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NEWSLETTER OF TOOTHFRIENDLY INTERNATIONAL
Belgians whip up first toothfriendly chocolate
Expert opinion: Xylitol is not a magic bullet
FIRST PACIFIER APPROVED AS TOOTHFRIENDLY
Future of caries prevention: fluoridation, diet, education?
Sweet, sweeter, intense sweeter?
Swiss kids groups for healthy eating
ch www. Elin Giertsen University of Bergen Today. One particularly creative dental technician came up with the design for the Happy Tooth logo: a sympathetically smiling tooth under a protective umbrella. Thomas Imfeld University of Zürich Prof. Stefan Zimmer teaches at the University of Witten/Herdecke. Lutz Stösser University of Jena Prof. the Happy Tooth is a paradigm for effective. look for the Happy Tooth logo.Editorial Introducing the world’s most sympathetic tooth The Happy Tooth logo is one of the most widespread quality seals in the world . Cor van Loveren University of Amsterdam Prof. Editor Kati Leskinen Germany: Hedi von Bergh Switzerland: Corinne Voisard Turkey: Selda Alemdar The Netherlands: Lisette De Jong SCIENTIFIC ADVISORY BOARD: Prof. Like regulators. That is why many of us keep the dietary advice to patients as simple as possible: when buying sweets. TOOTHFRIENDLY INTERNATIONAL Bundesstrasse 29 4054 Basel . Stefan Zimmer University of Witten/Herdecke. also dentists would find life easier if there was a symbol for healthy eating they can trust. Successful confectionery brands such as Mentos or Smint use the Happy Tooth logo for a simple reason: its message is easy to understand by all consumers . posing a challenge to the legitimacy of many commonplace claims such as “with xylitol” or “anti-cariogenic”. This is also the reason why the Happy Tooth symbol is expected to be included in the list of accepted claims under the EU Health Claims Regulation. Germany Prof. Nearly thirty years ago Swiss dentists were looking for a symbol which would easily guide consumers to guaranteed toothfriendly products. He is also a Board Member of Toothfriendly International.Switzerland Tel: +41 61 273 77 07 Fax: +41 61 273 77 03 contact@toothfriendly. Prof.also on international product labels.org President Prof. TOOTHFRIENDLY NEWS is the annual newsletter of the non-profit association Toothfriendly International Toothfriendly International is dedicated to improving oral health by promoting non-cariogenic dietary habits and oral hygiene. Albert Bär Project Manager. 2 Toothfriendly News 2/2009 . The new Europe-wide rule defines what constitutes legitimate nutrition and health claims.it is currently used on more than 100 confectionery brands worldwide. Bernhard Guggenheim Executive Director Dr.toothfriendly. globally-recognized health communications. The Happy Tooth is currently the only quality symbol for confectionery which is based on a recognized scientific test.
1%) for N and 0 for C.3%) in N. N=15. Dentistar has a special. Exclusion criteria were preterm birth (<8th month pregnancy). Albert Bär of Toothfriendly International. This special design allows the front teeth to develop without any significant misalignments. ANOVA: n. Zeven. The respective values were 16 (38. of Operative and Preventive Dentistry and Endodontics Heinrich Heine University Duesseldorf.4%) subjects in group D. says Dr. 129 new born children whose parents had decided to use pacifiers were randomly attributed to two experimental groups (D=Dentistar. “Studies show that more than half of mothers worry that pacifiers may cause bucked teeth. Novatex. RAAB Dept. ZIMMER*. The rubber neck of the pacifier is thin and shaped according to a child’s natural bite. n=73.4. Germany). Pattensen.3. Toothfriendly News 2/2009 3 .1%) in C. Normal occlusion (Angle’s class I) was found in 35 (81. The incidence of open bites was significantly less in group D and C when compared to N (chi2-test. It is unrealistic and pointless to ban all pacifiers. At an age of 10 . Experts agree that consistent sucking habit may cause dental abnormalities if continued after the age of two. Parents were advised to use only the allocated pacifier. the children were re-examined (operator blind) with respect to occlusion and existence of an anterior open bite. W. BIZHANG. The mean age was 15. Bär points out that pacifiers are controversial items not only for dentists but for many parents as well. SPSS 15.-M.9 (SD 3. Children (n=42) who did not use a pacifier served as control (C). Germany.7%) showed an anterior open bite. p<0. N=NUK.” Dentistar .0 served for statistical analysis. and 31 (86. and promotes the natural jaw development. Results: 121 toddlers (66 female. Dr. The incidence of normal occlusion was significantly higher in group D and C when compared to N (chi2-test. No significant difference was found between D and C. In group D two children (4. p<0. n=56.” Pacifiers have long been a source of debate among dentists.0. N: n=42.). C: n=36). 