Cavity Prevention

Tooth decay is both preventable and curable.  Remember what Ben Franklin said? "An ounce of prevention is worth a pound of cure." His concept is relevant to today's dental care! We recommend that our patients employ a "combined strategies" approach from the list below to not only stop decay, but actually reverse it, providing that it hasn't advanced too far.

Firstly, what's plaque and why is it so important to remove it from the teeth? Plaque is a sticky film of bacteria that constantly forms on the teeth. The bacteria in plaque create toxins that cause cavities in your teeth. If its allowed to accumulate, it can cause an infection of the tissues that support and surround the teeth. That's called gingivitis. When it progresses into the bone, it's the major cause of tooth loss in adults affecting three out of four adults after the age of 35. That's called periodontal disease.

Because plaque is constantly forming, it must be continually removed daily. The good news is that plaque is a soft deposit and is easily removed with a toothbrush and dental floss. That's your job! Plaque that is missed can solidify into a hard deposit called tartar. That should be removed a few times a year by the hygienist. That's our job!

Here are our tips for healthy, clean teeth and gums, and a beautiful smile:

1.  Clean the plaque from between your teeth daily with dental floss by using a wrapping, vertical movement (see my blog "How To Floss Your Teeth Properly"). Woven, cotton floss cleans the best. Synthetic floss and waxed floss slip through tight teeth easier, but don't clean quite as well.

2.  Brush twice a day thoroughly with a soft toothbrush and a fluoridated toothpaste. Consider using an electric toothbrush such as the Braun Oral-B or the Sonicare. But, you still must floss!

3.  Use a toothpaste that contains fluoride for cavity prevention...most do. Other options include supplemental, fluoride rinses and prescription, high-fluoride toothpastes such as Prevident. We have them it the office for you to try!

4.  Eat nutritious and balanced meals. Limit snacking of sweets.

5.  Look for sugars on labels. The following sugars can cause dental decay: sucrose, glucose, dextrose, maltose, fructose and hydrolysed starch. Invert sugar (sucrose converted to glucose and fructose) or syrup, brown sugar, cane sugar, muscavado and concentrated fruit juices all contain sugars. Maltodextrin is not a sugar, but may cause decay. Alcohol sugars or polysols which include sorbitol, mannitol and xylitol (somewhat effective in preventing decay) do not cause decay. Other sweeteners that do not cause decay include aspartame, saccharin, acesulfame K, sucralose and stevia (non-cariogenic sweeteners). You should know the medical implications before making substitutions to your diet. By selecting a non-cariogenic (won't cause decay) sweetener, a beverage that reduces the risk of dental caries can be developed. READ THE LABEL OF THE INGREDIENTS IN YOUR BEVERAGE! 

6.  Inquire about the need for dental sealants, which are applied to the chewing surfaces of the back teeth to protect them from decay. They are great for children, teens and even young adults.

7.  Visit your dentist regularly for professional cleanings and oral examinations.

Remember to use a "combined strategies" approach by following many of the suggestions above, and remember what Ben Franklin said.

How to Floss Your Teeth Properly

We are asked many questions about "dental flossing" by our patients. Most frequent are why is it necessary to floss and what’s the best floss to use? Here's what we tell our patients. 

Why is it necessary to floss my teeth? I brush twice daily!

There are actually two reasons to floss your teeth, one is dental and the other is medical. Brushing one’s teeth daily is part of a sound oral hygiene program. Brushing removes the soft plaque from the teeth which consist of colonies of bacteria. Ungrateful guests, those microscopic monsters thrive on the food particles that are left on your teeth. The result is the production of toxins that contribute to the development of dental diseases such as tooth decay, and diseases of the gums and bone called periodontal disease, not to mention bad breath. Unfortunately, even diligent brushing isn’t enough to remove the plaque that forms BETWEEN the teeth. That’s where flossing comes in. Simply stated, floss gets into the areas that the toothbrush can’t possibly reach.

What is the medical benefit to flossing my teeth?

