Dental caries-protective agents in milk and milk products: investigations in vitro

Caries Experience in Elderly People Consuming a Milk-Based Drink Nutritional Supplement: A Cross-Sectional Study

Nutritional supplements have been recommended to cope with malnutrition in elderly persons. In Chile, the Supplementary Nutrition Program for the Elderly (PACAM, for its Spanish acronym) consists in a monthly distribution of a low-fat-milk-based drink that contains 8% sucrose. The aim of this study was to determine whether older persons consuming the milk-based drink have a higher caries experience when compared to those not receiving the supplement. A cross-sectional study was conducted in the Maule Region in Chile. The representative sample comprised two groups: (a) PACAM consumers (CS) (n = 60) and (b) nonconsumers (NCS) (n = 60). Participants received intraoral examination and coronal (DMFT/DMFS) and root caries (RCI index) experience were recorded. Additionally, questionnaires regarding acceptability and consumption habits of PACAM and a 24-h diet recall were applied. The influence of predictors was calculated using binary logistic regression for a dichotomized DMFS and Poisson Regression for root caries lesions. A p value <0.05 was considered significant. No differences were detected in food consumption patterns between study groups (p > 0.05). CS participants had increased dairy product consumption. Higher DMFS mean value was observed in the CS (85.35 ± 39.0) compared with NCS (77.28 ± 28.9) (p = 0.043). The multivariate analysis showed nonconsumers of the milk-based product (β = -0.41, p = 0.02) are less likely to have root surfaces affected by caries. Additionally, CS show higher RCI, compared to nonconsumers (β = -0.17, p = 0.02). Daily consumption of a PACAM's milk-based drink supplement seems to increase coronal and root caries risk. Based on these results, composition modification of milk-based drinks with added sucrose appears mandatory.

Impact of Dairy Products and Plant-Based Alternatives on Dental Health: Food Matrix Effects

The impact of dairy products on dental health has been researched widely and shows an important role of various constituents, as well as the specific product matrix, in maintaining and improving dental health. These include, for instance, the position of lactose as the least cariogenic fermentable sugar, the high levels of calcium and phosphate, the presence of phosphopeptides as well as the antibacterial peptides lactoferrin and lysozyme and high buffering capacity. With plant-based alternatives for dairy products being developed and marketed these days, the specific benefits of dairy products in relation to dental health are often overlooked and most products contain more cariogenic carbohydrates, lack phosphopeptides, and have fewer minerals and less buffering capacity. Comparative studies performed to date indeed suggest that plant-based products do not match dairy counterparts when it comes to maintaining and improving dental health. Careful consideration of these aspects is required in relation to future developments of products and human diets. In this paper, we review the impact of dairy products and plant-based dairy alternatives on dental health.

Streptococcus mutans carriage in the saliva of mothers and its association with dental caries and Streptococcus mutans carriage in the saliva of children between 6 and 30 months old in a low-income setting in Karachi, Pakistan

BACKGROUND

Early childhood caries poses a significant health issue in children under 6 years old. It is determined that Streptococcus mutans is a primary etiological agent, likely to be transferred through maternal contact.

OBJECTIVES

To determine the association of maternal S. mutans counts with S. mutans counts in their children between 6 and 30 months of age, and to determine the maternal and child DMFT (decayed, missing, and filled teeth) indices.

MATERIAL AND METHODS

A community-based cross-sectional study was conducted in Karachi, Pakistan. A sample of 193 dyads of mother-children (6-30 months of age) was selected via purposive sampling. Saliva samples of the dyads were collected to assess S. mutans count. Caries assessment was performed for both using the DMFT index. A pretested questionnaire was used. The association of bottle-feeding, oral hygiene measures, and other factors with S. mutans counts in children were also explored. Zero-inflated negative binomial regression model at a 5% level of significance was applied using STATA version 12.0.

RESULTS

Out of 193 children, 109 (56.47%) were males and 84 (43.52%) were females. The mean age of mothers and children was 29.4 ± 6.2 years and 19.54 ± 6.8 months, respectively. Maternal S. mutans counts were not statistically associated with child's S. mutans counts (Mean child's S. mutans count ratio: 1; 95% confidence interval [CI]: 1, 1.01; p = .882). Compared with children who were breastfed, S. mutans counts were higher in children who were bottle-fed (mean S. mutans count ratio= 4.85 [95% CI: 1.53, 15.41], p = .007). Age of mother and present caries status of mothers was significantly associated with the child's S. mutans count.

CONCLUSION

No association between maternal S. mutans and child S. mutans was observed. However, maternal age, children who were breastfed, children who did not use pacifiers, and children with mothers who did not have caries, exhibited low S. mutans counts in their saliva.

Bioactive peptides of whey: obtaining, activity, mechanism of action, and further applications

Bioactive peptides derived from diverse food proteins have been part of diverse investigations. Whey is a rich source of proteins and components related to biological activity. It is known that proteins have effects that promote health benefits. Peptides derived from whey proteins are currently widely studied. These bioactive peptides are amino acid sequences that are encrypted within the first structure of proteins, which required hydrolysis for their release. The hydrolysis could be through in vitro or in vivo enzymatic digestion and using microorganisms in fermented systems. The biological activities associated with bio-peptides include immunomodulatory properties, antibacterial, antihypertensive, antioxidant and opioid, etc. These functions are related to general conditions of health or reduced risk of certain chronic illnesses. To determine the suitability of these peptides/ingredients for applications in food technology, clinical studies are required to evaluate their bioavailability, health claims, and safety of them. This review aimed to describe the biological importance of whey proteins according to the incidence in human health, their role as bioactive peptides source, describing methods, and obtaining technics. In addition, the paper exposes biochemical mechanisms during the activity exerted by biopeptides of whey, and their application trends.

