Milk, flavoured milk products and caries

Effect of various types of milk on salivary pH among children: a pilot randomized controlled crossover trial

OBJECTIVE

This study aimed to evaluate salivary pH changes after consuming three types of milk in children aged 3-5 years. The null hypothesis was that no statistically significant difference would be noted in the salivary pH between high-protein, full-fat, and sweetened milk groups at different time points.

MATERIALS AND METHODS

This was a double-blind, pilot randomized controlled crossover trial. 30 Children have undergone three experimental sessions with a 1-week washout period. Each child was given 250 mL of one of the following types of milk: high-protein, full-fat, or sweetened milk. The salivary pH was measured at the baseline (t0) after 5 (t1), 10 (t2), 15 (t3), 30 (t4), and 60 (t5) minutes of milk consumption, using a pH saliva indicator strip.

RESULTS

There is a sharp drop in salivary pH after 5 min of sweetened (P < 0.05) and full-fat milk consumption (p < 0.05). However, the initial drop in the salivary pH was found to remain above the critical level. For the high-protein milk group, salivary pH decreased slightly after 5 min but was similar to that at the baseline (p = 0.573). In the high-protein milk group (p < 0.05), the salivary pH was slightly greater than the baseline value at t5.

CONCLUSIONS

The study shows an initial suggestion that milk is a non-cariogenic beverage, even when sugar is added. Furthermore, high-protein milk has a protective effect from dental caries.

Plant-based milks: the dental perspective

Background Consumption of plant-based milk in the UK is increasing at the expense of cow's milk. Cow's milk consumption has traditionally been advocated by the dental profession as 'good for teeth'.Aims To identify the range of plant-based milks available in the UK and compare their nutritional benefits with cow's milk. A secondary aim was to explore reasons behind the increase in popularity of plant-based milks and discuss dental relevance.Methods Branded plant-based milks available in UK supermarkets were identified and nutritional data collected. Data were obtained from product labelling and manufacturer websites. The sample was collected in December 2019.Results Eighty-two products were identified. Differences were observed between plant-based and cow's milk, in particular regarding calcium, iodine, vitamin B12 and sugar content. Sugar content varied from 0-7.6 g/100 ml.Conclusions Dairy is a key source of dietary iodine and many plant-based milks contain much lower levels. Many plant-based milks contain free sugars which are cariogenic. Dentists should be aware of this emerging market and be able to advise patients accordingly.

Little Color, Little Flavor of Different kinds of Commercially Available Flavored Milk and their Consumption Effect on Salivary pH Value in Children: An In Vivo Study

Aim

This study aimed to compare the effect of different flavored kinds of milk on salivary pH value in 6 to 14 years old children.

Materials and methods

The impact of these different kinds of flavored milk on the salivary pH is evaluated between two groups of children, caries-active group (n = 35) constituted children who had decayed missing filled tooth (DMFT) ≥2, and the caries-free group (n = 35) constituted children who had DMFT = 0. Four different flavors of milk are taken for the study, and plain sweetened milk is chosen as the control baseline. The endogenous pH of the salivary samples is measured at baseline and after consumption of the flavored milk immediately and then at 5-, 10-, 15-, and 30-minute intervals. The results are statistically analyzed by using the paired t-test and analysis of variance (ANOVA).

Results

It is shown in the present study that caries-active group subjects had a more evident salivary pH fall than the caries-free group subjects which was statistically significant. For caries-active group, subject's salivary pH value took a longer duration to return to baseline pH as compared to caries-free subjects. However, salivary pH value is restored to standard/baseline value after 30 minutes for all the flavored milk taken in both groups; hence, their intake can be regarded safe for the oral environment.

Conclusion

It is concluded from the current study that the consumption of flavored milk can be considered as non-cariogenic for children.

Clinical significance

In the present study, the salivary pH fall in both caries-active and caries-free subjects was found above the critical pH level. Hence, all these flavored milk used in the study did not cause a threat to oral environment health as there was no significant decrease in salivary pH value so their consumption can be regarded as safe for children.

How to cite this article

Navit S, Agarwal S, Khan SA, et al. Little Color, Little Flavor of Different kinds of Commercially Available Flavored Milk and their Consumption Effect on Salivary pH Value in Children: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(S-1):S87–S91.

Are dairy products containing probiotics beneficial for oral health? A systematic review and meta-analysis

OBJECTIVES

To evaluate the effect of probiotic containing in dairy products on oral and salivary parameters.

MATERIAL AND METHODS

Electronic searches were performed based on the PICO criteria. Randomized controlled trials in adults/children (P) in which dairy products containing probiotics (I) were compared to controls (C) for establishment of oral health (O) were included. Risk of bias and data extraction were performed. The meta-analysis evaluated the influence of probiotics on Streptococcus mutans (SM), Lactobacillus spp. (LB), and yeast counts, plaque index, and salivary pH. Random or fixed effect models were used, and heterogeneity was tested.