Current research is beginning to point to a "mouth-body" connection. Infections in the mouth can play havoc elsewhere in the body. For a long time it was thought that bacteria was the factor that linked periodontal disease to other infections in the body; however, more recent research demonstrates that it's inflammation that may link periodontal disease to  conditions such as coronary artery disease and stroke. In addition there is an association between periodontal disease and  chronic inflammatory conditions such as diabetes, respiratory disease and osteoporosis. Evidence is also mounting that suggests that pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small. While all the information is not yet available, many clinicians feel that infections do play a role in heart disease, and may explain some of the risk that is not accounted for by other factors including high cholesterol, smoking, diabetes, being overweight, and living a sedentary lifestyle. Preventing gum disease from occurring or treating it early will help save your smile, and may also save your life!

Why do I need to floss, if I see the hygienist for a cleaning regularly?

If you fail to thoroughly remove the soft plaque by not brushing and flossing properly, the plaque eventually hardens into a substance called tartar. Unlike plaque which is easy to remove, tartar can only be removed by the hygienist during a cleaning. The best program of dental hygiene, therefore, includes diligent "home care", that's your job, and thorough professional care, that's our job.

What are the visible signs of not flossing?

Bleeding of the gums when you brush, even if you are a flosser, is an indication of inflammation. So are loose teeth, a change in your bite, red rather than pink gums, puffiness of the gums, a bad taste and bad breath. In the office, when patients complain of bad breath or a bad taste, the first thing that we ask them is if they are flossing daily.

What kind of floss should I use?

The best answer is any floss that you use regularly! However, some flosses work better than others at removing plaque. Floss comes in many varieties and compositions. Slippery flosses that are synthetic or waxed pass through tight contacts between the teeth easily. Unfortunately, they don’t remove plaque as well as floss made of cotton fibers. Look on the package for the word “woven” which separates into loose threads for effective plaque removal.

When is the best time to floss?

The best time to floss is in the evening before bedtime, but always after your milk and cookies! The beneficial cleansing action of your saliva diminishes during sleep, and your teeth will remain clean the longest. To be honest, it doesn’t matter when you floss as long as its done properly every day.

What’s the correct way to floss?

1.)  Always floss BEFORE you brush in order to clean BETWEEN your teeth where the brush doesn't reach. Be methodical!  Start on the upper right, and progress to the upper left. Then floss the bottom left, and move to the lower right.

2.)  Be generous with the floss. Tear off about 18 inches, as long as your lower arm. Wind some of it around the index or middle finger of each hand. The tips of your thumbs and forefingers are your “flossing-fingers.” A common mistake is to position the finger tips of each hand too far apart. They should be no wider than an INCH apart, otherwise the floss will snap between your teeth and injure your gums. The best control is when your fingers are close together!

3.)  Pull the floss taut between your hands. Now, gently guide the floss between your teeth where they touch each other. Try not to the snap the floss into your gums!

4.)  Here’s the KEY POINT in flossing correctly! There are two tooth-surfaces that you must clean below each tooth-contact, one on EACH tooth. When the floss reaches the gum line, curve it into a C-shape by lightly leaning against one tooth. We call this "wrapping" the floss. Gently slide the floss downward (upward on upper teeth) into the space between the gum and the tooth.

5.)  Holding the floss gently against the tooth, gently slide the floss with an UP AND DOWN motion. Mistakenly, many patients use a sawing motion when they floss, which is ineffective in removing plaque from the root surfaces! This is the CRITICAL STEP!  Please check out the diagram below.

6.)  After two or three up-and-down flosses of one tooth-surface, then slide your floss against the adjacent tooth. Now clean its surface the same way, UP AND DOWN. You've now cleaned the sides (root surfaces) of the two teeth that are adjacent to each other that share the same contact.

7.)  Now, begin to progress methodically through your entire mouth by wrapping and vertically cleaning each surface. You can reposition your fingers to a section of clean floss. If the floss is too tight to remove it through the contact, then simply pull the floss out to the side. Don't forget to floss the backsides of your four end teeth.

8.)  It’s time to brush, now that all of your in-between surfaces are clean. Brushing will remove all the remaining particles of food and colonies of plaque, and allow the fluoride in the toothpaste to thoroughly protect your teeth.

