In 1980, at the age of 16 and with $50 in his pocket, Dr. Harunani came to America dreaming of becoming a dentist. As he pursued his education, he noticed that dental disease (along with obesity, diabetes, and metabolic disease) was much more prevalent in the US than on the small island in Africa where he grew up. He also reflected on the emphasis he found on surgically treating teeth instead of preventing and/or reversing disease – we treat other chronic diseases with medications, but we cut teeth (or watch lesions continue to grow in an unchanged environment). Thus began his 40-year DREAM journey.
Studying both in and after school, he realized that the focus was not on the real culprit in dental decay. Not many people on the island he came from have access to the same oral care like we do, but they still rarely get cavities. He realized that their diets are more natural, wholesome, much less processed, and, crucially, much less acidic. Dental care has historically been centered around –

• Reducing the dental plaque/bacteria, which is only one of the sources of oral acidity.
• Remineralization as opposed to preventing demineralization. An acidic environment (<5.5 pH) is not conducive to remineralization.
• The use of xylitol, which does help reduce bacterial reproduction but, unfortunately, in therapeutic doses it also created gastric issues.

He realized that the solution would have to taste great, have an extended contact time with teeth, and create an environment conducive to repair and remineralization. The answer is create a hard candy that has all the benefits of artificial saliva and so DREAM candy was born! Unfortunately, using candy to protect and repair teeth is counterintuitive for most of us.
Based on our research and the literature review, DREAM candy works because it increases the oral pH while decreasing the bacterial count in the mouth due to the physical action of sucking and licking the candy and due to chemistry of providing an alkaline environment with the benefit of Erythritol (which reduces the reproductive capacity of oral bacterial over time (*2,*3,*13, *14,*16,*21)).

What is the Current Status:

Historically, dental care has been lacking in most populations due to lack of access and/or cost and as such many suffer from decayed and missing teeth. Majority of teeth are removed due to dental decay, which leads to a negative view of dentistry and decrease in oral health. Dental disease is mostly preventable but unfortunately oral health recommendations have been centered around reducing the dental plaque/bacteria and not acidity in the mouth, a major cause of decay. Bacteria are only one of the sources of oral acidity. Not being addressed is the diet we consume, which is a major contributing factors along with our own gastric acid. Thus the focus should be on increasing the oral pH for as long as we can. Additionally, the focus has been on remineralization as opposed to preventing demineralization. An acidic environment (<5.5 pH) is not conducive to remineralization (*1,*4); as such the efforts of remineralization without improving the pH have proven to not be as effective.

Dentistry has a long history of “watching” lesions get bigger. We now have technologies to help reverse the “watched” lesions. DREAM candy works with nature to neutralize the acids that are abundant in the modern diet and help the saliva provide the ions needed to repair the teeth– this will help us prevent the breakdown and encourage the repair of the Enamel. Artificial Caries Study on Caries-Inhibition Effects of DREAM candies have shown that they significantly reduced demineralization, and therefore not only inhibit cares but also have the potential to help repair (*15)

The Issues:
The hard outer layer of a tooth is enamel which is made up of 90% hydroxyapatite crystals and it undergoes demineralization and remineralization cycle throughout life and is thus susceptible to being dissolved by acids (demineralization) (*1.*4,*7). There are three basic sources of acidity in the mouth – stomach acids, foods/drinks we consume and dental plaque/bacteria (which convert the sugars/carbohydrates to lactic acid) (*1, *8,*9 ,*22). Acids from the foods/drinks/plaque, which break down enamel and cause cavities, continue to attack teeth until they are neutralized by saliva, which takes even longer in patients with dry mouth and/or in presence of citric acid. Sports drinks can cause significant erosion (*7, *9). In a study of 379 beverages, 93% were erosive (pH <4) and 39% were considered extremely erosive (pH < 3.0) (*5).

