Sour sweets: a new type of erosive challenge?

Effect of Popping Chocolate and Candy on Enamel Microhardness of Primary and Permanent Teeth

Aims and Objectives

Dental erosion is a common disease in children. Food diets, due to high amounts of juice, soft drinks, chewing gum, and acidic chocolate, are one of the most important risk factors in erosive processes among children. The aim of this study was to evaluate the effect of candy and chocolate on the microhardness of tooth enamel.

Materials and Methods

Two types of popping candy and one type of popping chocolate were used in this study. Thirty-three healthy permanent premolar teeth and 33 primary incisor teeth (A or B) were selected. Five grams of each popping chocolate or candy was dissolved with 2 ml of artificial saliva. Subsequently, their pH and titrable acidity (TA) as well as microhardness and surface roughness of enamel were examined in the laboratory. Data were analyzed and evaluated Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY through independent t-test, paired t-test, Tukey test, and ANOVA.

Results

The results of this study showed that only the pH of the candies was below the critical pH of the enamel (5.5) and their TA was B = 0.20 and C = 0.21. The most significant effect on the enamel microhardness of the permanent and primary teeth was by the following types of candy: orange flavor (C), strawberry flavor (B), and chocolate (A), respectively. This difference was significant (P < 0.001) and the surface roughness increased after exposure.

Conclusions

This study showed that popping chocolate and candy reduces microhardness of enamel.

Acid Erosion: An Increasingly Relevant Dental Problem. Risk Factors, Management and Restoration

A review of risk factors and management of acid erosion. Particular emphasis is placed on the use of direct composite as a reversible and relatively straightforward restorative option.

The availability of novelty sweets within high school localities

Highlights the growth in the novelty sweets market.

These sweets are acidic and sweet and therefore can lead to both dental caries and dental erosion.

The high sugar content may also contribute to overnutrition and overweight or obesity.

The design of these sweets, in resealable containers, encourages repeated consumption which is detrimental to oral health.

Background Reducing sugar consumption is a primary focus of current global public health policy. Achieving 5% of total energy from free sugars will be difficult acknowledging the concentration of free sugars in sugar sweetened beverages, confectionery and as hidden sugars in many savoury items. The expansion of the novelty sweet market in the UK has significant implications for children and young adults as they contribute to dental caries, dental erosion and obesity.

Objective To identify the most available types of novelty sweets within the high school fringe in Cardiff, UK and to assess their price range and where and how they were displayed in shops.

Subjects and methods Shops within a ten minute walking distance around five purposively selected high schools in the Cardiff aea representing different levels of deprivation were visited. Shops in Cardiff city centre and three supermarkets were also visited to identify the most commonly available novelty sweets.

Results The ten most popular novelty sweets identified in these scoping visits were (in descending order): Brain Licker, Push Pop, Juicy Drop, Lickedy Lips, Big Baby Pop, Vimto candy spray, Toxic Waste, Tango candy spray, Brain Blasterz Bitz and Mega Mouth candy spray. Novelty sweets were located on low shelves which were accessible to all age-groups in 73% (14 out of 19) of the shops. Novelty sweets were displayed in the checkout area in 37% (seven out of 19) shops. The price of the top ten novelty sweets ranged from 39p to £1.

Conclusion A wide range of acidic and sugary novelty sweets were easily accessible and priced within pocket money range. Those personnel involved in delivering dental and wider health education or health promotion need to be aware of recent developments in children's confectionery. The potential effects of these novelty sweets on both general and dental health require further investigation.

A simple, sensitive and non-destructive technique for characterizing bovine dental enamel erosion: attenuated total reflection Fourier transform infrared spectroscopy

Although many techniques are available to assess enamel erosion in vitro, a simple, non-destructive method with sufficient sensitivity for quantifying dental erosion is required. This study characterized the bovine dental enamel erosion induced by various acidic beverages in vitro using attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy. Deionized water (control) and 10 acidic beverages were selected to study erosion, and the pH and neutralizable acidity were measured. Bovine anterior teeth (110) were polished with up to 1 200-grit silicon carbide paper to produce flat enamel surfaces, which were then immersed in 20 mL of the beverages for 30 min at 37 °C. The degree of erosion was evaluated using ATR-FTIR spectroscopy and Vickers' microhardness measurements. The spectra obtained were interpreted in two ways that focused on the ν1, ν3 phosphate contour: the ratio of the height amplitude of ν3 PO4 to that of ν1 PO4 (Method 1) and the shift of the ν3 PO4 peak to a higher wavenumber (Method 2). The percentage changes in microhardness after the erosion treatments were primarily affected by the pH of the immersion media. Regression analyses revealed highly significant correlations between the surface hardness change and the degree of erosion, as detected by ATR-FTIR spectroscopy (P<0.001). Method 1 was the most sensitive to these changes, followed by surface hardness change measurements and Method 2. This study suggests that ATR-FTIR spectroscopy is potentially advantageous over the microhardness test as a simple, non-destructive, sensitive technique for the quantification of enamel erosion.