The most important movement of proper flossing is to hold the floss against each tooth surface in a C-shape,
and then guide the floss up-and-down in order to clean the surface.





 A word about availability

Understandably, patients tend to use those brands of floss that slip through the tight contacts of their teeth the easiest. Unfortunately, as we have discussed, the slippery synthetic and waxed flosses don't necessarily clean as well. As a result, stores stock the products that sell the best. Over the years we have gradually seen woven floss become harder to find on the shelves. The good news is that it's readily available on-line. There are many brands to choose from, but once again, look for the words "woven."

FAQ's: Your Child's Teeth

Q.  Dr. Jack, at what age should I first bring my child to the dentist?

A.  It's a good idea to have an oral exam, usually with your physician for convenience, within six months of the eruption of the first tooth, no later than the child's first birthday. Regular visits with the dentist should begin during the third year.

Q.  Why should I be concerned about my daughter's baby teeth when they will be replaced by permanent teeth later?

A.  Even though they are "temporary", the baby teeth serve important functions including speech development, proper nutrition and acting as space maintainers for the permanent teeth.

Q.  We don't drink much tap water, and I don't even know if it's fluoridated. How can I be sure if my child is getting the appropriate levels of fluoride for cavity protection?

A.  Controversy consistently surrounds this subject. Studies have shown that living in a water fluoridated community provides enough exposure from trace sources such as tooth brushing and casual drinking. In a non-fluoridated community, a strict, bottled water situation or the use of a fluoride filtration system, consider administering fluoride tablets or drops prescribed by your pediatrician. You can test the fluoride level of your bottled, tap or well water BEFORE supplements are given. A list of fluoridated towns in Massachusetts is available at www.state.ma.us/dph/bfch/oral/cityfluor.pdf.

Q. What happens if my child gets too much fluoride?

A. The ingestion of huge quantities of fluoride is very harmful, but is highly unlikely to happen. However, moderate excesses of fluoride can result in fluorosis, a patchy white and brown pigmentation of the tooth enamel which can be uncosmetic. That's why you should dispense a pea-size amount of toothpaste which usually contains fluoride. It is felt that young children could ingest much of the toothpaste that they brush which results in a high serum fluoride level. Along with fluoride from the tap and prescriptions, this could cause fluorosis.

Q.  Is it OK to give my child a bottle of milk or juice at naps, or at bedtime to help her fall asleep?

A.  Absolutely not! This practice can cause very destructive cavities called "baby bottle tooth decay". We recommend only water in the bedtime bottle.

Q.  Is teething painful, and what can I do to help?

A.  When babies are teething, usually between the ages of four months and 2 1/2 years, they often have sore and tender gums. Try soothing the pain by gently rubbing the baby's gums with your clean finger or a teething ring. By the way, teething does not cause a fever.  An elevated temperature needs to be addressed as a separate medical concern.

Q.  When should thumbsucking stop?

A.  By the time the permanent front teeth are ready to erupt, generally age 6. Usually, children stop between the ages of two and four years.

Q.  What happens if my child continues to suck his thumb while his permanent teeth come in?

A.  Aggressive and prolonged thumbsucking can actually move the teeth and affect the bite possibly resulting in the need for future orthodontic treatment. 

Q.  What is the best way to introduce my child to his first dental visit?

A.  In our office, we suggest bringing your child along when you get your teeth cleaned. That way he will become familiar with our faces and the office. After your cleaning, we'll give him a ride in the "big" chair and count his teeth. Saturdays are very popular in our office for kids and families. And, we have lots of great stickers and prizes!

FAQ's: Pregnancy and Your Dental Health

Q.  Dr. Share, I'm aware of the changes that my body is going through while being pregnant. Should I have any particular dental concerns at this time?

A.  During pregnancy there is a special need for good oral hygiene, because pregnancy may exaggerate some dental disorders. The old adage  "a tooth is lost for every child"  is untrue.  However, during pregnancy inflammation of the gums may be more pronounced due to a rise in your body's hormonal levels. This is due to the way that your gums react to the irritants in the plaque on your teeth, not the hormones themselves. By maintaining a sound program of brushing and flossing thoroughly twice daily, using an ADA-accepted toothpaste and seeing our hygienist regularly, your tissues will remain their healthiest. 