Soda consumption has gone from 35 gallons/capita in 1986 to 43 gallons/capita in 2022 (*6) and consumption of sports drinks in also on the rise. The per-capita consumption of sports drinks is estimated to be 30+ liters in 2027 (*19). Citric Acid (Lemon flavoring) is added to many foods and drinks and since Citrate ion is a strong chelating agent, its impact can be very detrimental (*9). The Candy’s alkaline make up along with the bioavailable Calcium and phosphatase can nullify and potentially reverse the detrimental impact of the Citrate ion (*7, *8, *15).
Children, and adults alike, like to enjoy sweets and treats. Most candies, sodas and other sour treats have a pH below 3 and studies show them to be very destructive and erosive (*7). Demineralization occurs anytime the pH is below 5.5. Additionally, citrus or citric acid is present in almost all fruit flavored candies, foods and drinks. Citric acid is not only destructive due to its acidic pH, which dissolves the tooth mineral, but it is also an excellent chelating agent which selectively removes calcium  resulting in greatly increased breakdown of the mineral component of the teeth (*1, *5,*7,*8, *17 – pg 66, *20).

There has been a lot of emphasis on the use of Xylitol as a sweetener but unfortunately, it is not possible for most people to consume therapeutic doses of xylitol without significant gastric distress (6gm for a small person, 8 grams for a medium and 10 grams for a large person). It would take 30, 40 or 50 pieces of Mentos Pure Fresh (0.2mg/piece) per day OR  43, 57 or 71 pieces of Trident Extra care (0.14mg/piece) to achieve therapeutic doses (*3).

REFERENCES:  (link to the study>Title of the study>Summary)

 *1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034904/pdf/ijn-11-4743.pdf: Demineralization–remineralization dynamics in teeth and bone - Biomineralization is a dynamic, complex, lifelong process by which living organ­isms control precipitations of inorganic nanocrystals within organic matrices to form unique hybrid biological tissues, for example, enamel, dentin, cementum, and bone. Understanding the process of mineral deposition is important for the development of treatments for mineralization-related diseases and also for the innovation and development of scaffolds. This review provides a thorough overview of the up-to-date information on the theories describing the possible mechanisms and the factors implicated as agonists and antagonists of mineralization. Then, the role of calcium and phosphate ions in the maintenance of teeth and bone health is described. Throughout the life, teeth and bone are at risk of demineralization, with particular emphasis on teeth, due to their anatomical arrangement and location. Teeth are exposed to food, drink, and the microbiota of the mouth; therefore, they have developed a high resistance to localized demineralization that is unmatched by bone. The mechanisms by which demineralization–remineralization process occurs in both teeth and bone and the new therapies/technologies that reverse demineralization or boost remineralization are also scrupulously discussed. Technologies discussed include composites with nano- and micron-sized inorganic minerals that can mimic mechanical properties of the tooth and bone in addition to promoting more natural repair of surrounding tissues. Turning these new technologies to products and practices would improve health care worldwide.
 

*2.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232036/: The effect of xylitol on dental caries and oral flora - Dental caries, the most chronic disease affecting mankind, has been in the limelight with regard to its prevention and treatment. Professional clinical management of caries has been very successful in cases of different severities of disease manifestations. However, tertiary management of this disease has been gaining attention, with numerous methods and agents emerging on a daily basis. Higher intake of nutritive sweeteners can result in higher energy intake and lower diet quality and thereby predispose an individual to conditions like obesity, cardiovascular disorders, and type 2 diabetes mellitus. Non-nutritive sweeteners have gained popularity as they are sweeter and are required in substantially lesser quantities. Xylitol, a five-carbon sugar polyol, has been found to be promising in reducing dental caries disease and also reversing the process of early caries. This paper throws light on the role and effects of various forms of xylitol on dental caries and oral hygiene status of an individual

*3.   Effectiveness of Xylitol in Reducing Dental Caries in Children:  Effectiveness of Xylitol in Reducing Dental Caries in Children - Based on this study’s results, the following conclusions can be made: (1) The present systematic review examining the effective-ness of xylitol on caries incidence in children, showed a small effect size in randomized controlled trials and a very low quality of evidence that makes preventive action of xylitol uncertain. And (2) The effect size of xylitol was greater with higher xylitol doses (greater than four grams per day).
 