Effectiveness of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) Compared to Fluoride Products in an In-Vitro Demineralization Model

The goal of this study was to evaluate the effectiveness of the toothpaste Tooth Mousse compared to conventional fluoride-based versions in the prevention of enamel and dentin demineralization. Human enamel and dentin samples (n = 120 each) were exposed to artificial demineralization at pH 4.92. During the demineralization process, the samples in the test groups were periodically treated with Tooth Mousse (TM) containing casein-phosphopeptide -amorphous-calcium-phosphate (CPP-ACP) and Tooth Mousse Plus (TMP) containing amorphous-calcium-fluoride-phosphate (CPP-ACPF) to evaluate their protective properties. Fluoride toothpastes containing 1400 ppm amine fluoride (AmF) and 1450 ppm sodium fluoride (NaF) were applied in the positive control groups. Treatment with distilled water (group C-W) or demineralization without treatment (group C-D) served as negative controls. After the demineralization and treatment process, all samples were cut longitudinally and lesion depths were determined at six locations using polarized light microscopy. In TM/TMP groups (enamel: 80/86 µm, dentin: 153/156 µm) lesion depths were significantly smaller compared to the negative control groups C-W/C-D (enamel: 99/111 µm, dentin: 163/166 µm). However, TM and TMP compared to the positive controls AmF/NaF (enamel: 58/63 µm, dentin: 87/109 µm) showed higher lesion depths. The application of TM/TMP (89%/78%) during demineralization led to a reduced number of severe lesions compared to the negative controls C-W/C-D (100%/95%). In this study we demonstrate that Tooth Mousse is less effective regarding prevention of enamel and dentin demineralization compared to fluoride containing toothpastes.

Fate of hydroxyapatite nanoparticles during dynamic in vitro gastrointestinal digestion: the impact of milk as a matrix

This study investigated the behavior of nano-sized particles of hydroxyapatite (nHA) during dynamic in vitro gastrointestinal digestion, alone or dispersed within skim milk. The dissolution and the structural changes of nHA were investigated by analyzing the dissolution of calcium and using transmission electron microscopy and X-ray diffraction. The dissolution of nHA during gastric digestion involved a rapid early stage and a much slower later stage. It was incomplete by the end of gastric digestion, both with and without milk. However, there was no sign of nHA recrystallization in the intestinal phase. X-ray diffraction analysis of digesta showed the breakdown of the crystalline structure of nHA and the formation of potentially new calcium phosphate phases during digestion. Skim milk formed a structural clot and significantly retarded the dissolution of nHA during gastric digestion. Possible mechanisms leading to the incomplete dissolution of nHA and the matrix effect of milk are discussed.

The consumption of processed sugar- and starch-containing foods, and dental caries: a systematic review

The relationship between high dietary intakes of sugar (sucrose) and dental caries is well established. Processed sugars and starches have been associated with greater dental caries experience in retrospective studies. The aim of this systematic review was to determine the relationship between the consumption of processed sugar- and starch-containing foods, the frequency of consumption of these foods, and dental caries. Prospective studies were identified in databases searched from 1970 to July 2020, and relevant retrieved papers that examined associations between the consumption of sugar- and starch-containing foods by human participants and dental caries were eligible for inclusion. Five cohort studies were identified for inclusion, all of which evaluated caries risk in young children or pre-adolescents. The between-meal consumption of processed sugar- and starch-containing foods was consistently found to be associated with greater caries experience. There were mixed findings on total consumption of processed sugar- and starch-containing foods, owing to a range of confounding factors, including the simultaneous consumption of caries-protective foods at mealtimes. Although there is a paucity of research of the dietary effects of frequent consumption of processed sugar- and starch-containing foods on dental caries, there is some evidence of plausible associations between this dietary behaviour and dental caries. Future research should investigate the effectiveness of interventions to change the dietary behaviour of high-frequency consumption of processed sugar- and starch-containing foods to decrease the risk of dental caries.

Long-Term Fluctuation of Oral Biofilm Microbiota following Different Dietary Phases