Q.  Why is prenatal dental care so important?

A.  Firstly, tooth development in the embryo begins as early as the fifth or sixth week of intrauterine life, often even before your pregnancy has been confirmed! And, your eating habits may change, causing changes in your oral health. Your own personal nutrition has a direct bearing on the development of your child's teeth. So, it is important that you receive sufficient amounts of nutrients especially vitamins A, C, and D, protein, calcium and phosphorus. It is also a myth that calcium is lost from the mother's teeth during pregnancy.  The calcium your baby needs is provided by your diet, not by your own teeth.

Q.  Can I have my teeth worked on while I'm pregnant?

A.  The best time for any treatment, especially if you are currently in the midst of dental care, should be discussed with us and your obstetrician. Normally, it's best to schedule necessary visits during the second trimester (the fourth through the sixth months) of your pregnancy. Morning sickness commonly occurs in the first trimester. During the last trimester it may be less comfortable for you to sit in one position for any length of time. Dental cleanings and check-up exams are not only safe during pregnancy but are important to continue. 

Q.  Can I take medications and have anesthetics during pregnancy?

A.  Many medications are perfectly safe and others are a risk to your unborn baby. Taking any medication during pregnancy should be done only on the advice of your physician. Most obstetricians approve the use of local anesthetic (without vasoconstrictors) during pregnancy.

Q.  Are X-rays safe?

A.  Although the amount of radiation from a dental X-ray is minute, the beam is limited to a small region of the face, and we cover our patients with a protective lead apron (pregnant or not), we generally refrain from taking X-rays during pregnancy. If a dental emergency arises mandating an X-ray for diagnosis and treatment, we will thoroughly discuss this with you and your physician.   

Q.  I've been hearing that there might be a link between unhealthy gums, and preterm births and low birth weight babies?

A.  Studies have shown a relationship between periodontal disease and preterm low birth weight babies.  In fact pregnant women with periodontal disease may be seven times more likely to have a baby that's born too early and too small.  The likely culprit is a labor-inducing chemical found in oral bacteria called prostaglandin.  Very high levels of prostaglandin are found in women with severe cases of periodontal diseases.  If the data is correct, this would make periodontal disease responsible for more cases of preterm, low birth weight deliveries than either smoking or alcohol use.

Incredible Tales of Dental Evolution Part I: The Story of How the Reptilian Jaw Joint Became Our Middle Ear

I am often asked questions about anatomy by my patients, many of whom know about my profound interests in paleontology and evolution. Many of their questions regard their jaw joint called the temporomandibular joint, or simply TMJ. Discussions often lead to the TMJ's interesting proximity to the ear, being directly in front of it. Curiosity usually peaks when discomfort arises within the ear or the TMJ, which can often be difficult to localize for patients when they are in pain. In fact, many patients have their ears examined before suspecting that their pain is arising from their TMJ.

I thought it would be interesting to initiate a series of posts on my blog pertaining to the evolution of various structures relating to dentistry and anatomy. So, let's discuss the evolutionary relationships between middle ear and the TMJ. 

One of my favorite evolutionary transitions is the spectacular modification of the jaw joint for chewing in primitive reptiles and mammals into the middle ear for hearing in modern mammals like us. Yes, you read that correctly! The primitive jaw joint became a part of our middle ear.

A COMMON ANCESTOR
It's important to begin by noting that all mammals (like cats and dogs, lion and tigers, and you and I) share a common ancestor with reptiles (like crocodiles and snakes, and dinosaurs and birds). As you know, mammals have hair, fur and mammary glands, the latter used to nourish their young. But those physical characteristics don't survive when their remains are fossilized. Only the bones and teeth do. Using those fossilized remains, we can trace back in time the relationships of mammals and reptiles to where their lineages converge with a common ancestor. That was about 310-330 million years ago. From that point on, changes gradually occurred through evolution that allow us to distinguish differences between mammals and reptiles. A prime example is our discussion concerning the jaw joint and middle ear.

