The effect of previous diet on plaque pH response to different foods

Dental plaque pH variation with regular soft drink, diet soft drink and high energy drink: an in vivo study

BACKGROUND

A high incidence of dental caries and dental erosion associated with frequent consumption of soft drinks has been reported. The purpose of this study was to evaluate the pH response of dental plaque to a regular, diet and high energy drink.

METHODOLOGY

Twenty subjects were recruited for this study. All subjects were between the ages of 20 and 25 and had at least four restored tooth surfaces present. The subjects were asked to refrain from brushing for 48 hours prior to the study. At baseline, plaque pH was measured from four separate locations using harvesting method. Subjects were asked to swish with 15 ml of the respective soft drink for 1 minute. Plaque pH was measured at the four designated tooth sites at 5, 10 and 20 minutes intervals. Subjects then repeated the experiment using the other two soft drinks.

RESULTS

pH was minimum for regular soft drink (2.65 ± 0.026) followed by high energy drink (3.39 ± 0.026) and diet soft drink (3.78 ± 0.006). The maximum drop in plaque pH was seen with regular soft drink followed by high energy drink and diet soft drink.

CONCLUSION

Regular soft drink possesses a greater acid challenge potential on enamel than diet and high energy soft drinks. However, in this clinical trial, the pH associated with either soft drink did not reach the critical pH which is expected for enamel demineralization and dissolution.

Nutrition and dental caries

Promotion of sound dietary practices is an essential component of caries management, along with fluoride exposure and oral hygiene practices. Scientific discoveries have lead to better understanding of the caries process, the ever-expanding food supply, and the interaction between the two. Fermentable carbohydrates interact dynamically with oral bacteria and saliva, and these foods will continue to be a major part of a healthful diet. Dental health professionals can serve their patients and the public by providing comprehensive oral health care and by promoting lifestyle behaviors to improve oral and general health within the time constraints of their practice. Dietary advice given should not contradict general health principles when providing practical guidance to reduce caries risk. The following principles should guide messages: * Encourage balanced diets based on moderation and variety as depicted by the Food Guide Pyramid and the Dietary Guidelines for Americans to provide a sound approach. Avoid references to "bad" foods and focus on "good" diets that include a variety of foods. * Give examples of how combining and sequencing foods can enhance mastication, saliva production, and oral clearance at each eating occasion. Combining dairy foods with sugary foods, raw foods with cooked, and protein-rich foods with acidogenic foods are all good examples. Suggest that eating and drinking be followed by cariostatic foods such as xylitol chewing gum. * Drink water to satisfy thirst and hydration needs as often as possible. Restrict consumption of sweetened beverages to meal and snack times when they can be combined with other cariostatic foods. * When a patient reports excessive dietary intake of a fermentable carbohydrate to the point of displacing other important foods in the diet, identify alternatives that will help the patient maintain or achieve a healthy body weight, oral health status, and a nutrient-dense intake.

Food starches and dental caries

Sucrose and starches are the predominant dietary carbohydrates in modern societies. While the causal relationship between sucrose and dental caries development is indisputable, the relationship between food starch and dental caries continues to be debated and is the topic of this review. The current view of dental caries etiology suggests that in-depth evaluation of the starch-caries relationship requires the consideration of several critical cariogenic determinants: (1) the intensity (i.e., the amount and frequency) of exposure of tooth surfaces to both sugars and starches, (2) the bioavailability of the starches, (3) the nature of the microbial flora of dental plaque, (4) the pH-lowering capacity of dental plaque, and (5) the flow rate of saliva. Studies of caries in animals, human plaque pH response, and enamel/dentin demineralization leave no doubt that processed food starches in modern human diets possess a significant cariogenic potential. However, the available studies with humans do not provide unequivocal data on their actual cariogenicity. In this regard, we found it helpful to distinguish between two types of situations. The first, exemplified by our forebears, people in developing countries, and special subject groups in more modern countries, is characterized by starch consumption in combination with a low sugar intake, an eating frequency which is essentially limited to two or three meals per day, and a low-to-negligible caries activity. The second, exemplified by people in the more modern societies, e.g., urban populations, is characterized by starch consumption in combination with significantly increased sugar consumption, an eating frequency of three or more times per day, and a significantly elevated caries activity. It is in the first situation that food starches do not appear to be particularly caries-inducive. However, their contribution to caries development in the second situation is uncertain and requires further clarification. Although food starches do not appear to be particularly caries inducive in the first situation, the possibility cannot be excluded that they contribute significantly to caries activity in modern human populations. The commonly used term "dietary starch content" is misleading, since it represents a large array of single manufactured and processed foods of widely varying composition and potential cariogenicity. Hence, increased focus on the cariogenicity of single starchy foods is warranted. Other aspects of starchy foods consumption, deserving greater attention, include the bioavailability of starches in processed foods, their retentive properties, also in relation to sugars present (starches as co-cariogens), their consumption frequency, the effect of hyposalivation on their cariogenicity, and their impact on root caries. The starch-caries issue is a very complex problem, and much remains uncertain. More focused studies are needed. At present, it appears premature to consider or promote food starches in modern diets as safe for teeth.