Sour sweets and acidic beverage consumption are risk indicators for dental erosion

This study aimed to investigate the association between dental erosive wear and potential background, behavioural and dietary risk indicators and to assess whether there is a dose-response relationship between the level of acidic beverage consumption and dental erosive wear among adolescents. Of 846 adolescents (aged 16-18 years) scheduled for dental recall examinations, 795 (94%) accepted to participate. All participants completed a self-administered questionnaire regarding their background (gender and age), tooth-brushing frequency and dietary habits (the amount and frequency of acidic food and beverage consumption as well as the chosen method and manner of consuming acidic drinks). The association between the presence of erosive lesions and the possible risk indicators was assessed by logistic regression analyses. Of all participants examined, 37% had ≥3 surfaces with dental erosions and were considered to be affected individuals. In the present study, multivariate logistic analyses revealed a significant association between the dental erosive wear and high consumption of sour sweets and sports drinks. The tooth-brushing frequency was not significantly associated with dental erosive wear. Additionally, to the best of our knowledge, the results are the first to indicate a dose-response relationship between the daily consumption of acidic drinks and dental erosive wear.

Food references in UK children's magazines - an oral health perspective

OBJECTIVE

Children's magazines are popular in the United Kingdom, but their content is poorly regulated. Consequently, food and beverages high in fat, salt and sugar (HFSS), detrimental to oral and wider health, make unrestricted appearances. The study aim was to assess the amount of HFSS food and drink children are exposed to while reading magazines; with particular focus on foods containing free sugars due to their known cariogenic properties, and foods with low pH due to their erosive potential.

DESIGN

Eleven of the most popular UK children's magazines were selected and purchased at four separate time points in 2012. These 44 magazines were examined using content analysis; any references to food/beverages (in advertisements, free gifts, editorial and general content) were recorded.

RESULTS

Of the 508 food references observed, 73.6% (374/508) were for foods detrimental to oral health owing to their high sugar and/or acid content. 5.9% (30/508) were considered 'unhealthy' due to their fat or salt content. 20.5% of references were for 'healthy' foods (104/508). The most common food categories referenced were baked goods (181/508) and sweets (86/508). Over a third (36.4%, 16/44) of magazines came with free sweets. In terms of positioning, the food/drink references were predominantly found in the general content of the magazines, including the editorial spreads. Direct advertisements for food/drink only accounted for 9.6% (36/374) of the total number of references counted.

CONCLUSION

Food references within children's magazines are biased towards unhealthy foods especially those detrimental to oral health; these permeate throughout the general and editorial content and are not restricted to direct advertisements. Magazine editors, journalists and illustrators are responsible for the editorial and general content of magazines. Without regulation, subliminal placement of advertisements within editorial and general content leads to 'advertorials' which are known to confuse children and parents alike. This study concludes that regulation may therefore need to cover more than just the direct advertisements. Dental professionals need to be aware of current trends in children's media when giving health education advice or designing health promotion initiatives.

Children's understandings and motivations surrounding novelty sweets: a qualitative study

BACKGROUND

Novelty sweets resemble or can be used as toys, are brightly coloured, with striking imagery, and sold at pocket money prices. They encourage regular consumption as packaging can be resealed, leading to prolonged exposure of these high-sugar and low pH products to the oral tissues, risk factors for dental caries and erosion, respectively.

AIM

To determine how children conceptualise novelty sweets and their motivations for buying and consuming them.

DESIGN

Focus groups conducted using a brief schedule of open-ended questions, supported by novelty sweets used as prompts in the latter stages. Participants were school children (aged 9-10) from purposively selected state primary schools in Cardiff, UK.

RESULTS

Key findings related to the routine nature of sweet eating; familiarity with and availability of novelty sweets; parental awareness and control; lack of awareness of health consequences; and the overall appeal of novelty sweets.

CONCLUSIONS

Parents reported vagueness regarding consumption habits and permissiveness about any limits they set may have diluted the concept of treats. Flexible permissiveness to sweet buying applied to sweets of all kinds. Parents' reported lack of familiarity with novelty sweets combined with their low cost, easy availability, high sugar content, and acidity give cause for concern.

Summary of: an in vitro investigation of the erosive potential of smoothies

INTRODUCTION

Recent health promotion campaigns have encouraged the public to consume at least five portions of fruit and vegetables per day. Many see consuming fruit smoothies as a way of achieving this.

