The effect of frequent sucrose mouthrinsing on the induction in vivo of caries-like changes in human dental enamel

Intake of Artificial Sweeteners by Children: Boon or Bane?

BACKGROUND

Sugar is the main culprit in many health dysfunctions. Excessive sugar intake can negatively affect oral health, precipitate diabetes, and lead to weight gain and obesity. Sucrose is the primary form of sugar, and is strongly correlated with dental caries. Artificial sweeteners are chemically synthesized sugar substitutes that are generally regarded as being low-calorie.

OBJECTIVE

This review examines the current evidence in the literature for the need for artificial sweeteners and outlines its implications for the health of children. We briefly outline its adverse effects, and concerns regarding their safety.

REVIEW RESULTS

Artificial sweeteners are a widely used food additive. Six main artificial sweeteners are approved by the food and drug administration (FDA). The conflicting results and divergent regulatory norms of each sweetener are a constant cause of concern and debate. However, most studies have spotlighted the beneficial effects of artificial sweeteners. Dental caries diminish with the increase in sweetener intake. An increase in appetite and eventually weight gain is observed in individuals consuming artificial sweeteners.

CONCLUSION

Artificial sweeteners are indeed a bane according to present studies, although more research on recently discovered non-nutritive artificial sweeteners is required. It also has a positive effect on overall health disorders. If one curbs the onset of dental caries, then the eventual rise is highly unlikely.

CLINICAL SIGNIFICANCE

Artificial sweeteners' effect on lowering dental caries will help to reduce the caries index in general. Oral hygiene is maintained, and the growth of oral bacterium is depressed. Research on novel sweeteners will help to compare their efficacy in caries prevention compared to existing ones. It is necessary to educate people on artificial sweeteners and its implication as one can use them by being aware of their properties.

Role of sugar and sugar substitutes in dental caries: a review

Dental caries is a chronic disease which can affect us at any age. The term "caries" denotes both the disease process and its consequences, that is, the damage caused by the disease process. Dental caries has a multifactorial aetiology in which there is interplay of three principal factors: the host (saliva and teeth), the microflora (plaque), and the substrate (diet), and a fourth factor: time. The role of sugar (and other fermentable carbohydrates such as highly refined flour) as a risk factor in the initiation and progression of dental caries is overwhelming. Whether this initial demineralization proceeds to clinically detectable caries or whether the lesion is remineralized by plaque minerals depends on a number of factors, of which the amount and frequency of further sugars consumption are of utmost importance. This paper reviews the role of sugar and sugar substitutes in dental caries.

Surface remineralization potential of casein phosphopeptide-amorphous calcium phosphate on enamel eroded by cola-drinks: An in-situ model study

AIM

The aim of this study was to investigate the remineralization potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on enamel eroded by cola drinks.

SUBJECTS AND METHODS

A total of 30 healthy subjects were selected from a random sample of 1200 children and divided into two groups of 15 each wherein calcium and phosphorus analyses and scanning electron microscope (SEM) analysis was carried out to investigate the remineralization of enamel surface. A total of 30 non-carious premolar teeth were selected from the human tooth bank (HTB) to prepare the in-situ appliance. Three enamel slabs were prepared from the same. One enamel slab was used to obtain baseline values and the other two were embedded into the upper palatal appliances prepared on the subjects' maxillary working model. The subjects wore the appliance after which 30 ml cola drink exposure was given. After 15 days, the slabs were removed and subjected to respective analysis.

STATISTICAL ANALYSIS USED

Means of all the readings of soluble calcium and phosphorous levels at baseline,post cola-drink exposure and post cpp-acp application were subjected to statistical analysis SPSS11.5 version. Comparison within groups and between groups was carried out using ANOVA and F-values at 1% level of significance.

RESULTS

Decrease in calcium solubility of enamel in the CPP-ACP application group as compared to post-cola drink exposure group (P < 0.05) was seen. Distinctive change in surface topography of enamel in the post-CPP-ACP application group as compared to post-cola drink exposure group was observed.

CONCLUSION

CPP-ACP significantly promoted remineralization of enamel eroded by cola drinks as revealed by significant morphological changes seen in SEM magnification and spectrophotometric analyses.

Sugars – The Arch Criminal?