14 (33.s. congenital maxillofacial defects and systemic diseases of the infant.001). Mapa. Conclusion: In comparison to a commonly used pacifier. M. A comparative 2-year study with 129 newborn children conducted at the Heinrich Heine University of Düsseldorf shows that children using Dentistar have a normal occlusion and do not develop anterior open bites which often develops as a consequence of the continued use of a traditional pacifier. pacifiers havebeen shown to decrease the risk of Sudden Infant Death Syndrome. 55 male) were included in the final analysis (D: n=43..9) months (D=17. Germany Objectives: To evaluate the efficacy of a novel pacifier in preventing malocclusion.PRODUCT OF THE MONTH First toothfriendly pacifier obtains dentists endorsement German pacifier manufacturer Novatex has developed the first pacifier with no known detrimental effect on teeth and jaw development. Efficacy of a Novel Pacifier in the Prevention of Malocclusion S. “Dentists welcome the first toothfriendly pacifier”.001). but not significantly different between D and C. C=15. LJUBICIC. And yet. flat design which helps prevent dental misalignments.26 months. The pacifier named as “Dentistar” has been granted the recognized ‘Happy Tooth’ quality seal from the dental experts of Toothfriendly International. H. R. “In comparison to regular pacifiers. Most significantly. the novel one may prevent the occurrence of anterior open bites and may lead to a higher incidence of normal occlusion in 16 months old children. pacifiers have also undeniably positive effects. Methods: In the University Hospital of Duesseldorf/Germany.a five-star pacifier for baby teeth Dentistar has a unique spoon-like shape which leaves more space for the tongue than any conventional pacifier on the market.
The resource pack contains patient leaflets and a yummy selection of sugar-free freebies. according to recent AC Nielsen market figures. The Happy Tooth symbol was introduced in 1982 as an initiative of Swiss Dental Institutes. say market research Sugar-free candies are up 18 per cent in the UK as health conscious consumers continue to opt for toothfriendly alternatives. the Netherlands. Since 2007. most attempts to develop toothfriendly beverages have failed – mainly due to excessive acidity. job title and delivery address at contact@toothfriendly. sugarless sweets have risen by 18 percent in the UK.7.News First non-erosive soft drink on the market The first soft drink to make an explicit connection to healthy teeth are introduced in March in Switzerland. while the sales of sugary candy fell by 5 percent. “We are delighted to see that Dutch consumers find the ‘Happy Tooth’ symbol so attractive”. The aim of the Happy Tooth logo is to enable easy recognition for guaranteed toothfriendly products. Toothfriendly Resource Packs up for grabs Toothfriendly International offers dental practices free educational material and product samples to support the Oral Health Month initiative. Toothfriendly International was established in 1989 as a second stage of the campaign to encourage confectionery manufacturers create healthier alternatives for sugar confectionery. more than 100 brands worldwide carry the symbol. say consumers Nine in ten (86%) consumers say the ‘Happy Tooth’ logo would help them to easily identify guaranteed toothfriendly products. as it does not depress the plaque-pH below the critical level of 5. Nine out of ten respondents say that the quality seal should be plcaed on the front label rather on the back-side of a packaging in order to enable easy recognition. including confectionery.ch 4 Toothfriendly News 2/2009 . bringing the market to 11 percent. To claim your free pack. Plaque pH-tests at the University of Zurich demonstrated that the ice tea has no risk for caries. It also does not promote dental erosion. says Kati Leskinen of Toothfriendly International. Albert Bär of Toothfriendly International. where the logo enjoys a spentaneous awareness of 83% across the population. Sugar-free sales in Italy and Australia have increased by 9 and 10 percent respectively. Today. medicinal products. The product is nearly acid-free and sweetened with isomaltulose. it would help cut down the frequency of sugar consumption”. a novel sugar which is kind to teeth. Swiss Migros is worldwide the first retailer to roll out a toothfriendly ice tea.”. says Dr. Most products with the Happy Tooth logo can be found on the Swiss market. He points out that until now. Acids which are commonly used in soft drinks for taste and for ensuring microbial stability have a demineralizing effect on the tooth surface which may develop to dental erosion. Happy Tooth logo helps identify toothfriendly products. Spain has the largest sugar-free market with 50% of the candies sold containing no sugar. please send your name. “If consumers began to check confectionery labels and choose products which are guaranteed toothfriendly. Most consumers (95%) find that the ‘Happy Tooth’ logo has a self-explanatory design which ensures that even illiterate children understand the meaning of the eye-catching symbol. according to consumer survey conducted in Utrecht. Worldwide. Consumers opt for sugar-free candy worldwide.. beverage and oral care products. ““A non-erosive soft drink is a real innovation.