OBJECTIVE

To ascertain the potential or otherwise for fruit smoothies to bring about dental erosion.

DESIGN

Laboratory study.

METHOD

This was an in vitro investigation in which five varieties of shop bought fruit smoothies, including a 'thickie' were investigated, with respect to their initial pH, titratable acidity and effect upon exposure to the surface microhardness and profile of extracted human teeth. In addition their performance was compared to negative (Volvic™ water) and positive (orange juice) control drinks as well as a homemade smoothie, based upon the recipe of one of the commercially bought drinks, from which ingredient omissions were made.

RESULTS

The majority of the drinks investigated had a baseline pH below the critical pH of enamel (5.5) and required comparable volumes of 0.1M NaOH to raise their pH to neutrality as the positive control. Only two drinks (Volvic™ still mineral water, the negative control, and the yoghurt, vanilla bean and honey 'thickie') displayed a higher pH, though to neutralise the thickie, a lesser quantity of alkali addition was required. The immersion of the tooth samples in the drinks brought about reductions in their surface hardness (expressed as a percentage change of median hardness) but these were only significant (p <0.001) for the cranberry, blueberry and cherry fruit smoothie and homemade strawberry and banana fruit smoothie. There was no reduction in surface hardness in the case of the teeth immersed in the thickie. Omission of certain ingredients from the homemade smoothie affected the magnitude of surface hardness reductions seen. With regard to the loss of surface contour of the tooth samples following immersion in the drinks, as assessed by depth loss, there were significant differences between the drinks (p = 0.0064) with the thickie and negative control not causing depth loss and the kiwi, apple and lime smoothie producing most depth loss (28.26 (5.45) μm).

CONCLUSIONS

Within the limitations of this study some fruit smoothies have the potential to bring about dental erosion if consumed irresponsibly. This can be influenced by ingredient variations. In order to minimise the risk of developing dental erosion, without removing the claimed nutritional benefits of their consumption, their consumption should be confined to mealtimes.

Dental erosion in the 21st century: what is happening to nutritional habits and lifestyle in our society?

Several developments in Western Europe may have contributed to the increased prevalence of dental erosion during the last decades. Exposing children to sour taste at an early age increases the preference for acidic food and drinks later in life. Acidic fruits and beverages became widely available due to economic prosperity. New types of acidic candies were developed, some of which are kept in the mouth for very long times. Children are exposed to intense marketing of these acidic products, which are widely available in supermarkets and school canteens. In the meantime, much less attention has been paid to the development and marketing of less erosive food products.

Are sugar-free confections really beneficial for dental health?

BACKGROUND

Various sugar substitutes have been introduced and are widely used in confections and beverages to avoid tooth decay from sugar and other fermentable carbohydrates. One group of sugar substitutes are sugar alcohols or polyols. They have been specifically used in foods for diabetic patients because polyols are not readily absorbed in the intestine and blood stream, preventing post-prandial elevation of glucose level. Additionally they may lower caloric intake.

METHODS

We searched PubMed, Cochrane Controlled Trials Registry, Cochrane Oral Health Review, Centre for Reviews and Dissemination in the UK, National Library for Public Health and a Centre for Evidence Based Dentistry website up to the end of October 2010, using the search terms 'sugar alcohol' or 'sugar-free' or 'polyols' and combined with a search with terms 'dental caries' or 'dental erosion'.

RESULTS

Xylitol, a polyol, has been approved by the US Food and Drug Administration for its non-cariogenic properties that actually reduce the risk of dental decay and recently, the European Union also officially approved a health claim about xylitol as a 'tooth friendly' component in chewing gums. Although the presence of acidic flavourings and preservatives in sugar-free products has received less attention, these additives may have adverse dental health effects, such as dental erosion. Furthermore, the term sugar-free may generate false security because people may automatically believe that sugar-free products are safe on teeth.

CONCLUSION

We concluded that polyol-based sugar-free products may decrease dental caries incidence but they may bring another dental health risk, dental erosion, if they contain acidic flavouring. There is a need for properly conducted clinical studies in this area.

Effect of casein phosphopeptide-amorphous calcium phosphate added to acidic beverages on enamel erosion in vitro

BACKGROUND

To investigate, in vitro, the effect on enamel erosion of the addition of 0.2% w/v casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) to four commercially-available soft drinks, two of which were carbonated.