Numerous lines of evidence have conclusively established the role of sugars in caries etiology and the importance of sugars as the principal dietary substrate that drives the caries process has not been scientifically challenged. While sugars appear to differ little in acidogenic potential, sucrose has been given special importance, as the sole substrate for synthesis of extracellular glucans. Water-insoluble glucans might enhance accumulation of mutans streptococci on smooth tooth surfaces and appear to enhance virulence by increasing plaque porosity, resulting in greater acid production immediately adjacent to the tooth surface. Data indicating that the sugar consumption/caries relationship is now weaker have led to suggestions that recommendations to restrict sugar consumption are no longer necessary. Clearly, fluoride has raised the threshold of sugar intake at which caries will progress to cavitation, but fluoride has its limits, and caries remains a serious problem for disadvantaged individuals in many industrialized countries and is a rising problem in many developing countries. A weakening of the sugar/caries relationship may also be explained by many technical, biological, behavioral and genetic factors. Future research should aim to determine the biologic and behavioral factors that influence caries risk. Measures to educate the public on the dangers of frequent sugar consumption, combined with recommendations for proper oral hygiene and fluoride use, are still warranted. Individual dietary counseling is highly recommended for patients at high caries risk. As dental caries is a preventable disease, each country must decide: what level of disease is society willing and able to tolerate?

Effect of plaque accumulation and salivary factors on enamel demineralization and plaque composition in situ

This study evaluated the effect of some plaque and salivary factors on caries progression in situ. The salivary secretion rate, buffering capacity and mutans streptococci counts from 13 volunteers were determined. For three distinct periods of time, 4, 7 and 10 days, each of them wore a palatal appliance containing 4 bovine enamel blocks. They used a non-fluoridated dentifrice during the experiment and a 20% sucrose solution was dripped onto the blocks 10 times a day. Mutans streptococci (MS), calcium (Ca), and insoluble polysaccharide (IP) were quantified in the dental plaque formed on the enamel blocks, after each period. Enamel demineralization was assessed by surface microhardness, and the percentage of surface microhardness change (%SMC) in relation to the baseline values was calculated. Enamel demineralization occurred after each period of plaque accumulation (p < 0.05), and the %SMC increased with time (from 13.8 to 48.3%). The concentrations of Ca and IP in plaque were not statistically different among the experimental times, but significant correlations were found between these concentrations and %SMC. Neither the salivary factors assessed initially nor mutans streptococci in plaque presented statistically significant correlations to %SMC. The results suggest that enamel demineralization is time-dependent and is more related to the composition of the biofilm formed than to the salivary factors studied.

Relationship among dental plaque composition, daily sugar exposure and caries in the primary dentition

The relationship among daily sugar exposure, dental plaque composition and caries patterns in the primary dentition is not known. Three groups of 20 children (18-48 months old) were studied: (1) caries-free (CF), (2) presenting pit and fissure caries (PFC), and (3) with nursing caries (NC). Dental caries index (dmfs) was assessed and the frequency of daily sugar exposure (TS) and its forms were estimated by questionnaires. Fluoride (F), calcium (Ca), inorganic phosphorus (P(i)), insoluble polysaccharide (IP) and mutans streptococci were quantified in dental plaque. The three groups of children were statistically different regarding daily sugar exposure. Concentrations of F, Ca and P(i) were lower and the IP and mutans streptococci statistically higher in dental plaque from NC children than those from CF children. PFC children also showed statistically lower F and P levels in their plaque than CF children. Statistically significant correlations were found between IP, TS and dmfs from NC and PFC children. A statistically significant correlation between mutans streptococci in plaque from anterior teeth and dmfs for NC children was also observed. These results suggest that the dietary sugar experience changes the biochemical and microbiological composition of dental plaque, which could partly explain the different caries patterns observed in primary dentition.

In vivo caries models--mechanisms for caries initiation and arrestment

The effects of intra-oral mechanical forces on caries initiation, progression, and arrestment are evaluated by examination of different in vivo caries models. The models are grouped in four categories: (1) a population study, (2) short-term clinical trials, (3) clinical experiments, and (4) controlled clinical observations. Taken together, these in vivo studies convincingly demonstrate that partial or total elimination of the intra-oral mechanical forces operating during mastication or toothbrushing leads to evolution of cariogenic plaque, resulting in localized carious enamel dissolution. In addition, they show that re-exposure to the partly or totally eliminated mechanical forces not only arrests further lesion progression, but also results in partial lesion regression. The data from in vivo caries studies also show that the clinical and structural changes associated with lesion arrestment or partial regression are not related to any salivary repair mechanism, but are solely the result of mechanical removal of the cariogenic biomass which is physically interrelated with the eroded surface of the active, dull-whitish enamel lesion. No indications of superficial mineral deposition or "blocking" of the external intercrystalline spaces are seen in the surface layer of lesions arrested in vivo. For this reason, the conventional usage of the terminology 'remineralization' is considered absolutely misleading when used to describe the mechanisms responsible for the arrest of lesion progression in vivo.

Prevention Revisited— Summary of Scientific Symposium

A symposium, "Prevention Revisited", was held in September of 1990 in Rochester, New York, as part of the 75th Anniversary celebration of the Eastman Dental Center. The symposium covered a broad range of topics, including risk assessment for oral diseases, the diagnosis and classification of periodontal diseases, caries prevention, fluorides, dental materials, TMJ disorders, and the geriatric patient. Each topic was approached from the perspective of prevention: past accomplishments, present status, and future directions. A format of major presentations, reactor papers, and discussion was used.

