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Caries Process and Prevention Strategies: The Agent
Sugar Metabolism

Course Author(s): Susan Higham, BSc, PhD, CBiol, MRSB; Chris Hope, BSc (Hons), PhD, FHEA; Sabeel Valappil, BSc, MSc, PhD, PGCertEd, FHEA; Phil Smith, BDS, MDS, PhD, FDS, DRD, MRD, FDS (Rest Dent) RCS (Edin), FHEA

Sugar Metabolism

Dietary sugars, starches, and fermentable carbohydrates (usually collectively referred to as sugars) are present in the diet, and are in direct contact with plaque during eating, and for some time afterwards. The breakdown of sugars is an important step that influences the plaque environment. Enzymes in bacteria and saliva break down sugars’ polysaccharides and disaccharides to monosaccharides. There are five main mechanisms by which oral Streptococci hydrolyze (break down) sucrose (Figure 5).

  1. Extracellular invertase cleaves the energy rich α(1-2) glycosidic bond between the glucose and fructose moieties.
  2. The bacterial cell transports the sucrose across the cell membrane and cleaves the glycosidic bond using an intracellular invertase.
  3. Extracellular glycosyltransferases polymerize the glucose molecule while liberating the fructose molecule so it is free to enter the bacterial cell. Streptococci are particularly proficient at this.
  4. Extracellular fructosyltransferases polymerize the fructose while the glucose molecule is liberated, so it is free to enter the cell.
  5. Salivary amylase cleaves the polysaccharides.

Figure 5. Mechanisms of sucrose hydrolysis by oral bacteria.

fig05
Adapted from: Marsh PD, Lewis MAO, Rogers H, et al. Oral Microbiology. 6th ed. 2016; Edinburgh: Churchill Livingstone Elsevier.
Among the full range of fermentable carbohydrates, the one that’s most cariogenic is sucrose. The reason that it is a relatively small molecule and that it fills into the plaque and the bacteria like to use sucrose for energy production and the process produces acid. Sucrose actually can, during the process, the bacteria can make use of sucrose to produce a key carbohydrate called dextrins. It will help plaque stick to the tooth surface, making it more sticky and more difficult to remove.
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