The first two toothfriendly chocolate products are now available in Belgium. the workshops will help you explore opportunities in these areas. If you are thinking of diversifying into areas such as botox. The 2009 exhibition will take place in the Scotish Exhibition and Conference Centre’s largest hall. have just launched the first toothfriendly chocolate products. the world’s largest chocolate manufacturer.” So a different type of sugar is the secret of toothfriendly chocolate. knows the secret of dentist-friendly chocolate.” Toothfriendly News 2/2009 5 . the bacteria in the mouth cannot use isomaltulose as a source of energy. Albert Bär of Toothfriendly International. we have already started ticking off the days on our calender until the next British Dental Conference. This is set to be our biggest Exhibition to date and with increased numbers of delegates attending year on year we anticipate this year to be buzzing full of excitement. setting up in practice. There will be a range of sessions focusing on career paths. “All products which carry this logo have been tested by academic institutes for oral health. and both carry the Happy Tooth quality seal.24-28 March 2009 Sino-Dental Beijing . explains Marijke De Brouwer. whitening. while peer Daskalides has developed toothfriendly chocolate bars with hazelnut filling.you can meet our team. However. Two Belgian chocolate specialists. realising your potential’ and will feature motivational. feature areas. says De Brouwer. But does it taste any different? “In our blind tests 82% of the kids said they liked it a lot”. smoking cessation and implants.ch Belgians whip up toothfriendly chocolate It looks like chocolate. expert speakers who will inspire you to develop new ideas and grow your career. which takes place in Glasgow from 4th to 6th June 2009. it tastes like chocolate. the visual guide to remember the healthiest foods to eat. Innovation Officer at Barry Callebaut.sge-ssn. Swiss dieticians have now modified the pyramid into a wheel targeted at 5-12year-old kids. Running alongside the comprehensive conference programme will be the popular exhibition. It gives tips also for parents and educators. “Isomaltulose belongs to the same group of sugars as sucrose. Chocolaterie Smet and Daskalides. “We only give the Happy Tooth seal of approval to products which are guaranteed safe for teeth”. isomaltulose does not promote cavities. “But I think the only proof that they really like something is when they ask for a second piece. Toothfriendly International has a stand (C 28) at the event . says Dr. exhibition hall seminars and an internet cafe. Chocolaterie Smet is producing a range of hollow chocolate figures. And they did”.News British Dental Conference Here at Toothfriendly International. Unlike sucrose. and business planning. The exhibition hall will contain a variety of caterng points. as well as learn about new products.2-5 September 2009 Dieticians launch healthy food wheel for kids Everyone knows Food Pyramid. “Toothfriendly chocolate is sweetened with isomaltulose”. Meet the Toothfriendly team also at: IDS Dental Show Cologne . The wheel can be downloaded at www. pick up toothfriendly samples and patient leaflets. Both products have been approved by Toothfriendly International. The theme for UK’s major dental event of 2009 is ‘Securing your future.10-13 June 2009 International Pediatric Dental Congress Munich 17-20 June 2009 FDI World Dental Congress Singapore . Also Barry Callebaut. and it is chocolate – but it wont rot your teeth. which is set to be the largest yet. Hall 4. The wheel shows at a glance the principles of healthy eating.