*4.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881791/: Saliva and dental erosion - Dental erosion is a multifactorial condition. The consideration of chemical, biological and behavioral factors is fundamental for its prevention and therapy. Among the biological factors, saliva is one of the most important parameters in the protection against erosive wear.

*5.   https://jada.ada.org/article/S0002-8177(15)01050-8/fulltext: The pH of beverages in the United States - Most (93%, 354 of 379) beverages had a pH of less than 4.0, and 7% (25 of 379) had a pH of 4.0 or more. Relative beverage erosivity zones based on studies of apatite solubility in acid indicated that 39% (149 of 379) of the beverages tested in this study were considered extremely erosive (pH < 3.0), 54% (205 of 379) were considered erosive (pH 3.0 to 3.99), and 7% (25 of 379) were considered minimally erosive (pH ≥ 4.0).

*6.   https://www.ibisworld.com/us/bed/per-capita-soft-drink-consumption/1786/: Recent Trends – Per Capita Soft Drink Consumption - Soda consumption is estimated at 42.9 gallons per person. This does not include Sports drinks and carbonated waters, etc.

*7.   https://pubmed.ncbi.nlm.nih.gov/18084191/: Sour sweets: a new type of erosive challenge? - The pH of the sour sweets ranged from 2.30-3.14 with their neutralisable acidity ranging from 9.78-66.9 ml of 0.1M NaOH. The amount of permanent enamel removed following one hour immersion in the drinks ranged from 2.16-10.88 microm and from 1.02-18.34 microm for deciduous enamel. In comparison, the orange juice (Tropicana smooth) control had a pH of 3.86, a neutralisable acidity of 37.1 ml of 0.1M NaOH and removed 5.23 microm of permanent enamel and 6.27 microm of deciduous enamel. All the sour sweets tested were found to be erosive, some more so than orange juice.
*8.   https://pubmed.ncbi.nlm.nih.gov/16687885 (2006) & https://pubmed.ncbi.nlm.nih.gov/24993265: (2014): Understanding the chemistry of dental erosion - The mineral in our teeth is composed of a calcium-deficient carbonated hydroxyapatite containing impurity ions such as Na(+), Mg(2+) and Cl(-). These substitutions in the mineral crystal lattice, especially carbonate, renders tooth mineral more acid soluble than hydroxyapatite. During erosion by acid and/or chelators, these agents interact with the surface of the mineral crystals, but only after they diffuse through the plaque, the pellicle, and the protein/lipid coating of the individual crystals themselves. The effect of direct attack by the hydrogen ion is to combine with the carbonate and/or phosphate releasing all of the ions from that region of the crystal surface leading to direct surface etching. Acids such as citric acid have a more complex interaction. In water they exist as a mixture of hydrogen ions, acid anions (e.g. citrate) and undissociated acid molecules, with the amounts of each determined by the acid dissociation constant (pKa) and the pH of the solution. Above the effect of the hydrogen ion, the citrate ion can complex with calcium also removing it from the crystal surface and/or from saliva. Values of the strength of acid (pKa) and for the anion-calcium interaction and the mechanisms of interaction with the tooth mineral on the surface and underneath are described in detail. The net effect of the solution factors determines the overall erosive potential of different products. Prospects for remineralization of erosive lesions are evaluated.
*9.   https://pubmed.ncbi.nlm.nih.gov/21675676/: Sports drinks and dental erosion- Sports drinks were originally developed to improve hydration and performance in athletes taking part in intense or endurance sporting events. These drinks contain relatively high amounts of carbohydrates (sugars), salt, and citric acid. These ingredients create the potential for dental ramifications and overall public health consequences such as obesity and diabetes. High intake of sports drinks during exercise, coupled with xerostomia from dehydration, may lead to the possibility of erosive damage to teeth.