Caries development is associated with shifts in the oral biofilm microbiota and primarily linked to frequent simple carbohydrate consumption. Different nutritional ingredients can either promote or prevent caries development. To investigate the effects of selected ingredients on the oral biofilm microbiota in situ, 11 study participants underwent 3-month-long dietary phases with intake of a regular diet (PI), additional frequent sucrose (PII), milk and yoghurt (PIII), and a diet rich in dietary fiber (PIV) and then returned to their regular diet (PV). Oral biofilm was sampled and analyzed applying 16S rRNA Illumina MiSeq sequencing. Additionally, the effect on the enamel was analyzed by measuring enamel surface roughness with laser scanning microscopy. The beta-diversity results showed that the microbiota in all the following phases differed significantly from PI and that the microbial community in PII was significantly different from all other phases. The abundance of the genus Streptococcus fluctuated over the course of the five phases, with a significant increase in PII (P = 0.01), decreasing in PIII and PIV (PIII and PIV versus PII: P < 0.00001) and increasing again toward PV. Other taxa showed various fluctuations of their abundances, with PV returning approximately to the levels of PI. In conclusion, while elevated sucrose consumption favored caries-promoting non-mutans streptococci, frequent milk and yoghurt intake caused a significant decrease in the abundance of these microbial taxa and in addition reduced enamel surface roughness. These results indicate that modulations of the oral biofilm microbiota can be attained even in adults through dietary changes and corresponding recommendations can be made for the prevention of caries development.IMPORTANCE Caries affects a large proportion of the population worldwide, resulting in high treatment costs. Its etiology can be ascribed to shifts of the microbiota in dental biofilms primarily driven by dietary factors. It is unclear how diet affects the microbial community of plaque biofilm in situ and whether it can be modulated to help prevent caries development. To address these issues, we analyzed changes of the in situ plaque microbiota following 3-month-long dietary changes involving elevated sucrose, dairy, and dietary fiber consumption over a period of 15 months. Applying high-throughput sequencing, we found non-mutans streptococci, a taxonomic group involved in the beginning stages toward microbial dysbiosis, in decreased abundance with elevated dairy and dietary fiber intake. Through analysis of the enamel surface roughness, these effects were confirmed. Therefore, correspondent dietary measures can be recommended for children as well as adults for caries prevention.

Analysing the Relationship between Nutrition and the Microbial Composition of the Oral Biofilm-Insights from the Analysis of Individual Variability

The influence of a change in nutrition on the oral microbiota are discussed in literature, but usually only changes of population mean values are reported. This paper introduces simple methods to also analyse and report the variability of patients’ reactions considering data from the culture analysis of oral biofilm. The framework was illustrated by an experimental study exposing eleven participants to different nutrition schemes in five consecutive phases. Substantial inter-individual variations in the individual reactions were observed. A new coherence index made it possible to identify 14 instances where the direction of individual changes tended to coincide with the direction of the mean change with more than 95% probability. The heterogeneity in variability across different bacteria species was limited. This allowed us to develop recommendations for sample sizes in future studies. For studies measuring the concentration change of bacteria as a reaction to nutrition change, the use of replications and analysis of the variability is recommended. In order to detect moderate effects of a change in nutrition on the concentration of single bacterial taxa, 30 participants with three repetitions are often adequate. Insights into the relationship between nutrition and the microbial composition can be helpful for the development of dietary habits that promote the establishment of a healthy microbial flora and can therefore prevent the initiation of oral diseases such as caries and periodontitis.

The protein and peptide fractions of kashk, a traditional Middle East fermented dairy product

Kashk is a typical dairy product of Iran, made from sour milk. It is traditionally produced from buttermilk in a dry, round-shaped form. Today, it is also produced at industrial level in a liquid form starting from fermented milk. We aimed to characterise the kashk proteome and peptidome comparing a traditional product with the industrial using a combination of proteomic approaches including advanced chromatographic and electrophoretic separation technique coupled to tandem mass spectrometry. We identified also phosphorylated casein-derived peptides (CPP) and investigated kashk protein digestibility using a static model of food protein digestion. The molecular characterization, coupled with bioinformatic in silico analysis, allowed the identification of potential bioactive peptides.

Proteolytic Activity of Bacillus subtilis upon κ-Casein Undermines Its "Caries-Safe" Effect

Milk is believed to be a relatively “caries-safe” food. This belief relies on the fact that caseins, which constitute around 80% of milk’s protein content, were found to inhibit the adhesion of Streptococcus mutans to enamel and, therefore, decrease biofilm formation. While S. mutans is considered a leading cause of dental disorders, Bacillus subtilis is a non-pathogenic foodborne bacterium, frequently contaminating milk and its products. This study aimed to investigate the effects of dairy-associated foodborne bacteria such as B. subtilis on biofilm formation by S. mutans in the presence of casein proteins. Our results indicate that there is a significant decrease in total biofilm formation by S. mutans exposed to a casein protein mixture in a mono-species culture, whereas, in the co-culture with B. subtilis, an inhibitory effect of the caseins mixture on S. mutans biofilm formation was observed. Proteolytic activity analysis suggested that B. subtilis is capable of breaking down milk proteins, especially κ-casein, which enables biofilm formation by S. mutans in the presence of milk caseins. Therefore, these findings may challenge the assumption that milk is “caries-safe”, especially in a complex microbial environment.

Feasibility and development of a cariogenic diet scale for epidemiological research

BACKGROUND

Diet cariogenicity plays a major role as both a protective and risk factor in the development of early childhood caries (ECC).

AIM

Develop a scale measuring the cariogenicity of foods and beverages and employ it to describe the cariogenicity of young children's diets and predict dental caries outcomes.

DESIGN

Scores of cariogenicity and consumption frequency were applied to food frequency questionnaire (FFQ) collected from an Australian children's cohort study with three time-points of data. One-way ANOVA, with post hoc Tukey test compared mean cariogenic scale measured at 18 months between the subsample of children with caries classification at age 5 years.

