Maltodextrin and dental caries: a literature review

REVISÃO | REVIEW CLINICAL CLÍNICO http://dx.doi.org/10.1590/1981-8637201800030000103288 Maltodextrin and dental caries: a literature review Maltodextrina e cárie dentária: uma revisão de literatura Gabriela REZENDE1 ORCID iD 0000-0002-7347-0973 Lina Naomi HASHIZUME1 ORCID iD 0000-0001-5477-2768 ABSTRACT Carbohydrates are largely present in our diet. Sucrose the most commonly consumed carbohydrat and presents a high cariogenic potential. Starch has low cariogenic potential but this effect may be increased if it is consumed in combination with a sucrose-rich diet due to a prolonged retention on tooth surfaces. Maltodextrin is derived from the acid hydrolysis and/or enzymatic hydrolysis of corn starch and it is increasingly present in a variety of industrialized foods such as infant formulas, sports drinks and energy supplements. Yet, its role in the development of dental caries is not clear. The objective of this study was to conduct a literature review of the association between maltodextrin and dental caries. Based on the studies included in this review it can be concluded that maltodextrin has an acidogenic potential lower than sucrose, and that there is a lack of studies about the association between maltodextrin and sucrose and it may not be possible to assess the relationship to dental caries. Indexing terms: Carbohydrates. Dental caries. Literature. RESUMO Os carboidratos são amplamente presentes em nossa dieta. A sacarose é o carboidrato mais comumente consumido e apresenta um alto potencial cariogênico. O amido apresenta um baixo potencial cariogênico, mas este efeito pode ser aumentado se for consumido em combinação com uma dieta rica em sacarose, devido a uma retenção prolongada nas superfícies dos dentes. A maltodextrina é derivada a partir da hidrólise ácida e/ou enzimática do amido de milho e está cada vez mais presente em uma variedade de alimentos industrializados, como fórmulas infantis, bebidas esportivas e suplementos energéticos. Contudo, o seu papel no desenvolvimento da cárie dentária ainda não está esclarecido. O objetivo deste estudo foi realizar uma revisão da literatura sobre a associação entre a maltodextrina e a cárie dentária. Com base nos estudos incluídos nesta revisão, pode-se concluir que a maltodextrina apresenta um potencial acidogênico menor do que a sacarose, e que estudos sobre a associação entre maltodextrina e sacarose são escassos não podendo ser possível avaliar sua relação com cárie dentária. Termos de indexação: Carboidratos. Cárie dentária. Literatura. INTRODUCTION Maltodextrin is a starch hydrolysate that is often used by the industry and is increasingly present in a variety of foods such as infant formulas, sports drinks, and energy supplements. Maltodextrin-based products, especially infant soy formulas, are commonly used for children who have allergies or lactose intolerance [1,2]. These formulas are used as cow's milk substitute and are given to children at high frequency and at night when the salivary flow is reduced, favoring the development of dental caries [3,4]. However, its role in the development 1 of dental caries is not clear. Therefore, the objective of this study was to conduct a literature review regarding the association between maltodextrin and dental caries. Carbohydrates and dental caries Although epidemiological indicators of dental caries have shown important decline in the prevalence of this disease, it appears to be present in childhood in many countries [5-7]. Dental caries is considered a multifactorial disease and its development is strongly associated with a diet high in carbohydrates. Ingestion of high quantities of fermentable carbohydrates induces the formation of a Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Departamento de Odontologia Preventiva e Social. Rua Ramiro Barcelos, 2492, 90035-003, Porto Alegre, RS, Brasil. Correspondência para / Correspondence to: G REZENDE. E mail: . ▼ ▼ ▼ ▼ ▼ Como citar este artigo / How to cite this article Rezende G, Hashizume LN. Maltodextrin and dental caries: a literature review. RGO, Rev Gaúch Odontol. 2018;66(3):257-262. http://dx.doi.http:// dx.doi.org/10.1590/1981-8637201800030000103288 RGO, Rev Gaúch Odontol. 2018 Jul-Set; 66(3):257-262 G REZENDE et al. biofilm with cariogenic microorganisms [8,9]. The association between dental caries and excessive consumption of sugars is affirmed by experts at World Health Organization, who performed an assessment of the evidence in the literature relating diet and caries in 2003. They have reported an increase in the risk for development of caries that is associated with frequent intake of sugars [10]. In the recent Food Guide for the Brazilian Population, it is emphasized that excessive sugar consumption increases the risk of developing caries [11]. With the changes in eating habits and the growth in processed food industrialization, foods high in fibers and nutrients are being replaced by processed foods with an excess of fats and carbohydrates. This facilitates the development of dental caries [12]. Carbohydrate is the food group abundantly prevalent in our diet. Carbohydrates can be classified in different ways, such as by chain length (monosaccharides, disaccharides, polysaccharides) and origin [13]. Sucrose is the most commonly consumed carbohydrate and presents a greater cariogenic potential. This feature is, in part, attributable to the fact that this is the only carbohydrate that can be used as a substrate for the synthesis of soluble and insoluble extracellular polysaccharides (EPS) by dental biofilms, favoring the colonization and adherence of microorganisms to dental surfaces and increasing the porosity of the dental biofilms [14-16]. Classical studies assessing the relationship of dental caries with diet showed that there is an increase in dental caries with the increased consumption of carbohydrates. The consistency of foods and how often foods high in sugar are consumed has also a large influence [17-18]. A study conducted monitored mentally disabled adults over 5 years in order to assess the caries increment with increased sucrose intake, influence of food consistency, and frequency of sugar intake. The authors observed that there was a low incidence of caries when the diet was almost free of carbohydrates and less of a caries increment with the consumption of carbohydrates derived from starch at meals [17]. Other study with a group of children, living in an orphanage, who had a lacto-vegetarian diet with minimal amounts of sugar and refined flour observed a lower prevalence of caries. However, an increase in dental caries prevalence occurred when the children left the orphanage. They concluded 258 RGO, Rev Gaúch Odontol. 2018 Jul-Set; 66(3):257-262 that diet had extreme influence on the development of caries [18]. A recent systematic review about the association between sugar intake and dental caries, analyzed 55 studies and the authors concluded that there (...truncated)