The effect of sucrose application and implantation of mutans streptococci on the microbial composition of three-week experimental plaque--an in situ study

This study describes the predominant cultivable microflora of three-week-old plaque samples obtained from human enamel sites, on the basis of microbial identification of over 9000 fresh isolates. Lower removable appliances, on which were mounted enamel sections and slabs, were worn by five young adult subjects under three experimental protocols. These were (1) 'normal' plaque conditions, (2) extra-oral sucrose applications nine times daily, and (3) inoculation of each subject's own mutans streptococci onto the enamel test sites and sucrose applications, as described above. With the exception of slightly higher proportions of Gram-negative bacilli associated with slab plaque following sucrose application, no significant differences in percentage or absolute counts of organisms were found between normal and sucrose plaques. The inoculation of mutans streptococci, combined with extra-oral sucrose applications, was associated with significantly higher percentages and absolute mean counts of both mutans streptococci and lactobacilli, and lower proportions of S. sanguis and S. oralis. Although the isolation frequency of mutans streptococci increased in all subjects and the overall mean proportion rose following inoculation, considerable inter-subject variation was seen in mean percentage counts of these organisms isolated from the three-week plaque samples.

Clinical evidence of the role of pre-eruptive fluoride in caries prevention

Recent clinical and laboratory evidence has suggested that systemic fluoride plays a more minor role in caries inhibition than was previously believed. This paper reviews clinical data on water fluoridation, the topical administration of fluorides, and fluoride supplements in the light of more recent understanding of the disease dental caries. Due to reduced functional usage, erupting teeth tend to accumulate plaque which has cariogenic potential. For this reason, the period from tooth emergence to the establishment of interproximal contact and full occlusion is the most critical for caries initiation. Analyses of clinical data indicate that maximum protection against caries is obtained when teeth erupt into an environment with low concentrations of ionic fluoride. The similarity in caries reductions obtained in water fluoridation studies and long-term studies with topically administered fluoride regimens, including fluoride-containing dentifrices, indicates that the pre-eruptive effect of fluoride is of borderline significance relative to the more significant post-eruptive effect. Water fluoridation and topical fluoride programs are thus important measures for the control of caries at the community level. For the individual, topical application of fluoride is seen as an integral part of caries treatment aimed at arresting progressive caries. Fluoride application is thus considered a supportive therapy, in conjunction with cariogenic plaque control. Daily use of fluoridated dentifrices from tooth eruption is more efficacious than daily use of fluoride supplements from birth.

Effects of dietary sucrose levels on pH fall and acid-anion profile in human dental plaque after a starch mouth-rinse

The effects on the metabolism of starch by plaques formed in human subjects during periods of dietary sucrose limitation or supplementation were studied. High sucrose (HS) plaques showed lower resting pH and pH minima, and higher concentrations of lactate ion after the starch mouth-rinse than low sucrose (LS) plaques. Plaque samples incubated with starch solutions in vitro showed no differences in final pH or acid-anion concentrations between HS and LS diets. Plaque-amylase activity was higher on HS than LS diets. Thus starch was more acidogenic when consumed as part of a diet already rich in sucrose, but it is unclear whether this was a specific or non-specific effect of starch on plaque metabolism.

Microflora and chemical composition of dental plaque from subjects with hereditary fructose intolerance

We compared the microbiological and chemical composition of dental plaque from subjects with hereditary fructose intolerance who restrict their dietary sugar intake with that of control subjects who do not. The two groups showed no significant differences in chemical composition of plaque: the mean protein, carbohydrate, calcium, magnesium, and phosphate contents were similar. Dental plaque from both groups contained similar numbers of total colony-forming units per microgram of plaque protein, and Streptococcus sanguis, an indigenous nonpathogen, was isolated with equal frequency from plaque samples of both groups. However, potentially odontopathic Streptococcus mutans and Lactobacillus were isolated three to four times more frequently from plaque samples of control subjects than from plaque samples of subjects with hereditary fructose intolerance. Clearly, diet (sucrose in particular) influences the colonization and multiplication of specific cariogenic organisms in dental plaque.

The epidemiology of dental caries and periodontal disease

Dental caries and periodontal disease are common in industrialized countries and caries is increasing in non-industrialized countries. The predominant method of coping with the disease problem has been to treat rather than prevent the diseases, an approach which has obviously failed to cope with the problem as shown by the results of the International Collaborative Study of Dental Manpower Systems (58). Epidemiological evidence suggests that a food policy directed at lowering the refined sugar consumption level to about 10 kg per person per year in conjunction with fluoride supplementation of the diet would virtually eliminate dental caries in industrialized countries. Health education to improve the effectiveness of toothbrushing will reduce the progression of periodontal disease to a rate compatible with keeping teeth for a life-time.