RESULTS

At 6 months, children's mean cariogenic score was 10.05, increasing to 34.18 at 12 and 50.00 at 18 months. Mean cariogenic scale score at 18 months was significantly higher in children with advanced disease at 5 years (mean scale score: 59.0 ± 15.9) compared to those that were healthy (mean score 47.7 ± 17.5, P = 0.007) or had mild-moderate disease (mean score 48.2 ± 17.3, P = 0.008).

CONCLUSIONS

The cariogenic diet scale provides a useful indication of the increasing cariogenicity of children's diets with age and highlights the incorporation of discretionary choice foods and beverages into the diets of young children much earlier than nutritionally recommended.

The potential acidogenicity of liquid breakfasts

OBJECTIVES

To determine the potential acidogenicy of liquid breakfasts.

METHODS

In vitro acid production by Streptococcus mutans was measured in the beverages at a pH of 5.5, as was the fall in pH over 10min. The buffering capacity was determined, as well as the calcium, inorganic phosphate and fluoride concentrations (total and soluble) of the beverages. Bovine milk (UHT) was used for comparison.

RESULTS

The rate of acid production by S. mutans, and pH fall over 10min was greater in liquid breakfasts compared to bovine milk. All beverages except one demonstrated a significantly lower buffering capacity than bovine milk. All beverages contained significantly greater concentrations of soluble calcium than bovine milk, and all except two contained significantly more soluble inorganic phosphate.

CONCLUSIONS

S. mutans was able to generate significantly more acid in the liquid breakfasts than in bovine milk, indicating these drinks may contribute to a cariogenic diet. In general, the liquid breakfasts required significantly less acid than bovine milk to reduce their pH to the approximate critical pH for enamel demineralisation. However, the liquid breakfasts also tended to contain significantly more soluble calcium and inorganic phosphate than bovine milk.

CLINICAL SIGNIFICANCE

The substantial amounts and various types of sugars found within liquid breakfast beverages may result in a significant pH drop in dental plaque following consumption of these products.

Remineralization potential of bioactive glass and casein phosphopeptide-amorphous calcium phosphate on initial carious lesion: An in-vitro pH-cycling study

Aims:

The aim of this study was to evaluate and compare the remineralization potential of bioactive-Glass (BAG) (Novamin^®/Calcium-sodium-phosphosilicate) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) containing dentifrice.

Materials and Methods:

A total of 30 sound human premolars were decoronated, coated with nail varnish except for a 4 mm × 4 mm window on the buccal surface of crown and were randomly divided in two groups (n = 15). Group A — BAG dentifrice and Group B — CPP-ACP dentifrice. The baseline surface microhardness (SMH) was measured for all the specimens using the vickers microhardness testing machine. Artificial enamel carious lesions were created by inserting the specimens in de-mineralizing solution for 96 h. SMH of demineralized specimens was evaluated. 10 days of pH-cycling regimen was carried out. SMH of remineralized specimens was evaluated.

Statistical Analysis:

Data was analyzed using ANOVA and multiple comparisons within groups was done using Bonferroni method (post-hoc tests) to detect significant differences at P < 0.05 levels.

Results:

Group A showed significantly higher values (P < 0.05) when compared with the hardness values of Group B.

Conclusions:

Within the limits; the present study concluded that; both BAG and CPP-ACP are effective in remineralizing early enamel caries. Application of BAG more effectively remineralized the carious lesion when compared with CPP-ACP.

Association of oral hygiene habits and food intake with the risk of dental caries among undergraduate university women in Saudi Arabia

OBJECTIVE

The purpose of this study was to determine the risk of dental caries in relation to oral hygiene habits and food intake among women at university in Saudi Arabia.

METHODS

A sample of 935 undergraduate university women was selected from the King Abdulaziz University in Jeddah, Saudi Arabia. A previously pretested questionnaire was used to collect the data. Odds ratios were calculated to estimate the risk of dental caries associated with oral hygiene and food intake.

RESULTS

The findings revealed that women who cleaned their teeth three times or more per day mostly cleaned their teeth after intake of sweets and chocolates, and had no gingivitis were at less risk of dental caries than other women (p=0.029, p=0.000 and p=0.000, respectively). The intake of milk, fruit and vegetables on 4 days or more per week was found to protect against dental caries (odds ratios=0.34, 0.64 and 0.73, respectively), whereas the intake of chocolate and soft drinks for the same period was found to be a risk factor for dental caries (odds ratios=1.8 and 1.4, respectively).

CONCLUSION

The results of this study are useful for public health intervention programs to combat dental caries in the Saudi community.

Strategies for a direct characterization of phosphoproteins on hydroxyapatite surfaces

We show in this work how systems formed by phosphoproteins on calcium phosphate surfaces can be directly characterized, in real time, in liquid medium, without the need for elution or labeling. Specifically, we show how this is possible by applying three different techniques: ellipsometry, quartz crystal microbalance with dissipation, and atomic force microscopy-based friction force spectroscopy. We apply these techniques to study two different model systems, i.e. those formed upon the adsorption of two model phosphoproteins (κ- and β-casein) on hydroxyapatite (HA) surfaces. Information on the kinetics of adsorption, surface excess, viscoelasticity, water content, thickness of the layers, and protein-surface interaction is provided. Results indicate that both phosphoproteins form homogeneous elastic highly hydrated monolayers on the HA surfaces, the strength of β-casein layers being higher by approximately a factor of 4. Based on the experimental results, models for the conformation of κ- and β-casein molecules adsorbed on HA surfaces are proposed.

