Fighting plaque on the front lines

by Jeff Gelski
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Call it chemical warfare against plaque. The U.S. Army endorses xylitol as a way to prevent tooth decay, and dental associations in several foreign countries hold similar views on the alternative sweetener polyol. Other "W.P.D.s" — weapons of plaque destruction — are out there, too.

While suppliers of alternative sweeteners often promote their products as tools to fight obesity, they also may work as "tooth friendly" ingredients, or ones that may play a role in applications for sugarfree chewing gum and sugar-free soft drinks.

The U.S. military became interested in xylitol following a study conducted in January 2004. It revealed soldiers in one division, after serving in Iraq for six months, came home with 2.5 times the number of cavities than before deployment.

As a result, the 2004 Joint Services Operational Rations Forum approved adding gum with xylitol to the Meals, Ready-to-Eat (M.R.E.) program. The xylitol gum potentially could impact 2.68 million military personnel. The U.S. Army Dental Command’s Health Promotion Program created the "Look for Xylitol First" initiative. It encourages military personnel to see if xylitol is the first item, appearing, even before gum base, on the ingredient lists of gums and mints.

Dental associations in Finland, Norway, Sweden, England, Ireland, Estonia and The Netherlands also have endorsed xylitol, according to Xlear, Inc., Orem, Utah, a manufacturer of products that contain xylitol. The Scottish Intercollegiate Guidelines Network (SIGN) recently included xylitol recommendations in its section devoted to prevention of dental carries. SIGN was formed in 1993 with the goal of improving the quality of health care for patients in Scotland.

The American Dental Association endorses no alternative sweeteners, but it has published opinions on sugar.

"Each and every time bacteria come in contact with sugar or starch in the mouth, acid is produced, which attacks the teeth for 20 minutes," said a 2001 report called "Diet and Tooth Decay" from the A.D.A. "This can result in tooth decay."

Xylitol, a natural sugar produced in fruits, vegetables and birch trees, may block bacteria and interfere with their ability to stick to teeth. The National Institute of Health promoted xylitol when it discussed sweeteners, specifically noncariogenic sweeteners, in a 2001 report on dental issues.

"Noncariogenic sweeteners have been delivered to teeth as constituents of chewing gum, hard candy and dentifrices," the report said. "The evidence for both sorbitol and xylitol is positive, although the evidence for xylitol is stronger.

"Almost all studies of these agents included other interventions, such as fluoridated dentifrices, dietary modification and oral hygiene instruction."

Two health care providers in the United States endorse xylitol products to their clients. The Principal Financial Group, Des Moines, Iowa, and Epic Dental reached an agreement this year in which discounts of up to 50% are available to dental customers of The Principal for Epic xylitol products such as gums, mints, toothpaste and mouthwash.

Aetna contracted with Epic Industries this year to offer oral health care products. Based in Hartford, Conn., Aetna has about 12.8 million dental members.

Xlear promotes the use of xylitol through four different product lines: gums, mints, toothpastes and mouthwashes. The company’s products have entered 3,000 retail outlets, mostly natural foods stores and drug stores.

Thanks to annual revenue growth of 50% to 60%, Xlear hopes for mass distribution of its products in the next year or so, said Ryan Stirland, vice-president of marketing and business development.

Danisco Sweeteners, Ardsley, N.Y., plans to increase its supply of xylitol. The company has established a joint venture with Henan Tanqyin Yuxin Co., Ltd. to produce xylitol and xylose. The joint venture company is called Danisco Sweeteners (Anynang) Co. Ltd. and is located in the Henan Province of China. Danisco already has xylitol manufacturing plants in Thompson, Ill., and Finland.

Xylitol costs more than sugar, Mr. Stirland of Xlear said. It is as sweet as sugar and has fewer calories, 2.4 calories per gram as opposed to sugar’s 4 calories per gram.

Laxation is a concern in applications involving xylitol. SPI Polyols, New Castle, Del., gives xylitol a laxation threshold of 50 to 90 grams per day, which is higher than fellow polyols mannitol (20) and sorbitol (50) and lower than erythritol (125) and sucrose (less than 100).

"We discourage large uses all at once," Mr. Stirland said. "You wouldn’t want to make a bucket of Kool-Aid with (xylitol)."

Xylitol will not work in any foods that need yeast for leavening, Mr. Stirland added. The antibacterial qualities of xylitol will eliminate the yeast.

Xylitol works best in foods and gums used between meals or right after meals because of its cleansing action, said Ross Craig, product manager for Danisco Sweeteners. The amount of xylitol needed to have an effect in beverages probably makes it cost-prohibitive in that category, he added.

Soft drink consumption remains a pathway for plaque. Nondiet soft drinks may contain as many as 11 teaspoons of sugar per serving, according to the 2001 A.D.A. report.

"Although there are few studies reported in scientific literature that specifically evaluate the role of soft drinks in the development of tooth decay, increased sugar in the diet increases the risk of decay," the report said.

It added, "Diet soft drinks rely on nonnutritive sweeteners instead of sugar. They also are acidic and may increase the risk of experiencing enamel erosion, although the research on the role of soft drinks and tooth erosion is preliminary."

Palatinose, a new functional carbohydrate from the German company Palatinit, addresses that issue. It may work in both foods and beverages. Soft drink manufacturers may take out 25% of the sucrose in their products and replace it with Palatinose, a "tooth friendly" ingredient that inhibits plaque formation.

Palatinose, introduced at the Institute of Food Technologists Annual Meeting and Expo, held in New Orleans this past July, is 50% as sweet as sugar and classified as a carbohydrate but not as a polyol or high-intensity sweetener.

Diet drinks, many with alternative sweeteners, are growing in popularity in the carbonated soft drink industry, where sales increased 0.7% in the United States in 2004, according to Beverage Marketing Corp. (B.M.C.), New York.

"Diet soft drinks drove most of the category’s growth," said Michael Bellas, chairman of B.M.C. "Consumers are increasingly seeking out healthier products."

Diet Coke and Diet Sprite both increased in sales volume in 2004. Diet Pepsi also saw an increase.

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