METHODS

Enamel specimens (n=27) were sectioned from sound extracted human third molar teeth and polished to a mirror finish. Exposed enamel windows of 1 mm2 were created by painting the surface with acid-resistant nail varnish. Four citric flavoured soft drinks (pH range 2.2 to 2.4) and distilled deionized water (DDW) were tested. Each drink was tested with and without 0.2% CPP-ACP w/v. The specimens were placed into 50 mL of solution at 37 °C for 30 minutes, rinsed and varnish removed. The samples were profiled with a white light profilometer and erosive depths recorded.

RESULTS

All soft drinks tested caused enamel erosion but adding 0.2% w/v CPP-ACP significantly reduced (p<.05) erosive depth in all test solutions in comparison with the solutions without CPP-ACP. The erosive depths for all solutions with 0.2% CPP-ACP did not differ significantly from those of DDW.

CONCLUSIONS

Adding CPP-ACP at 0.2% w/v significantly decreased the erosivity of all four soft drinks. The erosivity of the soft drinks with 0.2% CPP-ACP added did not differ significantly from that of distilled water.

Dietary behavior and knowledge of dental erosion among Chinese adults

Objectives

To study the dietary behavior and knowledge about dental erosion and self-reported symptoms that can be related to dental erosion among Chinese adults in Hong Kong.

Methods

Chinese adults aged 25-45 years were randomly selected from a list of registered telephone numbers generated by computer. A telephone survey was administered to obtain information on demographic characteristics, dietary habits, dental visits, and knowledge of and presence of self-reported symptoms that can be related to dental erosion.

Results

A total of 520 participants were interviewed (response rate, 75%; sampling error, ± 4.4%) and their mean age was 37. Most respondents (79%) had ever had caries, and about two thirds (64%) attended dental check-ups at least once a year. Respondents had a mean of 5.4 meals per day and 36% had at least 6 meals per day. Fruit (89%) and lemon tea/water (41%) were the most commonly consumed acidic food and beverage. When asked if they ever noticed changes in their teeth, most respondents (92%) said they had experienced change that can be related to erosion. However, many (71%) had never heard about dental erosion and 53% mixed up dental erosion with dental caries.

Conclusion

Hong Kong Chinese adults have frequent intake of food and many have experienced symptoms that can be related to dental erosion. Their level of awareness of and knowledge about dental erosion is generally low, despite most of them have regular dental check-ups. Dental health education is essential to help the public understand dental erosion and its damaging effects.

In vitro enamel erosion associated with commercially available original-flavor and sour versions of candies

BACKGROUND

Exposure to acidic foods and beverages is thought to increase the risk of developing dental erosion. The authors hypothesized that the erosion potential of sour candies was greater than the erosion potential of original-flavor versions of the candies.

METHODS

The authors measured the pH and titratable acidity of candies dissolved in artificial saliva or water. They then measured the lesion depths of enamel surfaces exposed to candy slurries for 25 hours. Statistical analyses included two-sample t tests and Wilcoxon rank-sum tests to identify differences between original-flavor and sour candies, as well as correlations to identify relationships between lesion depths, pH and titratable acidity.

RESULTS

The study results show that lesion depths generally were greater after exposure of enamel to sour candies than they were after exposure of enamel to original-flavor candies, as well as for candies dissolved in water compared with those dissolved in artificial saliva. Lesion depths were negatively associated with the initial slurry pH and positively associated with titratable acidity.

CONCLUSIONS

Both original-flavor and sour versions of candies are potentially erosive, with sour candies being of greater concern. Although saliva might protect against the erosive effects of original-flavor candies, it is much less likely to protect against the erosive effects of sour candies.

CLINICAL IMPLICATIONS

People at risk of developing candy-associated erosion, particularly those with a high intake of candy, pocketing behaviors or decreased salivary flow, should receive preventive guidance regarding candy-consuming habits.

Anisotropic demineralization and oriented assembly of hydroxyapatite crystals in enamel: smart structures of biominerals

It is interesting to note that the demineralization of natural enamel does not happen as readily as that of the synthesized hydroxyapatite (HAP), although they share a similar chemical composition. We suggest that the hierarchical structure of enamel is an important factor in the preservation of the natural material against dissolution. The anisotropic demineralization of HAP is revealed experimentally, and this phenomenon is understood by the different interfacial structures of HAP-water at the atomic level. It is found that HAP {001} facets can be more resistant against dissolution than {100} under acidic conditions. Although {100} is the largest surface of the typical HAP crystal, it is {001}, the smallest habit face, that is chosen by the living organisms to build the outer surface of enamel by an oriented assembly of the rodlike crystals. We reveal that such a biological construction can confer on enamel protections against erosion, since {001} is relatively dissolution-insensitive. Thus, the spontaneous dissolution of enamel surface can be retarded in biological milieu by such a smart construction. The current study demonstrates the importance of hierarchical structures in the functional biomaterials.