Novel nutritional treatment for manic and psychotic disorders: a review of tryptophan and tyrosine depletion studies and the potential of protein-based formulations using glycomacropeptide

RATIONALE

Current amino acid (AA) mixtures used in acute tryptophan (Trp) and tyrosine (Tyr) plus phenylalanine (Phe) depletion and loading tests are unpalatable and lack specificity. Specificity is improved by reducing content of branched-chain amino acids (BCAA) and palatability to a certain extent by dose reduction.

OBJECTIVES

This study aims to identify a palatable naturally occurring alternative(s) to amino acids with the desired BCAA content for use in the above tests.

METHODS

A palatable alternative lacking in Trp, Tyr and Phe has been identified in the whey protein fraction caseino-glycomacropeptide (c-GMP). The absence of these three aromatic amino acids renders GMP suitable as a template for seven formulations for separate and combined depletion or loading and a placebo control. The absence of Phe and Tyr enables GMP to provide a unique nutritional therapy of manic and psychotic disorders by inhibition of cerebral dopamine synthesis and release and possibly also by enhancing glutamatergic function, in general, and in patients resistant to anti-psychotic medication, in particular.

RESULTS

Seven GMP-based formulations for the above tests are proposed, two of which can be used in the above nutritional therapy and a third formulation as a placebo control in clinical trials.

CONCLUSIONS

Development of these formulations should advance the above research and diagnostic tests, open new avenues for neuroscience research on monoamine function, and improve the therapy of bipolar and psychotic disorders and enhance the quality of life of sufferers.

[Dietary guidelines for the Brazilian population: implications for the Brazilian National Policy on Oral Health]

Dietary guidelines are intended to orient dietary habits and policies for health promotion and disease prevention. This article discusses Brazil's national dietary guidelines, aiming to identify issues that can support the strategies proposed by the National Policy on Oral Health. The two currently available official guidelines produced by the Ministry of Health were reviewed: the Dietary Guidelines for Children under Two and the Population Dietary Guidelines. The guidelines recommend reduction in sugar intake, essential for caries prevention, and other measures to prevent tooth decay and oral cancer. These guidelines are thus a key part of an oral and overall health promotion strategy and should be integrated into the National Policy on Oral Health.

PP3 forms stable tetrameric structures through hydrophobic interactions via the C-terminal amphipathic helix and undergoes reversible thermal dissociation and denaturation

The milk protein proteose peptone component 3 (PP3), also called lactophorin, is a small phosphoglycoprotein that is expressed exclusively in lactating mammary tissue. The C-terminal part of the protein contains an amphipathic helix, which, upon proteolytic liberation, shows antibacterial activity. Previous studies indicate that PP3 forms multimeric structures and inhibits lipolysis in milk. PP3 is the principal component of the proteose peptone fraction of milk. This fraction is obtained by heating and acidifying skimmed milk, and in the dairy industry milk products are also typically exposed to treatments such as pasteurization, which potentially could result in irreversible denaturation and inactivation of bioactive components. We show here, by the use of CD, that PP3 undergoes reversible thermal denaturation and that the α-helical structure of PP3 remains stable even at gastric pH levels. This suggests that the secondary structure survives treatment during the purification and possibly some of the industrial processing of milk. Finally, asymmetric flow field-flow fractionation and multi-angle light scattering reveal that PP3 forms a rather stable tetrameric complex, which dissociates and unfolds in guanidinium chloride. The cooperative unfolding of PP3 was completely removed by the surfactant n-dodecyl-β-d-maltoside and by oleic acid. We interpret this to mean that the PP3 monomers associate through hydrophobic interactions via the hydrophobic surface of the amphipathic helix. These observations suggest that PP3 tetramers act as reservoirs of PP3 molecules, which in the monomeric state may stabilize the milk fat globule.

Remineralization of early enamel lesions using casein phosphopeptide amorphous calcium Phosphate: an ex-vivo study

Objective:

This study aimed at qualitatively evaluating the remineralization potential of casein phosphopeptide amorphous calcium phosphate on artificial early enamel lesions in an ex-vivo scenario by observing the treated tooth surface using a scanning electron microscope (SEM).

Materials and Methods:

This randomized study was conducted on 10 subjects undergoing orthodontic treatment with premolar extraction as part of their treatment. Artificial white lesions were created with the application of 37% phosphoric acid for 20 mins. Teeth were then divided into two groups: one experimental and the other control. Customised orthodontic band with a window was luted with intermediate restorative material in the experimental group whereas in the control group, band without a window was luted. The casein phosphopeptide amorphous calcium phosphate (GC TOOTH MOUSSE) paste was then applied on the window region of the experimental group for 3 mins thrice daily after meals for 14 days, whereas no paste was applied in the control group. After 14 days, teeth were extracted and viewed under an SEM.

Results:

The study groups showed remineralization of the lesions as compared with the control group in most of the samples.

Conclusion:

Casein phophopeptide could significantly remineralize the artificial enamel lesions in vivo.

Associations of social and behavioural factors with early childhood caries in Xiamen city in China

BACKGROUND

Early childhood caries (ECC) is the presence of caries in primary teeth in children 71 months of age or younger. Despite a decreasing prevalence of caries in China, ECC and related risk factors in China have not been well studied.

