Dental caries is a chronic disease which can affect us at any age. The term “caries” denotes both the disease process and its consequences, that is, the damage caused by the disease process. Dental caries has a multifactorial aetiology in which there is interplay of three principal factors: the host (saliva and teeth), the microflora (plaque), and the substrate (diet), and a fourth factor: time. The role of sugar (and other fermentable carbohydrates such as highly refined flour) as a risk factor in the initiation and progression of dental caries is overwhelming. Whether this initial demineralization proceeds to clinically detectable caries or whether the lesion is remineralized by plaque minerals depends on a number of factors, of which the amount and frequency of further sugars consumption are of utmost importance. This paper reviews the role of sugar and sugar substitutes in dental caries. 1. Introduction To most people the term “sugar” refers to the common household foodstuff table sugar (sucrose). Yet sucrose is only one of many naturally occurring sugars used in the human diet. Technically the term “sugars” applies to two classifications of carbohydrates: free-form monosaccharides (simple sugars) which include the more common glucose, fructose, and galactose and disaccharides (two simple sugar molecules linked together) which include the most common sucrose, lactose, and maltose. Naturally occurring sugars are available in fruits, vegetables, grains, and dairy foods. Sweeteners are added sugars that are used as ingredients to both satisfy our taste and in some cases provide added energy. Grouping sweeteners as “nutritive” or “nonnutritive” acknowledges a difference in the amount of energy provided by the sweetener. Nutritive sweeteners may be referred to as caloric and include sugars and sugar alcohols. Nonnutritive sweeteners offer no energy and can sweeten with little volume. Both sugar alcohols and nonnutritive sweeteners can replace the sugars and are sometimes referred to as sugar substitutes, sugar replacers, or alternative sweeteners [1]. We searched the pertinent literature in PubMed and MEDLINE databases by using key words such as sugar in dental caries, sugar substitute in dental caries, and various types of sugar in dental caries. 2. Sugar and Dental Caries Of the many factors that contribute to the development of dental caries, diet plays an important role. Fifty years ago dietary issues relevant to dental caries were largely concerned with dietary sugars. Although sugars are undoubtedly the most important dietary factors in the
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