The risk of adaptation of the oral microflora to Sorbitol.
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Biomedical subjects
Publications and source records attributed to S Kalfas.
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Two varieties of agar medium (Trypticase [BBL Microbiology Systems]-serum-sorbitol-bromcresol purple agar [TSSB] and Trypticase-blood-sorbitol-CaCO3 agar [TBSCa]) indicating microbial acid production from sorbitol were tested. The media were devised for use in studies on the prevalence of sorbitol-fermenting human oral microorganisms incubated in an anaerobic or microaerophilic atmosphere containing 5 to 6% CO2. TSSB contains bromcresol purple as the pH indicator and NaHCO3 as the main buffering salt. TBSCa contains CaCO3 as both the buffering salt and the indicator of acid production. The growth yield of pure cultures of oral microorganisms on TBSCa was shown to equal that on blood agar incubated under similar conditions. TSSB inhibited the growth of several bacteria to various extents. The recovery of sorbitol-fermenting microorganisms from oral specimens was the greatest when the specimens were assayed with TBSCa. The poorer results obtained with TSSB were mainly due to the decoloration of the pH indicator in this medium and the presence of greater numbers of sorbitol false-positive colonies.
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Several caloric sugar substitutes are available today, e.g. maltitol, Lycasin, sorbitol, xylitol, palatinit, sorbose, coupling sugar, palatinose, fructose and invert sugar. When evaluating the cariogenicity of these sugar substitutes from a bacteriological point of view, different analytical procedures should be considered. In vitro studies on the capacity of pure oral bacterial strains and dental plaque material to decompose the substitute to acid. Studies on the catabolism of the substitute. Possible adaptation of the oral microflora to metabolize the substitute in vivo as well as in vitro. Studies on any inhibitory effect of the substitute on the microbial activities in dental plaque and on the oral microflora. The capacity of oral bacteria, e.g. Streptococcus mutans, to induce caries in animal experiments should also be considered. Results from such microbiological studies make it possible to classify the caloric sugar substitutes into different groups. The first, most suitable, group seems to consist of xylitol and sorbose. These substitutes are fermented by few oral bacteria and no negative adaptation of the oral flora has been observed. A reducing effect upon dental plaque formation and on acid production from glucose has been reported. A second group consists of maltitol, palatinite, palatinose, sorbitol and Lycasin. These substitutes are fermented by certain groups of organisms within the oral genera Actinomyces, Lactobacillus and Streptococcus. Adaptation of oral bacteria to palatinose and to sorbitol, resulting in a more pronounced acid production, has been observed. No inhibitory effects have been reported. The results from experimental studies suggest that these sugar substitutes have no or little cariogenic action in rodents inoculated with S. mutans.(ABSTRACT TRUNCATED AT 250 WORDS)
Sorbitol is a commonly used sweetener in many so called sugar-free products, like chewing-gums, lozenges and medicines. It is also used as a stabilizer in tooth pastes and is found naturally in some fruits and berries. Many methods have been used to evaluate the cariogenicity of sorbitol, e.g. short and long term studies in man, animal experiments and pH-measurements in dental plaque in vivo and in vitro. Most of these studies indicate that sorbitol has a low or no cariogenicity. However, there are some data showing that frequent consumption of sorbitol may result in an increased acid production in dental plaque and in an increased number of sorbitol-fermenting microorganisms. This adaptation is probably of no or only minor clinical importance, at least for persons with a normal salivary function and for people with a moderate consumption of sorbitol-containing products. Thus, present knowledge shows that sorbitol might be considered as a "low cariogenic" sugar substitute.