AIMS

This study aimed to investigate the status of ECC in children living in Xiamen city in China and to analyse the associated social and behaviour determinants.

DESIGN

A stratified random sample consisted of 1523 children with normal birth records. Clinical examination was performed to record caries at the surface level. Parents filled in questionnaires regarding eating habits, family status, childcare provider, and oral intervention.

RESULTS

Prevalence of ECC in studied child population was 56.8-78.31%, with an increasing tendency with age. The following factors were found to be significantly associated with ECC: age, candy, carbonated drink, bedtime eating, late start of brushing, low education of parents, private childcare, increased number of siblings, rural residence, and lack of oral health knowledge. Using a stepwise forward logistic regression analysis, a prediction model was established.

CONCLUSION

Early childhood caries in children living in Xiamen city was strongly associated with eating habits, family- and childcare-related factors and tooth-brushing. The ECC-high-risk group is children in rural private childcare facilities.

Diet and caries-associated bacteria in severe early childhood caries

Frequent consumption of cariogenic foods and bacterial infection are risk factors for early childhood caries (ECC). This study hypothesized that a short diet survey focused on frequency of foods, categorized by putative cariogenicity, would differentiate severe ECC (S-ECC) from caries-free children. Children's diets were obtained by survey and plaque bacteria detected by PCR from 72 S-ECC and 38 caries-free children. S-ECC children had higher scores for between-meal juice (p < 0.01), solid-retentive foods (p < 0.001), eating frequency (p < 0.005), and estimated food cariogenicity (p < 0.0001) than caries-free children. S-ECC children with lesion recurrence ate fewer putative caries-protective foods than children without new lesions. Streptococcus mutans (p < 0.005), Streptococcus sobrinus (p < 0.005), and Bifidobacteria (p < 0.0001) were associated with S-ECC, and S. mutans with S. sobrinus was associated with lesion recurrence (p < 0.05). S. mutans-positive children had higher food cariogenicity scores. Food frequency, putative cariogenicity, and S. mutans were associated with S-ECC individually and in combination.

Cariogenicity of soft drinks, milk and fruit juice in low-income african-american children: a longitudinal study

BACKGROUND

The authors conducted a study to test the hypothesis that high consumption of soft drinks, relative to milk and 100 percent fruit juice, is a risk factor for dental caries in low-income African-American children in Detroit.

METHODS

Trained dentists and interviewers examined a representative sample of 369 children, aged 3 to 5 years, in 2002-2003 and again two years later. The authors used the 2000 Block Kids Food Frequency Questionnaire (NutritionQuest, Berkeley, Calif.) to collect dietary information. They assessed caries by using the International Caries Detection and Assessment System.

RESULTS

Soft drinks, 100 percent fruit juice and milk represented the sugared beverages consumed by the cohort. A cluster analysis of the relative proportion of each drink at baseline and follow-up revealed four consumption patterns. Using zero-inflated negative binomial models, the authors found that children who changed from being low consumers of soft drinks at baseline to high consumers after two years had a 1.75 times higher mean number of new decayed, missing and filled tooth surfaces compared with low consumers of soft drinks at both time points.

CONCLUSION

Children who consumed more soft drinks, relative to milk and 100 percent fruit juice, as they grew older were at a greater risk of developing dental caries.

CLINICAL IMPLICATIONS

Health promotion programs and health care providers should emphasize to patients and caregivers the caries risk associated with consumption of soft drinks.

Cariogenic potential of cows', human and infant formula milks and effect of fluoride supplementation

The aim of the present study was to evaluate the cariogenicity of cows', human and infant formula milks, supplemented or not with fluoride, in rats. Sixty female Wistar rats were desalivated and infected withStreptococcus sobrinus6715.Animals were divided into six groups: group 1, sterilised deionised distilled water (SDW; negative control); group 2, 5 % sucrose added to SDW (positive control); group 3, human milk; group 4, cows' milk; group 5, Ninho®formula reconstituted with SDW; group 6, Ninho®formula reconstituted with 10 parts per million F and SDW. At day 21 the animals were killed and their jaws removed to quantify total cultivable microbiota,Strep. sobrinusand dental caries. The concentration of carbohydrate and fluoride in the milks was analysed. The Kruskal–Wallis test (α = 5 %) was used to analyse the data. The caries score by the milk formula was as high as that provoked by sucrose. Regarding smooth-surface caries, human milk was statistically more cariogenic than cows' milk, which did not differ from the SDW and the Ninho®with fluoride (P>0·05). Groups 2–6 showed higherStrep. sobrinuscounts when compared with the negative control group (P < 0·05) but no statistically significant difference was found among them (P>0·05). HPLC analysis showed that infant formula had 9·3 % sucrose and 3·6 % reducing sugars. The infant formula should be considered cariogenic due to the sugars found in it, but fluoride supplementation reduced its cariogenic effect. The human milk was more cariogenic than the cows' milk but not as much as the formula milk.