MOVING FROM A LIFE IN WATER TO A LIFE ON LAND 
In amphibians, reptiles and birds, the eardrum (tympanum) is a circular, thin membrane located behind the jaw joint. Sound is transmitted via the eardrum to the middle ear in the form of vibrations conducted along a small bone called the stirrup (stapes). In primitive amphibians, a bone called the hyomandibula helped to brace the upper jaw against the skull (the suspension-system in all animals is called the suspensorium). In order for our amphibian to fully migrate to land and evolve into a reptile (living and reproducing solely on land), it had to evolve a more sophisticated sound receptor within the middle ear, along with other numerous terrestrial modifications, since air has 3,600 times greater acoustic impedance than water. So, the hyomandibula of the upper jaw  "migrated" through evolution to the middle ear and became the reptilian stapes to enhance auditory reception. But, that wasn't all that was evolving!

THE MIDDLE EAR EVOLVES ALONG WITH THE JAW JOINT
In modern mammals, sound is transmitted from the eardrum to a set of three tiny bones within the middle ear called the auditory ossicles. They are the hammer (malleus), anvil (incus) and stapes (same as the reptilian stapes). 

Here's the Big Question: How did we go from one reptilian, middle ear-ossicle to three in mammals? Primitive reptiles had a jaw joint that consisted of two-bones called a quadrate-articular joint (Q-A). In mammals the Q-A joint was replaced by another two-boned jaw joint called the dentary-squamosal joint (D-S). The D-S is our jaw joint. We refer it as our TMJ or temporomandibular joint. What happened to the reptilian Q-A joint when we evolved  into mammals?

Here's the Big Answer: The primitive quadrate-articular bones of the Q-A joint moved into the middle ear and became the incus and malleus auditory ossicles. That gave us three ossicles in the middle ear, all for improved hearing on land. It also left us with a D-S joint that was more flexible for chewing that the reptilian Q-A joint. Hearing, protection and chewing, as you can imagine, are fundamentally critical traits for survival. More on that later.

A diagram of the human ear showing the ear drum (tympanum)
and the three ossicles of the middle ear
from http://www.kids-ent.com/



Notice the reptilian jaw joint in this crocodile.
It is formed from two bones: the quadrate and articular.
Our croc has only one auditory ossicle, the stapes.

Notice our mammalian jaw joint. It is formed from two bones:
the dentary (also called the mandibular) and squamosal (also called the temporal).
We have three auditory ossicles, the maleus, incus and stapes.



Another way to look at it would be that mammals required better hearing ability on land. They needed three bones in the middle ear, not the reptilian two. So, the reptilian joint (its two bones) migrated to the middle ear in mammals to join the stapes (which was already there).



Legend: (a) Reptilian jaw formed between the quadrate and articular bones,
(b) Mammalian jaw formed between the dentary and squamosal bones,
(c) Reptilian middle ear consisting of only the stapes,
(d) Mammalian middle ear consisting of the incus, maleus and stapes bones,
in which the stapes was the reptilian ossicle, 
and the incus and maleus was the reptilian jaw joint. 
From Addison Wesley Longman, Inc. 1999

The evolutionary and anatomical relationship of our jaw joint to our ear explains why we hear our jaw movements so loudly when we chew, and why our present jaw joint is located so close to our ear. In fact, within our middle ear there are actually tiny muscles and nerves that "belong" to the original jaw bones.    

IT'S ALL ABOUT SURVIVAL
About two hundred million years ago, with their higher rates of metabolism and improved means of locomotion, mammals began expanding into ecological niches far beyond the capacity of reptiles. The mammal's "new" jaw joint provided for a wider range of motion for chewing, and their new-and-improved middle ear provided greater hearing acuity.

These evolutionary changes occurred through the process of natural selection. This is the process in nature whereby only the organisms best adapted to their environment tend to survive and transmit their genetic characteristics in increasing numbers to succeeding generations, while those less adapted tend to be eliminated. Those organisms with greater fitness have a better chance of survival and reproduction. A truly incredible tale of dental evolution!

