carbohydrates into acids or buffering activity.

Study results (Macioce et al., 2010) showed that four weeks’ consumption of maltitol chewing gum had a positive impact on saliva: it increased flow rate and buffering capacity as compared with a gum base stimulation. It also decreased the activity of some carbohydrate-degrading enzymes (glucan sucrase) and the concentration of specific binding proteins (free sialic acids).

These benefits may be due to the modulation of the oral microbiota towards less acidogenic bacterial species after regular consumption of maltitol. However, this hypothesis needs further investigations to be demonstrated properly.

Sweetpearl® Maltitol Improves Dental Enamel Remineralisation

The consumption of the sugar-free maltitol chewing gums enhanced the remineralisation of the dental enamel as compared to the consumption of sugar-sweetened chewing gums (Lee et al., 2009).

In the eight-week clinical trial, healthy adults consumed chewing gums sweetened with SweetPearl® maltitol or sucrose (among other sweeteners. Electron microscopy was used to evaluate the micro hardness of the enamel surface in this study. Results showed that chewing the maltitol gum made it possible to remineralise the enamel at the tooth surface with fewer lesions than after chewing a sugar gum (figure 2).

[Figure 2: scanning electron microscopy of the enamel surface of the tooth. The dental surface in the SweetPearl® Maltitol group (left) displays fewer micro lesions than in the sugar-containing chewing gum group (right) (Lee et al., 2009).]

Sweetpearl® Maltitol And Oral Health: Beyond Tooth Decay

Gingivitis is a common oral health issue in the adult population which may lead to gum disease and even tooth loss. A recent clinical trial by ACTA (University of Amsterdam, the Netherlands) demonstrated that the consumption of sugar-free chewing gums sweetened with SweetPearl® Maltitol, significantly reduced gum bleeding (a marker of gingivitis onset) in a split mouth model of experimental gingivitis.

Briefly, after a 15-day period of wash-out, volunteers were asked to brush only the teeth of the upper jaw and not those of the lower (i.e. “gingivitis” jaw). They consumed sugar-free chewing gums five times a day for 21 days. At the end of the trial, the bleeding score was significantly lower in the maltitol-sweetened group as compared to the gum base group, where the chewing gum only comprised gum base and no polyol.

The consumption of maltitol-sweetened chewing gums may therefore prevent the development of gingivitis (Keukenmeester et al., 2014). This benefit can support long-term protection of oral health capital such as in the senior population.