*10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323473/: Saliva pH and Flow Rate in Patients with Periodontal Disease and Associated Cardiovascular Disease - Study suggests that the decrease of salivary flow rate and pH level might be associated with the severity of periodontal disease. A severe form of periodontal disease was found in 22.4% of patients. Disease severity was strongly correlated with low pH values (6.25 in stage IV periodontal disease), lower salivary flow rate (0.28 mL/min), smoking, poor oral hygiene habits and obesity, with no significant differences by sex. We observed a significant increase of pH (up to 6.30±0.17) in patients with severe periodontal disease (P=0.001) and salivary flow rate values (0.29±0.07 mL/min; P=0.014) 3 months after oral hygienization. There was a strong association between the severity of periodontal disease and presence of cardiovascular disease (P=0.001).

*11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3800408/: Salivary pH: A diagnostic biomarker - The salivary pH was more alkaline for patients with generalized chronic gingivitis as compared with the control group (P = 0.001) whereas patients with generalized chronic periodontitis had more acidic pH as compared with the control group (P = 0.001). These results indicate a significant change in the pH depending on the severity of the periodontal condition. The salivary pH shows significant changes and thus relevance to the severity of periodontal disease. Salivary pH may thus be used as a quick chairside diagnostic biomarker

*12. https://pubmed.ncbi.nlm.nih.gov/6937261/: Remineralization of natural and artificial lesions in human dental enamel in vitro. Effect of calcium concentration of the calcifying fluid - Exposure of both small carious lesions and artificial caries-like lesions to a synthetic calcifying fluid in vitro produced a significant degree of ‘healing’ or remineralization of the lesion. Changing the calcium concentration of the calcifying fluid had a marked effect on the degree of remineralization produced.

*13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756564/: Erythritol as sweetener—wherefrom and whereto? – Erythritol is polyol that is non-caloric and majority of it cannot be metabolized by the human body and is excreted unmodified into the urine without changing blood glucose and insulin levels; thus a great choice for diabetics or people suffering obesity. It also means that a severe disadvantage of other polyols, namely sorbitol and xylitol, leading to diarrhea is eliminated. Only a little amount, less than 10%, undergoes a reversible metabolic reaction. Finally, erythritol is also a free radical scavenger with the ability to potentially exercise its anti-oxidant activity while circulating the body before it is excreted into the urine.

*14. https://pubmed.ncbi.nlm.nih.gov/27635141/: Erythritol Is More Effective than Xylitol and Sorbitol in Managing Oral Health Endpoint – The review reported the important differences in the effect of individual polyols on oral health. The review provided evidence demonstrating better efficacy of erythritol compared to sorbitol and xylitol to maintain and improve oral health.

*15. Dr John Burgess Study on DREAM Candy:  Artificial Caries Study on Caries-Inhibition Effects of Experimental Candies - Experimental candy materials have significant effect to reduce demineralization, and therefore have potential caries-inhibition effect.

*16. https://pubmed.ncbi.nlm.nih.gov/32286378/: Exploration of singular and synergistic effect of xylitol and erythritol on causative agents of dental caries - Study found both xylitol and erythritol to express high growth inhibition effect on cariogenic bacteria. In synergistic effect experiments, 10% polyol combination with excess of erythritol was found to be more effective against growth of Streptococcus mutans and the combination with excess of xylitol more effective against growth of Streptococcus sobrinus and S. wiggsiae. In biofilm inhibition experiments, solutions of 10% polyols in different combinations and 15% single polyols were equally effective against mutans streptococci. At the same time, higher biofilm formation of S. wiggsiae compared to experiments without polyols was detected in different polyol concentrations for up to 34%. In conclusion, both erythritol and xylitol as well as their combinations inhibit the growth of different cariogenic bacteria. Biofilm formation of mutans streptococci is also strongly inhibited.

*17. Scaramucci T, Carvalho JC, Hara AT, Zero DT. Causes of Dental Erosion: Extrinsic Factors. Berlin: Springer International Publishing; 2015:69–96.