FAQ's: Teeth Grinding and Clenching

Q.  Dr. Share, I've been told by my partner that I make noises with my teeth at night while I'm asleep. I can actually see little yellow spots starting to form on the tops of my teeth. Do you think that I'm grinding my teeth in my sleep?

A. The verification of noises and jaw movement by a sleep partner is an excellent indication that you are grinding your teeth. Yellow areas on the biting surfaces of the teeth, especially if they are sensitive, could be the start of wear into the dentin, the softer tooth tissue that lies under the enamel. Keep in mind that dentin can be exposed for other reasons than teeth grinding. Your chewing patterns, type of bite, diet, and even ageing will cause wear, exposing the dentin. So in time, wearing of the teeth is perfectly normal. The big question is whether you’re accelerating the process of wear by grinding your teeth while you are asleep.

Q. If I am grinding my teeth, why am I doing it...I'm not even aware of it?

A.  Grinding or bruxism is extremely common and occurs most often during sleep, when you're least conscious of the movement; however, many individuals clench and grind their teeth during the day. This is considered to be an indication of stress, anger, frustration or anxiety. 

Q.  I've done some googling. It sounds like I have "TMJ." Exactly what does that mean?
A.  The letters TMJ refer to the temporomandibular or jaw joint. They are the hinges that attach the lower jaw to the skull, one on each side directly in front of the ears. It also refers to a complex disorder, with many varied symptoms and many varied names, involving the jaw, jaw joint and the surrounding facial muscles that control chewing and jaw movement.

Q.  I have noticed jaw pain and some facial tightness in the morning when I awaken. I have even noticed tightness in my jaws during the day as well. What might the explanation be for that?

A. Your lower jaw is a curved bone that houses the teeth. It is attached to the skull by muscles, ligaments, and the two temporomandibular joints on each side. From a night of grinding or clenching, the TMJ can become sore and actually feel like an earache, because of its closeness to the ear. The muscles that work the jaw can even ache and become tender from overuse and fatigue. Often, this is at the cheekbone or where the jaw comes to an angle near the neck. Upon awakening the jaw can feel tight and difficult to open due to the tightness of the muscles. This can make the bite feel like it's off. Sometimes a headache will appear at the sides of the head from tight muscles. Also, the joint itself can be a source of popping and grating sounds called crepitus that can also be painful. It's important to mention that pain and aching in the jaws and face may not be accompanied by ear or jaw joint pain. 

Q. How does all this affect the teeth?

A. Years of grinding can cause the teeth to become sensitive as the protective enamel wears down. This exposes the yellow dentin underneath the enamel exposing the nerve endings. Grinding the teeth can be destructive and painful, but clenching, which has no movement, can be painful as well, but wear is not a factor.

Q.  It sounds like I might be a bruxer. How do we confirm my suspicions?
A.  The first step is to schedule an appointment at the office. An examination of your teeth might disclose patterns of wear called facets that indicate habitual use. We also complete an examination of the muscles of the head and neck, and exam your jaw joints for sounds and freedom of movement. In some circumstances an x-ray examination of your TMJ is recommended. The results of the exam along with your history of symptoms may suggest bruxism.  

Q.  What are the treatments for clenching and grinding?

A.  Once a diagnosis has been made, we can suggest various forms of treatment. Several options exist and need to be addressed on an individual basis. At home, a soft diet with no gum-chewing is recommended to rest tired, over-worked muscles and joints.  Analgesics such as Advil or Motrin, if tolerated medically, should alleviate the pain and reduce the inflammation in the muscles and tendons. Slow, careful stretching exercises work well, but try to limit wide opening of the jaw, which includes eating and even yawning. Thermal towel-treatments applied facially can be very soothing. Often bruxism is episodic related to work stress, and family and personal issues. A stress reduction program and regular exercise for healthy relaxation is suggested. Caffeine in the evening is discouraged in order to promote sound sleep. At the professional level, often patients find great relief through stress management. Assuming the stress-induced sleep activity is not short-lived, as from a career change or an imminent wedding, we can provide you with a custom-fitted, plastic mouth guard worn during sleep. This may alleviate or eliminate the painful symptoms and prevent the wear from damaging your teeth. Most patients find that sleeping with a mouth guard will provide dramatic relief.

