Aspartame and Dental Caries: Systematic Review Confirms It’s a Non-Cariogenic Sugar Alternative

New evidence confirms that aspartame is a non-carcinogenic alternative to sucrose, but its protective benefits may be limited. With the increasing prevalence of dental caries and rising awareness of sugar’s detrimental impact on oral health, non-nutritive sweeteners like aspartame are often promoted as safer alternatives. A recent systematic review and meta-analysis (PROSPERO registration: CRD42024513463) conducted in February 2024 offers valuable insights into aspartame’s cariogenicity and its role in oral disease prevention.

Study Scope and Methodology

The analysis incorporated data from multiple research domains, including:

• Two human clinical trials
• Seven preclinical animal studies
• Four in vitro studies using bovine enamel blocks

The review systematically examined aspartame’s effects on caries development, acid production, changes in oral microbiota, and enamel demineralization, comparing it to sucrose, water, and other control agents. The GRADE framework was used to assess the certainty of evidence, and random effects models were applied to synthesize heterogeneous data.

Findings: Aspartame Demonstrates Non-Cariogenic Behavior

Clinical Studies

In clinical settings, aspartame was found to be less acidogenic than sucrose and comparable to water, indicating a neutral impact on salivary pH. However, due to small sample sizes and methodological variability, the certainty of this evidence remains low to very low.

Preclinical Animal Studies

In rodent models, aspartame consistently demonstrated a reduction in caries incidence when used in place of sucrose (moderate certainty). However, when aspartame was combined with sucrose, it did not significantly attenuate caries formation, except in specific instances such as sulcal caries.