Maltitol Based Sugar-Free Chocolates may not Promote Dental Caries: An Open-Label Clinical Study

There are many etiological factors that contribute to the development of dental caries (DC), but the sugars in the diet are important contributory factors affecting all age groups. Sugars increase the risks of DC, depending on how frequently they are consumed, and decreasing their amount to <10% of daily energy intake, decreases the risk of developing DC. A drop in the pH below the critical value of <5.5 has been related to the dental caries development, against the normal saliva pH of 6.7 - 7.4. Sugar has been considered a potential cariogenic substrate for oral bacteria Streptococcus mutans and Lactobacillus rhamnosus, as it is fermented to produce a large amount of acid that decreases the pH in the mouth. Chocolate contains sugars like sucrose and lactose, along with cocoa, and hence has the ability to cause dental caries. The factors that influence the relative cariogenicity of chocolates include their composition (esp. concentration of cocoa), texture, solubility, retaining capacity, and ability to stimulate salivary flow. Low calorie-sweeteners (LCS), commonly used sugar substitutes, have low calories and cannot be fermented by oral bacteria. Hence, they cannot cause tooth decay and the States Food and Drug Administration (USFDA) has approved the claim for sweeteners that they “do not promote tooth decay”. Low calorie-sweeteners (LCS) like maltitol, sorbitol, and xylitol and stevia glycosides (natural) are widely used in sweet confectionaries to replace their sugars. With the wide consumption of chocolate, by both adults and children and the rising incidence of dental caries, the current open-label study evaluated the safety and efficacy of maltitol-based sugar-free chocolates on salivary pH, through measurement of salivary pH and growth of S. mutans, in healthy human subjects. A total of 15 healthy adults and children were screened having a mean age of 13.3 years and were segregated into different age groups. The sucrose was completely replaced with the sweeteners, maltitol (minimum 45%), and steviol glycoside (0.05%) in the chocolate. Each subject was asked to consume the test product, the dose of the same was as per their respective age group.The saliva samples were collected for measurement of Streptococcus mutans colonies at baseline and at 0 h and 4 h after test product consumption. The study demonstrated a statistically significant increase in the salivary pH level from the baseline at 0 h measurement (p = 0.0181) and noted a reduction in S. mutans formation from baseline, at 0 h and 4 h (p = 0.0001). Although this dental study had a limited sample size, it concluded that the maltitol based chocolates might not cause tooth decay or lead to DC.

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