Also the glycemic index (GI). Today. When consumed in excess. Due to their high sweetness intencity.cargillsweetness. It is a non-nutritive sweetener.caloriecontrol. Food manufacturers have long noticed that not only diabetics avoid eating sugar.food. waistline and blood sugar levels. In 1980s.e. i. or best avoided? Kati Leskinen lays down the facts and fiction of toothfriendly sweeteners.polyols-eu. which makes them an ideal ingredient for toothfriendly sweets. sweeter. neohesperidine DC. The reaction resembles an over-consumption of high-fibre foods. After the second world war. they are digested more slowly. mouthfeel and sweetness intensity. According to a recent survey. a number of other sweeteners including cyclamate. Sucralose is now being used across a broad spectrum of food and beverage products.org European Association of Polyol Producers www.maltitol-maltisorb. Intense sweeteners provide sweet taste without calories. chemical composition.com Maltitol: www. toothpastes and mouth washes.com More infromation on intense sweeteners: www. the discovery of new. daily consumption of products containing intense sweeteners is safe. aspartame. chewing gum.sucralose. Nearly twenty different sweeteners are currently authorized by the European Food Safety Authority (EFSA) for food production. Consumers often regard sugar substitutes as one homogenous group of “artificial sweeteners”.sweeteners. in t e n s e sweetener? A glance at the supermarket shelves indicates that “sugar-free” is becoming a standard in several product categories.com www. safe for teeth. mannitol and xylitol. and provide less than half the calories of sucrose. They all have little impact on blood sugar or insulin levels.gov. harmless for the body. first among diabetics and later on by calorie-conscious consumers. and is. all with their own variations in terms of taste. Honey and fruits have long been sought out for their sweet taste.com Erythritol: www. Like beans. at least in confectionery and soft drink categories. Sugar substitutes hit the mainstream in the early 1960s with the introduction of first sugar-free chewing gum in the Unites States. saccharin.net www. Are sugar substitutes safe for teeth and good for the waistline. or with very few calories. All intense sweetenes are non-cariogenic.e. sucrose was virtually the only sweetener in general use. In reality. energy value and physiological properties. Since then. the European Food Safety Authority (EFSA) is controlling the safety of all sweeteners used in food production. which is 600 times sweeter than sugar. but unlike sugar. one of the four fundamental taste sensations. however.roquette. other alternative sweeteners became popular.S we e t .acesulfamek. may used in food products without a stringent safety assessment and approval by the European Comission. polyols can cause discomforts such as flatulence or upset stomach. No food additive. only minimal amounts are needed.e. maltitol. table sugar (sucrose) has been the standard for sweetness. The oral bacteria cannot ferment polyols. nearly 100% of all chewing gum and over 10% of sweets sold in the UK are sugar-free.uk/safereating/chemsafe/additivesbranch/sweeteners/ 6 Toothfriendly News 2/2009 . Consumers often tend to think that sugar substitutes are something “artificial” – yet they provide many benefits to sugar. People have an inborn desire for sweet taste. since it was first refined some 600 years ago. They usually replace sugar in products with a ratio of about 1:1. The most common polyols used in the food production today are sorbitol. despite its inconvenient nature. Sugar is also closely associated with dental cavities. such as an intense sweetener. In Europe. Sucralose is one of the fastest growing intense sweeteners on the market today. In 1963.org www. isomalt. mints and candies. The levels of intense sweeteners used in food products are based on an accepted daily intake level set by EFSA. produced and used around the world.org www.aspartame. polyols are good for the digestive health when eaten in moderate amounts. and currently only intense sweetener that is actually derived from beet sugar.com Isomalt: www. This conservative measure makes sure that even a frequent. thaumatin. prunes and other high-fibre foods. most young consumers choose sugar-free sweets and chewing gum for oral health reasons and not so much for the lack of calories. claim food manufacturers. An amount of 25-50g of polyolcontaining products consumed throughout the day is normally well tolerated. Coca Cola introduced the first sugarfree soft drink sweetened with cyclamate. It is the first. sucralose and alitame have been “All intense sweeteners are non-cariogenic. sweetness. the ability to increase blood sugar level. was discovered in 1878. improved sugar substitutes fuelled the development of sugar-free lozenges. Sugar and other carbohydrates have become a culprit for many health enthusiasts following a low-carb or low glycemic diet. Polyols are carbohydrates.” Sweetening agents can be devided into two main categories: polyols (bulk sweeteners) and intense sweeteners. varies greatly. i. Until recent decades. sugar substitutes differ from each other by origin. safe for teeth. The level is 100-fold lower than the safe dose demonstrated in studies. Sugar substitutes are better for teeth. i.beneo-palatinit. More infromation on polyols: Calorie Control: www. The first intense sweetener. acesulfame K.