Diet Intake and Caries Prevalence in Four-Year-Old Children Living in a Low-Prevalence Country

Preventive measures have dramatically decreased the prevalence of dental caries in children. However, risk factors for the disease in children living in low-prevalence areas remain elusive. In the present study we evaluated associations between dental caries, saliva levels of mutans streptococci and lactobacilli, and diet with special emphasis on the intake of fermentable carbohydrates and dairy products in 4-year-old children living in an area where the overall caries prevalence was low. Dietary intake was recorded in 234 infants as part of the Study of Infant Nutrition in Umeå, Sweden (SINUS). Of these the parents of 124 children gave consent to participate in a follow-up at 4 years of age. Dietary intake, height and weight, dental caries, oral hygiene, including tooth brushing habits, presence of plaque and gingival inflammation, fluoride habits and numbers of mutans streptococci and lactobacilli in saliva were recorded. Using multivariate stepwise logistic regression, caries experience was negatively associated with intake frequency of cheese (OR = 0.67; 95% CI = 0.44-0.98) and positively associated with the salivary level of mutans streptococci (OR = 1.57; 95% CI = 1.21-2.03). Caries experience was not correlated with intake frequency or amounts of carbohydrate-containing foods, with any other particular food, or with daily intake of energy, carbohydrate or any other macro- or micronutrient. We conclude that cheese intake may have a caries-protective effect in childhood populations where the overall caries prevalence and caries experience are low and the children are regularly exposed to fluoride from toothpaste.

Milk biologically active components as nutraceuticals: review

Milk contains components that provide critical nutritive elements, immunological protection, and biologically active substances to both neonates and adults. Milk proteins are currently the main source of a range of biologically active peptides. Concentrates of these peptides are potential health-enhancing nutraceuticals for food and pharmaceutical applications. Several bioactive peptides may be used as nutraceuticals, for example, in the treatment of diarrhea, hypertension, thrombosis, dental diseases, as well as mineral malabsorption, and immunodeficiency. Minor whey proteins, such as lactoferrin, lactoperoxidase, lysozyme, and immunoglobulins, are considered antimicrobial proteins. Milk also contains some natural bioactive substances. These include oligosaccharides, fucosylated oligosaccharides, hormones, growth factors, mucin, gangliosides, and endogenous peptides, which are present in milk at secretion. Most of the claimed physiological properties of milk bioactive components have been carried out in vitro or in animal model systems, and these hypothesized properties remain to be proven in humans. Whether these milk bioactive components will replace drugs entirely in the immediate future is still unclear, but the increasing appreciation of "drug foods" or nutraceuticals plays a complementary rather than a substitutional role to the synthetic pharmacological drugs.

The effect of different milk formulas on dental plaque pH

OBJECTIVES

The purposes of this study were (1) to investigate the effect of different milk formulas on dental plaque pH after rinsing with these three categories, type of protein-based formulas (milk-based, soy-based, protein hydrolysate), type of sugar (only lactose, lactose and other sugars, only non-milk extrinsic sugars), and casein ratio (high and low casein), and (2) to observe organic acids formed by different milk formulas.

METHODS

Baseline plaque pH and plaque pH at 2, 5, 10, 15, 20, 25, 30, and 60 min after rinsing with milk formulas were recorded by a combination electrode in 14 healthy subjects. Deionized water and 10% sucrose were used as a negative and positive control. The plaque sample was also analysed to identify and quantify the organic acids using a high-performance liquid chromatography. Parameters including minimum pH, maximum pH drop, and area under curve were compared by RMANOVA and paired t-test.

RESULTS

The minimum pH was not significantly different among different protein-based formulas, whereas, the maximum plaque pH drop of soy-based and milk-based formula was significantly higher than that produced by protein hydrolysate formula (P=0.022 and 0.03, respectively). Area under curve produced by soy-based and milk-based formulas was significantly larger than that created by protein hydrolysate formula (P=0.025 and<0.001, respectively). Milk formulas containing only lactose caused significantly less plaque pH change in minimum pH (P<0.001), maximum pH drop (P=0.003), and area under curve (P<0.001) when compared with formulas containing lactose and other sugar but not with special formulas containing only non-milk extrinsic sugar. Similarly, special formulas containing non-milk extrinsic sugar produced significantly lower minimum pH and smaller area under curve than formulas containing lactose and other sugar did (P=0.044 and 0.009, respectively). No different results were found between high and low casein follow-on formulas. Lactic acid was produced more by rinsing with formulas containing lactose and other sugars than that produced by formulas containing only lactose.

CONCLUSIONS

This study suggests that milk formulas containing added other sugars tend to cause a decrease in plaque pH.

Effect of a Casein/Calcium Phosphate-Containing Tooth Cream and Fluoride on Enamel Erosion in vitro

The aim of this study was to determine whether a tooth cream containing casein/calcium phosphate (CasCP) protects enamel against erosion. Sixty bovine enamel specimens were prepared for profilometry and distributed into five groups. Specimens were rinsed with artificial saliva interrupted by 1% citric acid (pH 2.3) for 30 s 6 times daily for 14 days. Group 1 (n=12) was not treated (control); in group 2 (n=12) CasCP was applied for 120 s twice daily; in group 3 (n=12) 250 ppm fluoride as NaF was applied for 120 s twice daily; in group 4 (n=12) CasCP was applied for 120 s, then 250 ppm fluoride for 120 s twice daily, and in group 5 (n=12) amine fluoride (AmF) gel (12,500 ppm fluoride) was applied for 120 s twice daily. Differences between groups with respect to erosive enamel loss (profilometrically determined depth after 7 and 14 days) were tested by the Mann-Whitney test (alpha=0.05). After 7/14 days' erosive cycling, specimens treated with AmF gel showed significantly less enamel loss (18.5/35.5 microm; medians) than those treated with CasCP (25.5/46.9 microm), 250 ppm fluoride (25.0/ 40.9 microm), CasCP and 250 ppm fluoride (23.9/47.4 microm) or with no treatment (26.3/49.8 microm). It is concluded that highly fluoridated acidic AmF gel can protect enamel against erosion while CasCP, 250 ppm fluoride or a combination of CasCP and 250 ppm fluoride provide little protection.