*18. https://pubmed.ncbi.nlm.nih.gov/22899679/: Fluoride plus functionalized β-TCP: a promising combination for robust remineralization - Laboratory and clinical studies have demonstrated that the combination of fluoride and functionalized β-tricalcium phosphate (fTCP) produces stronger, more acid-resistant mineral relative to fluoride, native β-TCP, or fTCP alone.

*19. https://www.statista.com/statistics/306840/us-per-capita-consumption-of-sports-drinks/: Per-capita consumption of energy & sports drinks in the U.S. 2015-2027 - The average consumption per capita in the energy & sports drinks segment of the non-alcoholic drinks market in the United States was forecast to continuously increase between 2023 and 2027 by in total 1.2 liters (+4.07 percent). The per-capita consumption is estimated to amount to 30.72 liters in 2027.

*20. https://en.wikipedia.org/wiki/Citric_acid: Citric Acid - Citric acid is an excellent chelating agent, binding ions and making them soluble.
 
*21. https://pubmed.ncbi.nlm.nih.gov/24095985/ : Effect of three-year consumption of erythritol, xylitol and sorbitol candies on various plaque and salivary caries-related variables - Three-year consumption of erythritol-containing candies by initially 7- to 8-year old children was associated with reduced plaque growth, lower levels of plaque acetic acid and propionic acid, and reduced oral counts of mutans streptococci compared with the consumption of xylitol or sorbitol candies.
 
*22. https://pubmed.ncbi.nlm.nih.gov/8655757/: Cariogenicity depends more on diet than the prevailing mutans streptococcal species – The review concluded that the cariogenicity of the diet determines the development of dental caries while hardly affecting the mutans streptococci counts explains the limited value of the latter as an indicator of dental caries.
 
*23. https://pubmed.ncbi.nlm.nih.gov/33427224/ - Halitosis - Halitosis is a widespread condition presenting several social and psychological implications, leading to a reduction in the quality of life of an individual. Halitosis, per definition, defines an unpleasant smell of the exhaled air, independent of its etiology. It can have a long-term prevalence or be transient, making it difficult to establish this symptom's epidemiology. Oral malodor can be attributed to a high local concentration of intraoral microbial populations, particularly those of the tongue's biofilm, as well as the biofilms associated with teeth and periodontal tissue. Frequently, the treatment options rely on improving oral health via tongue cleaning, detecting periodontal diseases, insufficient dental restorations, alternating diets, and/or alleviating local factors. Different methods targeting specific bacteria species have been designed to improve this condition. The aim here is to underline the correlation between oral biofilms and halitosis, describing prime bacteria species influencing oral malodor and addressing new concepts to ameliorate this condition.
 
*24. https://pubmed.ncbi.nlm.nih.gov/16677187/: Prevalence of periodontopathic bacteria on the tongue dorsum of elderly people - A wide range of species, including anaerobes, was detected in 85-year-old subjects. It was found that the detection of periodontal bacteria on the tongue coating increased with the number of teeth. There was a positive relationship between the tooth number and periodontopathic bacteria, except for A. actinomycetemcomitans. These results suggest that tongue care is essential for preventing oral disease and needs to be part of any oral care programme in elderly people.
 
*25. https://pubmed.ncbi.nlm.nih.gov/36162884/: Effectiveness-of Calcium Phosphate derivative agents on the prevention and remineralization of caries among children- A systematic review & meta-analysis of randomized controlled trials - Topical treatment using CaP+F group showed superior remineralization potential as well as the antibacterial effect on dental caries among children as compared to no intervention and/or placebo or F alone. Apart from CPP-ACP, other CaP derivatives like TCP and fTCP seem to have promising effects in remineralizing early lesions, however, very few trials exist on these potential agents.
 
*26. https://pubmed.ncbi.nlm.nih.gov/28032049/: The efficiency of child formula dentifrices containing different calcium and phosphate compounds on artificial enamel caries - All toothpastes in this study had the potential to delay the demineralization progression of artificial enamel caries in primary teeth. The fluoride 500 ppm and TCP toothpastes were equal in the deceleration of enamel caries progression and better than CPP-ACP paste and TCP toothpaste.