Sugar. which are absorbed. These “toothfriendly” properties are determined by a standardized in vivo plaque pH-telemetry test. all other sugars are cariogenic.Suitable for diabetics . Caloric value As intense sweeteners are used in minimal amounts.5g sugars may be labelled as sugarfree.-free foods with high quantities of acid can attack dental enamel and cause erosion. Especially many sugar-free “diet” beverages .Excessive consumption (>50g) may cause laxative effects Properties . Properties Sugars are a good source of energy. Sugar-free? Products which contain maximum 0. Only products with the “Happy Tooth” symbol are guaranteed toothfriendly..Low GI . respectively. others 1-3 kcal/g. Since isomaltulose is relatively readily digested to glucose and fructose.Toothfriendly . a third group of so-called non-cariogenic sugars has emerged. Toothfriendly Derived from beet sugar.Toothfriendly .Less calories ..No laxative effects Properties Toothfriendly News 2/2009 7 .contain high amounts of citric aciic.Suitable for diabetics . corn. Caloric value Erythritol has a caloric value of 0 kcal/g. but should not be consumed in excess.such as light soft drinks . Tagatose has the advantage of providing less calories and having a much lower GI value than sucrose. Source Sucrose and fructose around 4 kcal/g. wood pulp Source Chemically processed from acids. Isomaltulose and tagatose are examples of toothfriendly sugars derived from beet sugar and milk sugar.. . they provide practically 0 calories. others 2-3 kcal/g. corn.Toothfriendly sugars? In addition to polyols and intense sweeteners. Caloric value Toothfriendly? A product can be called “toothfriendly” if it is neither cariogenic nor erosive. Isomaltulose and tagatose are toothfriendly. milk sugar. Only sucralose is processed from sugar beet. this sugar has a higher intestinal tolerance than the polyols. malt. as they have undergone a stringent telemetry testing procedure. Note: The claim “sugar-free” does not automatically mean that a product is safe for teeth. fruits Source Derived and processed from sugar beet. SWEETENERS SUGARS Sucrose Glucose Fructose Lactose Maltose Isomaltose Tagatose POLYOLS Xylitol Sorbitol Isomalt Maltitol Mannitol Erythritol Lactitol INTENSE SWEETENERS Cyclamate Aspartame Acesulfame-K ToothNeohesperidine DC friendly Sucralose Saccharin Thaumatin Alitame Cariogenic Toothfriendly What is.Low GI .No calories .
some differences in the fermentability of polyol sugar substitutes by micro organism of the dental plaque may be observed. the caries-preventive effect of toothfriendly chewing gums may be related to the chewing process itself rather than any added “active” ingredients. Under real life conditions. Vita Machiulskiene. due to its anti-microbial potential. Prof. In fact. Bernhard Guggenheim. on the other hand.g . Xylitol has often been claimed to possess anti-caries properties. As polyols are not fermented by the oral bacteria. FDI World Den t a l Fe d e r a t i o n Po l i c y St a t e m e n t : “ T h e a n t i c a r i o g e n i c e f f e c t o f polyols has yet to be sup p o r t e d by e v i d e n c e . from a number of clinical studies using different treatment protocols. comparative clinical studies have demonstrated that there is no sufficient evidence to support a superiority of xylitol.c a l l e d “a c t ive” ingredients – e. Prof. University of Jena. toffee.or may not . there is no sufficient evidence to support neither the superiority of xylitol. Prof.Expert Opinion Xylitol in caries prevention: is it a magic bullet? Confec tioner y manufac turers around the wor ld claim that x ylitol-sweetened chewing gum reduces the r isk of tooth decay. the contact time between ingested polyols and teeth is too short to allow for any relevant acid formulation or for anti-plaque effects. Under laboratory conditions. However. xylitol is not converted to organic acids to any significant extent and may even exert some inhibitory effects on certain micro-organisms.” Toothfriendly In t e r n a t i o n a l : “ W h e t h e r t h e p ro d u c t c o n t a i n s a n y s o .” 8 Toothfriendly News 2/2009 . This conclusion is in agreement with the reports of the Scientific Committee on Medicinal Products and Medical Devices of the EU Commission. x y l i t o l – i s m u c h l e s s i m p o r t a n t t h a n t h e f a c t t h a t t h e re c o m mended product is guara n t e e d t o o t h f r i e n d l y. nor the direct therapeutic effect of any polyols.p re ve n t a t i ve e f f e c t . University of Kaunas. will favourably affect the remin / demin balance of the tooth surface. T h e e s s e n c e o f a l l d e n t a l d i e t a r y a d v i c e i s to cut down the freque n c y o f s u g a r c o n s u m p t i o n . While it ’s generally recognized that x ylitol is an excellent. there is no evidence of an outstanding preventive effect of xylitol in comparision with other polyols. Howe ve r. Those findings have stimulated intensive research on their possible caries preventive effect in clinical conditions. Neither xylitol nor any other polyol has been shown to have an anti-caries effect.b a s e d d a t a .car iogenic alter native to sucrose. However. Lithuania. There is a consensus that the use of polyols may have contributed to the decline of dental caries in many industrialized countries.benefit oral health. University of Zurich. Xylitol is often referred to as a superior polyol due to an alleged anti-cariogenic effect. such differences have no practical consequences as shown by comparative studies with measurement of plaque pH in human volunteers. Sorbitol. In view of these findings and the absence of different caries incidence in comparative human studies with xylitol and sorbitol. hard candies or similar confectionery sweetened with polyols. The caries reductions which were observed in studies can rather be ascribed to a reduced frequency of sugar exposure or saliva stimulation. they do not promote caries. However. Germany. scientists remain sceptical about x ylitol ’s therapeutic effec t on teeth. non.or non-acidogenic in in-vitro tests. may be fermented slowly over several hours. the enhancement of salivary flow when eating chewing gum. Three dental professionals take a cr itical look at how the consumption of x ylitol may . Lutz Stösser. For example. All sugar alcohols have proven to be hypo. t h e e n h a n c e m e n t o f s alivar y flow may have a c a r i e s . In addition.