Children's acceptance of milk with xylitol or sorbitol for dental caries prevention

Background

Xylitol, a polyol sugar, has been shown to reduce dental caries when mixed with food or chewing gum. This study examines the taste acceptability of xylitol in milk as a first step toward measuring the effectiveness of xylitol in milk for the reduction of dental caries in a public health program.

Methods

Three different types of milk (Ultra High Temperature (UHT), powder and evaporated) were tested for acceptability by 75 Peruvian children (25 per milk group, ages 4 to 7 years). Each group evaluated xylitol and sorbitol in one type of milk. In the first phase, each child was presented with a tray of four plastic cups containing 50 ml of milk with 0.021 g/ml xylitol, 0.042 g/ml xylitol, 0.042 g/ml sorbitol or no sugar. Each child was asked to taste the samples in a self-selected order. After tasting each sample, the child placed the milk cup in front of one of three cartoon faces (smile, frown or neutral) representing the child's response to the taste of each sample. In the second phase, the child was asked to rank order the milk samples within each category (smile, frown or neutral). Ranks within categories were then combined to obtain a rank ordering for all the test samples.

Results

The ranking from best to worst for the samples across categories (UHT, powder, evaporated) was xylitol (0.0.042 g/ml), sorbitol (0.042 g/ml), xylitol (0.021 g/ml) and milk alone (Friedman's ANOVA). Xylitol and sorbitol were preferred over milk alone, and xylitol (0.042 g/ml) was preferred to sorbitol (0.042 g/ml)(p < .05 sign test).

Conclusion

Milk sweetened with xylitol is well accepted by Peruvian children ages 4–7 years.

Microradiographic study on the effects of salivary proteins on in vitro demineralization of bovine enamel

The aim of this investigation was to evaluate the effects of various proteins on in vitro demineralization of bovine enamel. From each of 100 bovine incisors two samples were prepared. The specimens were embedded in epoxy resin and polished up to 4000 grit. Subsequently, the specimens' surfaces were partly covered with nail varnish, thus serving as control of sound enamel. The specimens were divided randomly into five groups (n = 40) and demineralized in a solution of constant composition (pH 5.0; 10 days). For each subgroup of specimens (n = 10) 4 L were taken and either low (50% of medium conc.), medium, or high (150%) concentrations of the proteins [human albumin (100% conc. = 7 mg L(-1)), mucin (577.5 mg L(-1)), immunoglobulin G (IgG) (46 mg L(-1)), casein isolated from bovine milk (1.2 g L(-1))] or amino acid [l-Proline (7 mg L(-1))] were added to 1 L of the demineralizing solution, whereas 1 L served as control. Mineral loss and lesion depth (LD) were evaluated from microradiographs of thin sections (110 mum) by a dedicated software package (TMR 1.24). No differences were found between the five control groups (P > 0.05; ANOVA). Albumin, l-Proline, and IgG did not affect enamel demineralization, whereas the addition of both casein and mucin resulted in significant reductions of both mineral loss and LDs (P < 0.01; Tukey's test). Within the limitations of an in vitro study, the present investigation indicates that casein and mucin seem to affect enamel demineralization significantly. Thus, these proteins might be helpful as an additive to saliva substitutes or mouthwashes if the quality of saliva is altered.

Bioactive properties of milk proteins with particular focus on anticariogenesis

Beyond nutrition, there is an increasing amount of data and information to demonstrate a bioactive role for dairy components in adults including a role in prevention of dental caries. Specifically, the casein fraction and hydrolysates thereof have been the focus of researchers investigating cariogenicity prevention. Tooth enamel is a polymeric substance consisting of crystalline calcium phosphate embedded in a protein matrix. Dental caries develop by acidic demineralization (calcium and phosphorus solubilization) of tooth enamel. Demineralization occurs directly (acidic food consumption) or indirectly (by fermentation products of dental plaque odontopathogenic bacteria growing on residual food particles between teeth or adhering to the plaque). Research efforts with milk derived bioactive peptides have focused on inhibition of cariogenic, plaque-forming bacteria, inhibition of tooth enamel demineralization, and subsequent enamel remineralization. Caseinophosphopeptides (CPP) and glycomacropeptide (GMP) have been patented for use in common personal hygiene products to prevent dental caries. Research has shown CPP and GMP to be growth inhibitory to the cariogenic bacteria Streptococcus mutans and other species. Additionally, CPP forms nanoclusters with amorphous calcium phosphate (AMP) at the tooth surface to provide a reservoir of calcium and phosphate ions to maintain a state of super saturation with respect to tooth enamel. This would buffer plaque pH, and also provide ions for tooth enamel remineralization. Glycosidic structures attached to GMP are important to numerous bioactive properties of the peptide including anticariogenicity. Like CPP, GMP has shown inhibitory activity to enamel demineralization and promotes tooth enamel remineralization.