Background

Aspartame, a widely used low-calorie sweetener, has long been considered a non-cariogenic alternative to sugar. However, debates continue about its potential anti-cariogenic properties and its role in promoting oral health. This systematic review and meta-analysis evaluated the cariogenicity of aspartame by analyzing in vitro studies, preclinical trials, and clinical trials.

What we did

Through a comprehensive literature search and meta-analysis, we examined acidogenicity, oral bacterial composition, caries incidence, and dental erosion—providing a clearer picture of how aspartame impacts oral health compared to sucrose and water.

This article is currently under review, you can read the registration here.

Disclaimer: This review was funded by Ajinomoto Health & Nutrition North America, Inc. However, all other elements of design, planning, execution, analysis, interpretation, and writing were conducted without the approval or involvement of Ajinomoto outside of their notification of progress.

Key Takeaways

Acidogenicity & Oral pH

• Aspartame is less acidogenic than sucrose, reducing the acid production that can lead to tooth decay.
• In clinical studies, aspartame’s impact on oral pH was comparable to water, suggesting minimal potential to promote dental caries.
• Plaque pH remained above the critical demineralization threshold (pH 5.5) after aspartame exposure, unlike sucrose, which significantly reduced pH.

Caries Development

• In preclinical animal studies, aspartame did not promote caries and significantly reduced caries incidence when used as a sucrose replacement.
• When aspartame was added to sucrose, it provided minimal protection, with the most notable benefit seen in sulcal caries.

Oral Microbiota

• Aspartame had minimal impact on oral bacterial composition, including the levels of S. mutans and Lactobacillus, both associated with caries development.
• Replacing sucrose with aspartame led to a decrease in S. mutans abundance but did not significantly affect total oral microflora.

Dental Erosion & Mineralization

• In bovine block studies, aspartame was less erosive than sucrose, leading to lower enamel demineralization and reduced acidogenicity.
• However, aspartame had limited direct effects on promoting remineralization, suggesting its benefits stem primarily from reducing sugar exposure.

Implications for Oral Health

• Aspartame is confirmed as non-cariogenic and may offer some protection against caries when used as a complete sugar substitute.
• Its neutral effect on the oral microbiome and minimal acidogenicity make it a safe alternative to sucrose, especially for individuals at high risk of dental caries.
• However, there is limited evidence supporting active anti-cariogenic properties, and more long-term human studies are needed.

This systematic review and meta-analysis reinforces aspartame’s status as a non-cariogenic sweetener, supporting its use as a sugar substitute to help reduce the risk of dental caries. While aspartame reduces exposure to fermentable sugars and associated acid production, its anti-cariogenic potential remains inconclusive. Further research, especially long-term human trials, is needed to fully understand aspartame’s impact on oral health.