Effect of Maltitol or Xylitol Sugar-Free Chewing Gums on Salivary Parameters Related to Dental Caries Development
The Science Behind

Effect of Maltitol or Xylitol Sugar-Free Chewing Gums on Salivary Parameters Related to Dental Caries Development

Clinical approach to investigate the oral health benefits of maltitol.

Authors

Authors

  • Berard M. - formerly with Roquette, Shanghai, China
  • Guérin-Deremaux L. - Roquette Frères, Lestrem, France
  • Lefranc-Millot C. - Roquette Frères, Lestrem, France
  • Macioce V. - formerly with Roquette Frères, Lestrem, France
  • Thabuis C.Roquette Frères, Lestrem, France
  • Wang X. - Tongji University, School of Stomatology, the affiliated stomatology hospital of Tongji University, China
  • Wils D. - Roquette Frères, Lestrem, France
  • Zhong B. - Tongji University, School of Stomatology, the affiliated stomatology hospital of Tongji University, China

 

In the present study, the impact of maltitol containing chewing-gums on salivary parameters was evaluated in children.

Introduction

Saliva and dental caries

The development of dental caries is a complex phenomenon involving many factors, including saliva secretion and salivary components, as described in figure 1 (1). It is generally accepted that saliva is of crucial importance for dental health through clearance of food remnants and bacterial metabolites, defense against microorganisms, buffering capacity protecting the oral cavity against damaging pH changes, and remineralization at neutral pH owing to ions content.

Polyols and dental caries

Polyols are hydrogenated carbohydrates (also called sugar alcohols) used as sugar replacers. Unlike sugars, they are not fermented by the microorganisms present in the oral cavity and the dental plaque: they have all been tested and classified as hypo- or non-acidogenic.
Many studies have shown the oral health benefits of polyol-based chewing gums (CG). The present study examined whether these benefits are due to the mere action of chewing, which increases salivary flow, or if the polyols themselves have a specific effect.

The different polyols

Three of the polyols most frequently used in sugars-free products are xylitol, maltitol, and sorbitol. Even though xylitol has been the most extensively studied regarding dental properties, it seems that chewing sugars-free CG three or more times daily for prolonged periods of time may reduce caries incidence irrespective of the type of sugar alcohol added (2). The present study focuses on maltitol and compares its effects to those of xylitol.

Materials and methods

Objectives

Primary objective: Evaluation of the impact of SweetPearl® maltitol chewing gum (CG) on saliva and plaque parameters to prevent dental caries. This poster focuses on plaque parameters, and results on saliva flow and composition are presented in another one (3).

Secondary objectives:

  • Comparison of xylitol and maltitol CG effects
  • Evaluation of the digestive tolerance of the CG
 
Study design
  • Double controlled, double-blind, parallel, randomized according to gender and baseline plaque
  • index, single center
  • Implementation in China
  • Subjects: 240 children (4 x 60) - _ and _ -13 to 15 years
  • Four groups (parallel study): Maltitol CG / Xylitol CG / Gum Base CG / No gum
  • CG administration:
    o 5 intakes per day (after main meals and before sleeping) chewed for 10 minutes for 30 days
    o polyols CG: 2 pellets/intake (= 0.7g gum base); 57% xylitol or maltitol
    o Gum Base CG: 1 pellet/intake (= 0.7g gum base)
  • One tooth brushing/day (in the morning or after the clinical examination)

Results and Discussion

Salivary flow
  • Mastication increased the salivary flow rate
  • There was a clear polyol effect: Starting from Day 1 (cf. figure 2), polyols CG showed a consistent increase in the salivary flow compared to Gum Base CG.
  • A similar result was observed at Day 27 (data not shown).

Increased salivary flow rate is associated with faster clearance and higher buffer capacity.

Glucan sucrase activity
  • On Day 14 and Day 28, polyols CG showed a significant, consistent decrease in the salivary glucan sucrase activity compared to Gum Base CG

Glucan sucrase is an enzyme involved in sucrose cleaving. A decrease in its activity prevents plaque formation through decreased sucrose utilization.

Salivary pH
  • The cross-sectional comparison showed that at Day 1 (cf. figure 3) as well as at Day 27 (data not shown), the maltitol and xylitol groups
  • showed a higher rate of increase in salivary pH compared to the gum base and the no gum groups.
  • This suggests a polyol effect in addition to the impact of chewing

Increased salivary pH helps to counteract the acidification of dental plaque.

Free sialic acid concentration
  • On Day 14, the three gum groups showed a significant, consistent decrease in the salivary-free sialic acid concentration.
  • On Day 28, a steady decline was evident for polyols CG compared to Gum Base CG

A decrease in free sialic acid level prevents bacteria from adhering to the teeth

Conclusion

  • Saliva evaluations suggested that the maltitol and xylitol groups displayed significant benefits in terms of salivary flow, salivary pH, glucan sucrase activity, and free sialic acid level relative to both no-gum and gum-base groups. These biomarkers are related to dental caries development.
  • The study was also able to determine a significant benefit for the maltitol and xylitol groups in biomarkers related to dental plaque (3) (data not shown), in particular in terms of plaque pH, plaque accumulation, insoluble glucans concentration, and cariogenic bacteria levels.
  • Tested products were well tolerated as none of the children reported any feeling of digestive discomfort, evaluated by questionnaire.

Sugars-free chewing gums after meals appeared to induce clear benefits on biomarkers related to dental caries development. It seemed that those benefits were not only due to the mere action of chewing, but also to a specific polyol effect, similar to maltitol and xylitol. Major mechanisms involved seem to include lack of acidogenic potential, stimulation of the salivary flow, antimicrobial effect, and limitation of dental plaque formation

 

LIST OF REFERENCES

(1) Lenander-Luikari M and Loimaranta V (2000). Saliva and Dental Caries. Adv Dent Res 14:40-47.

(2) van Loveren C (2004). Sugar alcohols: what is the evidence for caries-preventive and caries-therapeutic effects? Caries Res 38:286-293

(3) Thabuis C, Macioce V, Zhong B, Wang X, Lefranc-Millot C, Berard M, Wils D, Guérin-Deremaux L (2010). Effect of maltitol or xylitol sugar-free chewing-gums on plaque parameters related to dental caries development.
57th ORCA Congress. Caries Res 44 (in press).

 

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