Dental caries is caused by an imbalance between tooth structure de- and remineralization, resulting in increased demineralization. Sugar, especially sucrose, facilitates dental plaque formation that covers the tooth surfaces. As a result, acids produced from the microorganisms in dental plaque decrease the plaque pH and eventually dissolve the dental hard tissue once it reaches a critical pH level. The critical pH value for enamel is 5.5–5.7; however, this value varies between individuals, depending on several factors, such as the subject's caries status, salivary flow rate, and concentration of calcium and phosphate in salivary or plaque fluid. To inhibit plaque metabolism, replacing sugar with non-cariogenic sweeteners is an alternative method to prevent caries. One of the most widely used sweeteners, xylitol, is a five-carbon sugar alcohol that can prevent dental caries. This is because the oral bacteria cannot metabolize xylitol and produce acid. Erythritol, which is a four-carbon sugar alcohol, has also received attention as a non-cariogenic sweetener. Erythritol reduces dental plaque acid levels; high acid levels initiate the demineralization process. Moreover, it reduces dental plaque formation and the Streptococcus mutans levels in plaque and saliva. Palatinose is a disaccharide sucrose isomer, composed of glucose and fructose. Studies found that it is non-cariogenic because it cannot be metabolized well by oral microorganisms, which might make it an interesting non-cariogenic sweetener, however its effect on plaque pH is still unclear. Palatinose provides half of sucrose's sweetness, while providing the same amount of calories with a low glycemic profile. Mogroside is an extract obtained from the Siraitia grosvenorii Swingle fruit, also known as Luo Han Guo or monk fruit. It is a natural-based non-nutritive sweetener that is FDA approved. Monk fruit has long been cultivated in southern China and used as a traditional Chinese medicine. This sweetener is 100–250 times sweeter than sucrose, but has few calories. Studies have indicated several positive biological activities of monk fruit extracts, e.g., anti-tussive, anti-diabetic, antibacterial, anti-inflammatory, and antihyperglycemic effects. Furthermore, mogroside V, which is the most abundant sweet constituent, also demonstrated a strong antioxidant and anticarcinogenic effect in in vitro studies. However, there are few reports on Monk fruit's dental effects. Parents tend to prefer adding a natural-based sweetener into their child's food compared with an artificial sweetener. Children prefer the sweet foods. Thus, it is important to have products available that contain non-cariogenic sweeteners. Although there have been numerous studies on non-cariogenic sweeteners, mogroside has not been thoroughly evaluated. The aims of this study were to investigate the effect of mogroside, palatinose, erythritol, and xylitol on the dental plaque pH of children and to compare the differences in plaque pH changes between caries-active and caries-free children caused by the investigated sweeteners.

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Regards,
Catherine
Journal Co-Ordinator
Journal of Orthodontics and Endodontics