For Dieters, Diabetics and Our Dental Patients: The Commonly Used Sugar Substitutes and Artifical Sweetners

Everyone loves sweets in one form or another. Unfortunately, sucrose ("table sugar") is fattening, promotes tooth decay, increases your blood glucose levels (Glycemic Index) and triggers the insulin reaction. For decades, dieters, diabetics and people concerned about their dental health have sought an alternative to sucrose. Although the perfect solution has not yet been discovered, there are many choices.

The majority of sugar substitutes approved for food use are artificially synthesized compounds. However, some natural sugar substitutes are known, including sorbitol and xylitol, which are found in berries, fruit, vegetables and mushrooms.

The three primary compounds used as sugar substitutes in the United States are saccharin, aspartame and sucralose. In many other countries cyclamate and the herbal sweetener stevia are used extensively.

SACCHARIN (Sweet'N Low) was discovered in 1879 by a scientist with abysmally poor lab technique. He spilled a chemical onto his hand and later touched it to his mouth. Saccharin got a bad reputation in the 1970's when experiments with rats indicated it might be carcinogenic.  Although the FDA attempted to ban saccharin in 1977, Congress issued a moratorium overriding the ban. The moratorium was extended seven times until 1991, when the FDA formally withdrew its proposal.   

CYCLAMATE (Sucaryl) was discovered in 1937 in a similar manner. A grad student who set his cigarette on a lab bench tasted sweetness when he took another drag. Cyclamate widely used both as a table-top sweetener and in foods until it was banned in the US in 1970, but is still in use in other countries. In 1984 the FDA concluded that cyclamate was not carcinogenic, and reversed its decision in 2000.

ASPARTAME was discovered in 1965 by a scientist who licked his finger to grab a sheet a paper. Aspartame (NutraSweet and Equal) quickly replaced saccharin in many foods. Unfortunately, aspartame breaks down at elevated temperatures (it can't be used in cooking), in carbonated beverages and simply over time. Because it is compounded of two amino acids, aspartic acid and phenylalanine (and breaks down into those compounds in the body), persons with the rare inherited disease Phenylketonuria should avoid aspartame. Persons suffering from fibromyalgia may also want to avoid foods containing aspartame and MSG. In addition, there have been reports of possible medical problems associated with aspartame. It has only 4 calories/gram, identical to sugar, but is 200 times its sweetness.

SUCRALOSE is the only non-caloric sweetener actually made from "real" sugar (sucrose). Discovered in 1976 when a student tasted instead of tested, it was granted approval by the FDA in 1998 and appears in little yellow packets on restaurant tables under the brand name "Splenda." Although sucralose is made from sucrose, it is not broken down by the body like sucrose and not used for energy. Research demonstrates that sucralose has no effect on carbohydrate metabolism, blood glucose control or insulin secretion.

TAGATOSE (Nutrilatose) is a naturally occurring sugar that can be found in small quantities in some dairy products. Its use as a low-calorie sweetener was determined in 1981. In the late 1980s Spherix patented an inexpensive process to produce tagatose in bulk from whey, a byproduct of cheese-making. Tagatose has only 40% of the calories of sucrose and is incompletely absorbed during the digestive process, providing the same bulk as sucrose with significantly fewer calories. The FDA has affirmed that tagatose may be used in food products "generally recognized as safe.

The polyols MALITOL, MANNITOL, SORBITOL, XYLITOL and others are naturally occurring sugar-free sweeteners. Although called "sugar alcohols", they are actually carbohydrates. Polyols can be used volume-for-volume like sugar, tend to have a low GI and cause smaller increases in blood glucose and insulin levels than do sugars and other carbohydrates. The FDA classifies some polyols as generally safe, and others are approved as food additives. Research has shown that regularly chewing xylitol sweetened gum actually reduces the incidence of dental decay. It is an ideal sweetener for gum, toothpaste and candies but can cause stomach upset and diarrhea in excess use.