in biochemistry from the Swiss Federal Institute of Technology (ETH) in 1974. reduce the risk of caries because they typically substitute for the consumption of corresponding products which are sweetened with sucrose or sucrose/glucose mixtures. The policy also states that “enhancement of salivary flow when using chewing gums may have a caries-preventive effect” and “non-cariogenic sugar substitutes when used in products such as confectionery.D. says Dr.is much less important than the fact that the recommended product is toothfriendly. Scand. He is also the director of the non-profit association Toothfriendly International. Appl. and Cruvinel V. The caries risk reduction claim for chewing gum with 100% xylitol suggests to consumers that other similar products with a lower content of xylitol or with other polyols have inferior properties.g. 61(6): 331-340. Stookey G. The new FDI Policy statement is fully in line with scientific reviews and meta-analyses of the scientific literature by renowned experts in cariology (e.T.. van Loveren C. Leal S. 2003. Zero.e. 2007. And finally. 104: 941-945. In the light of current expert opinions. Furthermore. Sugar-free chewing gum and dental caries – a systematic review. therefore. Burt. The results of the human intervention studies in support of the caries risk reduction claim of chewing gum with 100% xylitol. Petersson L.. About the author: Dr. Zero D. Conclusions Any caries risk reduction claims for chewing gum with 100% xylitol bears a significant risk of being misinterpreted as demonstrating that xylitol exerts an anti-cariogenic effect. Lägerlöf F. JADA 137: 190-196. Twetman S.7. 2008. reduce the risk of dental caries”...N. While certain studies point out that caries risk reduction can be obtained by consuming 2 – 3 g of chewing gum sweetened with 100% xylitol at least three times per day after the meals. Bär served for six years as Director. Toothfriendly News 2/2009 9 . Mickenautsch et al. which were observed in studies with sugar-free chewing gum and candies would. there are reviews which deviate somewhat from the majority view in one or the other direction (e.K.G.g. Prior to forming Bioresco Ltd. Van Loveren... no clear data to suppor t the concept that x ylitol possesses specific effec ts in vivo which validate a supe r ior it y over other polyols. xylitol . 15(2): 83-88. Clinical caries studies with polyalcohols. in 1986. Lingström et al. Norlund A. He is the author of numerous scientific publications. Imfeld. In the light of current expert opinions. Xylitol was derived from Finnish birch wood only in the very early days of xylitol production.. 1999. 1994.g. Whether sugar-free chewing gum and sweets contain any so-called . Mejàre I. (2008). be the consequence of a reduced sugar intake rather than an active interference with caries formation. JADA 139: 11S-17S. at Xyrofin Ltd and the Finnish Sugar Ltd.. Are sugar substitutes also anticariogenic? JADA 139: 9S-10S. Today it is manufactured mainly from corn cobs and other liquidified agricultural waste material. (1999). The effect of saliva on dental caries.A.”active” ingredients .. Albert Bär received his Ph. Schweiz. has a role to play in preventing dental caries because of its non-cariogenic nature and its salivary stimulatory effect”. this is wrong and indeed misleading. as of today.. (2004). Oral Sci. Yengopal V. 2004. Söder B. Research and Development.K. However. Dent. Moss S. (2003). Lingström P. Zahnmed. are completely in line with this combined sugar substitution/saliva stimulation mechanism of caries prevention. this is wrong and indeed misleading.. Nordenram G.. it is thought that the stimulation of salivary flow due to the consumption of confectionery promotes the remineralization of the surface layer of dental enamel during periods in which the pH of the dental plaque and the oral fluid stays above the critical value of 5. References: Burt B. J. Of course. Stookey. Mr. Position of the dental profession: reduce the sugar consumption The prevailing opinion in the dental profession is that chewing gum and other confectionery products which are formulated with non-fermentable ingredients. Alber t Bär of Toothfr iendly I nter national. J. chewing gum and drinks. (2008). Xylitol – an evaluation. and Källestal C. Bezerra A. 2008). The caries risk reduction claim for chewing gum with 100% xylitol suggests to consumers that other similar products with a lower content of xylitol or with other polyols have inferior properties. 