Sugar substitutes have become increasingly popular and are used in a wide variety of food and beverage
products in the current market. This is partly in response to consumers’ demands to reduce sugar intake in an effort
to reduce the risks of adverse effects on systemic and oral health due to sugar overconsumption. With regards
to systemic health, most consumers assume that the use of sugar substitutes would reduce the risks for several
important and increasingly prevalent chronic non-communicable diseases related to sugar overconsumption, such as,obesity, diabetes, and cardiovascular diseases. However, several lines of evidence from animal and longitudinal
cohort studies suggested that long-term consumption of sugar substitutes may not be able to reduce the risks for
these diseases as expected. Numerous mechanisms have been discovered that could explain how sugar substitutes
could affect metabolism and physiology. Interestingly, they may induce changes in gut microbiota, which are now
known to influence nutrient absorption, metabolism, and the functions of other organ systems. With regards to
oral health, sugar substitutes are widely used to reduce cariogenicity of sweet food and beverages since they are
not good substrates for cariogenic bacteria. In addition, certain sweeteners may be useful as an adjunctive tool for
caries prevention. This article aims to review existing literature on the effects of sugar substitutes on systemic and
oral health, and the possible mechanisms underlying these effects, especially those related to microorganisms.
Such information, integrating with data from future investigations, should be taken into consideration when advising
patients and the population on the use of sugar substitutes.