Role of micro-organisms in caries etiology

The microbial etiology of dental caries is discussed in terms of the dynamic relationship among the dental plaque microbiota, dietary carbohydrate, saliva, and the pH-lowering and cariogenic potential of dental plaque. The evidence supports a concept of caries as a dietary carbohydrate-modified bacterial infectious disease. Its key feature is a dietary carbohydrate-induced enrichment of the plaque microbiota with organisms such as the mutans streptococci and lactobacilli which causes an increase of plaque's pH-lowering and cariogenic potential. The shift in the plaque proportions of these organisms appears to be related to their relatively high acid tolerance. A large body of evidence also supports a major effect of saliva on caries development. Integration of salivary effects with the concept of caries as a dietary carbohydrate-modified bacterial infectious disease suggests a broader concept which includes a major role of saliva in the regulation of the exposure of tooth surfaces to carbohydrate and of plaque acidity and, hence, the microbial composition and the pH-lowering and cariogenic potential of dental plaque. It is proposed that caries occurs preferentially in dentition sites characterized by a relatively high exposure to carbohydrate and diminished salivary effects. Some implications of this concept are discussed.

The effect of increased mastication by daily gum-chewing on salivary gland output and dental plaque acidogenicity

The effect of increased mastication on plaque metabolism and salivary gland function was determined in 11 human subjects who chewed a sugarless gum for ten minutes of each waking hour for two weeks. Prior to and at the conclusion of the gum-chewing regimen, unstimulated whole saliva and 2% citric-acid-stimulated parotid saliva were collected. Flow rates, pH, and buffer capacity were determined on all saliva samples. In addition, parotid saliva was analyzed for protein concentration and the proteins further studied by SDS-PAGE. The plaque pH response to a 10% sucrose rinse was also measured before and after the regimen. Significant increases were observed in the pH and buffer capacity of unstimulated whole saliva as were similar increases in the flow rate, pH, and buffer capacity of stimulated parotid saliva. Protein concentrations and profiles remained unaffected. In addition, the resting plaque pH and minimum plaque pH reached after a sucrose challenge were both raised significantly, with a significant reduction in the cH area. The results of this study indicate that increased masticatory effort by frequent consumption of sugar-free chewing gum over a prolonged time period resulted in a functional increase in the output of stimulated parotid saliva, as well as in increases in pH and buffer capacity of whole and parotid saliva, which may help to reduce plaque acidogenicity.

In vitro acidogenic potential and mutans streptococci of human smooth-surface plaque associated with initial caries lesions and sound enamel

Samples of human dental plaque were pooled from several "white spot" smooth tooth surface areas as well as from several clinically-sound tooth surface areas in each of 12 caries-positive college students. Each of the two samples from each subject was used for the determination of: (1) pH-lowering potential in vitro involving dispersed plaque suspensions, excess glucose supply, and a 60-minute test, and (2) the proportions of mutans streptococci and lactobacilli. When all subjects were considered, plaques from "white spot" areas, as compared with samples from sound surface areas, were characterized by significantly higher proportions of mutans streptococci, a lower starting ("resting") pH, a faster rate of pH drop between pH 6.0 and 5.0, and a lower minimum pH of the suspension; the lactobacillus proportions were generally very low in both types of plaques. For individual subjects, however, the proportions of mutans streptococci in plaque associated with "white spot" areas showed a wide range (0.001-10.0%), and samples with high as well as low levels of these micro-organisms could exhibit a high rate of pH drop and a low pH minimum. This suggests that, besides mutans streptococci and lactobacilli, other bacteria capable of acidogenesis at a low pH may contribute to the high pH-lowering potential exhibited by many plaques.