49: 00-00. Monatsschr. not a single study provides hard data on the frequency of sugar consumption in the treated groups and controls which would invalidate the sugar substitution/saliva stimulation mode of action of chewing gum with 100% xylitol.and xylitolsweetened chewing gum in caries control.J.. The caries reductions. Sugar alcohols: what is the evidence for caries-preventive and cariestherapeutic effects? Caries Res. The statement “100%-xylitol chewing gum reduces the risk of caries” is somewhat misleading. Dietary factors in the prevention of dental caries: a systematic review. 38: 286-293. (2007).C.C. with regard to xylitol it maintains that “the anticariogenic effect of the sugar substitutes themselves has yet to be supported by evidence-based data”.. Acta Odontol. Holm A.. The essence of all dietary advice is to cut down the frequency of sugar consumption. So far. Imfeld T. (1994). The World Dental Federation (FDI) has adopted a new Policy Statement on sugar substitutes and their role in caries prevention saying that “the regular use of chewing gum containing non-cariogenic sweeteners such as xylitol. Dahlgren H. The use of sorbitol. as always in science. Moss. Mickenautsch S. Axelsson S.. a fair amount of clinical studies point out that the same beneficial effect can also be obtained with other non-cariogenic sugar substitutes. Int.Why the ‘xylitol gospel’ is misleading consumers There are. the consumption of sugarfree chewing gum and candies after meals will accelerate the clearance of dietary carbohydrates from the oral cavity and the neutralization of the dental plaque by stimulation of the salivary flow. (2006). 2006).
5 2.3 dl apple juice 5 dl Ice Tea 2. games and songs 3) They promote toothfriendly snacks “By the end of 2008. says Anna Lustenberger.5 8 4 0. The problem emerges only when sugar becomes a staple in a child’s diet. caries prevention should begin as early as the first teeth erupt. “Healthy eating is an ongoing concern in our society.” Note: Sugar is not “bad” per se. 1 glas of cola drink 100g of chocolate 1 chocolate snack bar (45g) 1 cup of fruit yogurt 1 spoon of jam 1 spoon of cacao 3.” Not only dentists praise the project. O ver 5000 k ids across Switzer land are par ticipating in the Toothfr iendly Playgroup program to help fight childhood cavities and promote healthy lifest yle among children.in the group. make “cars” out of carrots or “elephants” out of mandarines. yet they may carry surprising amounts of sugar. and gluing them on a piece of carton.2 dl flavoured milk 1 probiotic drink (125ml) 10 g ketschup 60 g sugared cereals 0. veggies and wholemeal sandwiches .except on special occasions. a Board Member of SSLV.” The preliminery aim of the project was to cut down the frequency of sugary snacks eaten by small children. explains Corinne Voisard. but not much has been done to reach younger children and their parents. So not only the teeth have benefited from this project.Top project Kids for carrots While youth caries rates have declined significantly since peaking in the mid-1970s. but also the Swiss Association of play group teachers (SSLV) takes a positive stock of the project work. In the city of Zurich already 13% of 2year-old children have cavities. The educational campaign encourages children. each play group teacher is committed to promote healthy snacks . Most imprtantly. Tips and tricks to promote toothfriendly snacks Visualise the amount of hidden sugar in most snacks by piling up the amount of sugar. “Switzerland has excellent school-based caries prevention. In addition to diverse course material. Slice vegetables and fruits in funny shapes. “That makes altogether thousands of children and their parents who have been reached with the positive message of early childhood caries prevention. look for advertisements of healthy and unhealthy snacks and make a collage of best pictures. “Our women have been highly motivated to take part in the education courses”. Browse magazines with children. teacher received story books and other material to make teeth a topic even with small children. However. however. Project Manager of the association.5 9 10 9.3 dl orange juice 3. “The aim is to create a long-term campaign which is fitted to the needs and abilities of small children”.. HOW MANY SUGAR CUBES are in. says Voisard..especially fruits. “Many parents are shocked to hear how many cubes of sugar many popular snacks contain”. says Voisard.6 10 20 5 2 Such statistics served as a wake-up call for the Swiss Toothfriendly Association (Aktion Zahnfreundlich) which decided to kick off a new project targeted at the nation’s play groups consisting of kids aged 3-5 years.25 l ice cream 25 g cacao-nut cream 1 sugary candy 9 19 14 9 2. Read product labels of common snacks and spot the amounts of hidden sugars. recent Swiss surveys found that over the past two years this progress has been stalled and may even have reversed in the toddler age group. 10 Toothfriendly News 2/2009 . we have carried out more than 20 training courses throughout the country. In 4% of toddlers all four incisors were rotten and had to be removed. each playgroup “Toothfriendly”-certified educators work according to following principles: 1) They inform parents about the importance of caries prevention 2) They sensitize kids with books. replacing healthy foods that contain vital nutrients. “Juices and muesli bars are promoted as healthy. Make a snack game by cutting pictures of healthy and unhealthy snacks. parents and educators to adopt healthier snack ing habits. and certified more than 200 groups”. Sugary snacks are consequently forbidden in the lunch boxes .” The first step of the project was to offer voluntary training courses on oral health prophylaxis to play group teachers. and it has been a revelation for many of us to learn that what is good for the teeth is also often good for the whole body.
Water fluoridation. For many years the simplified message to prevent tooth decay was ‘don’t eat sweets’. continuous and systematic prevention. Thomas Marthaler University of Zurich (Emeritus) Research and practical experience demonstrates that dental caries can be prevented effectively through establishment of fluoride programmes. Toothfriendly News 2/2009 11 . Partly due to influx of foreigners. We asked three Swiss exper ts what they see for the future of car ies prevention. This advice is unrealistic and too simplistic. milk fluoridation and use of affordable fluoridated toothpastes play a major role in caries prevention also in future. The good news is that the food industry has made great progress in the past 20 years: there is a wide range of toothfriendly confectionery available. but also a consequence of growing sugar consumption. The cost-benefit ratio is even better than that of water fluoridation. Fluoride: “Salt fluoridation is a beneficial and costeffective strategy for developing countries. with the aim of professionalizing the education of the nation’s school-based oral health instructors. In most industrialized countries. dental car ies remains a challenge par ticular ly among the under pr ivileged population groups.” Education: “Oral health education in schools saves tax payers money. the education of oral health instructors is expected to undergo a major revision. An especially relevant – and often forgotten – factor is the increasing frequency of sugar exposure. without compromising on taste. Positive dietary advice stresses the fact that foods that we nibble or sip often – such as sweets or soft drinks – should be replaced by toothfriendly alternatives. Additionally. the caries prevalence of kindergarten children and those of 1st level primary school has increased lately. In the past 40 years. Dr. The cariostatic effectiveness of fluoridated salt is equivalent to that of water fluoridation when implemented on a community base. This fact draws attention to the significance of a uniform. In many countries.consumers are likely to follow positive advice. All that is needed is political willpower and the unanimous support of the nation’s dental profession.Last word Future of caries prevention D espite great improvements in oral health. I personally consider salt fluoridation a beneficial. safe and extremely cheap public health measure. the cost of introducing and running salt fluoridation was so low that many producers did not even raise the price of fluoridated salt. the preventive measures have spared the Swiss tax payers more than 250 Million Euro in dental costs annually. In the case of Switzerland. the need for qualified oral health educators will increase. Albert Bär Toothfriendly International The fact that dental caries is still widespread is not only the result of inadequate exposure to fluorides. Esther Martinet Oral Health Instructor The Swiss model of school-based oral health education demonstrates the effect of classroom prophylaxis. the consequent fluoridation and tooth brushing instruction done at Swiss primary schools has helped reduce the number of cavities found in 12-year-olds by 90%. Small amounts of sugar and other fermentable carbohydrates eaten frequently during the day will increase caries risk more than large amounts eaten infrequently.” Prof.” Dietary habits: “Sugar should not be bedevilled . salt fluoridation. particularly for developing countries.
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