RESULTS

Thirty-two studies were included in the qualitative synthesis, and 24 in the meta-analysis. For dichotomous results, individuals who consumed probiotics exhibited decreased scores in SM concentrations (RD 0.15 [0.02, 0.28] p = 0.03, I² = 70%), but no change was observed for LB (RD 0.10 [- 0.03, 0.23] p = 0.13, I² = 94%), or yeast levels (RD 0.05 [- 0.02, 0.12] p = 0.7, I² = 48%). For continuous analysis, both probiotic and control groups presented similar results for SM and LB (MD - 0.55 [- 1.16, 0.07] p = 0.08, I² = 62%, and RD 0.10 [- 0.03, 0.23] p = 0.13, I² = 94%, respectively). The consumption of probiotics increased salivary pH (MD 0.20 [0.04, 0.35] p = 0.01, I² = 46%) and plaque index (MD 0.38 [0.11, 0.65] p = 0.005, I² = 0%). The probiotic milk reduced SM (MD - 0.59 [- 0.96, - 0.22] p = 0.002, I² = 0%), and the probiotic yogurt decreased LB counts (RD 0.35 [0.19, 0.51] p < 0.0001, I² = 0%).

CONCLUSIONS

In general, dairy probiotics were effective in reducing SM, increasing salivary pH, and promoting a higher plaque index. Liquid matrices, such as milk and yogurt, seem to be more effective in reducing SM and LB levels.

CLINICAL RELEVANCE

Consumption of dairy products containing probiotics could be a supporting method in caries prevention.

Probiotics and oral health effects in children

BACKGROUND

Probiotics are living micro-organisms added to food which beneficially affect the host by improving its intestinal microbial balance.

OBJECTIVE

This paper aims to present a general background on probiotics and its health effects in children, and to examine the evidence for oral colonization and the possible impact on oral health in children and young adults.

METHODS

For delivery and general health effects, recent systematic reviews, meta-analyses, and other relevant papers were used. Concerning oral installation and oral effects, a broad search for publications in English was conducted through February 2007 in PubMed. Studies describing an installation or intervention trial in humans with a controlled design and an oral endpoint measure were considered. Fourteen papers with dental focus were identified, of which two were narrative reviews.

RESULTS

Only one study of dental interest was conducted in children. Four papers dealt with oral installation of probiotic bacteria, and although detectable levels were found in saliva shortly after intake, the studies failed to demonstrate a long-term installation. Seven papers evaluated the effect of lactobacilli- or bifidobacteria-derived probiotics on the salivary levels of caries-associated bacteria in placebo-controlled designs. All but one reported a hampering effect on mutans streptococci and/or yeast. The single study carried out in early childhood reported a significant caries reduction in 3- to 4-year-old children after 7 months of daily consumption of probiotic milk.

CONCLUSION

Bacteriotheraphy in the form of probiotic bacteria with an inhibitory effect on oral pathogens is a promising concept, especially in childhood, but this may not necessarily lead to improved oral health. Further placebo controlled trials that assess carefully selected and defined probiotic strains using standardized outcomes are needed before any clinical recommendations can be made.

Dental caries and beverage consumption in young children

OBJECTIVE

Dental caries is a common, chronic disease of childhood. The impact of contemporary changes in beverage patterns, specifically decreased milk intakes and increased 100% juice and soda pop intakes, on dental caries in young children is unknown. We describe associations among caries experience and intakes of dairy foods, sugared beverages, and nutrients and overall diet quality in young children.

METHODS

Subjects (n = 642) are members of the Iowa Fluoride Study, a cohort followed from birth. Food and nutrient intakes were obtained from 3-day diet records analyzed at 1 (n = 636), 2 (n = 525), 3 (n = 441), 4 (n = 410), and 5 (n = 417) years and cumulatively for 1 through 5 (n = 396) years of age. Diet quality was defined by nutrient adequacy ratios (NARs) and calculated as the ratio of nutrient intake to Recommended Dietary Allowance/Adequate Intake. Caries were identified during dental examinations by 2 trained and calibrated dentists at 4 to 7 years of age. Examinations were visual, but a dental explorer was used to confirm questionable findings. Caries experience was assessed at both the tooth and the surface levels. Data were analyzed using SAS. The Wilcoxon rank sum test was used to compare food intakes, nutrient intakes, and NARs of subjects with and without caries experience. Logistic and Tobit regression analyses were used to identify associations among diet variables and caries experience and to develop models to predict caries experience. Not all relationships between food intakes and NARs and caries experience were linear; therefore, categorical variables were used to develop models to predict caries experience. Food and beverage intakes were categorized as none, low, and high intakes, and NARs were categorized as inadequate, low adequate, and high adequate.

RESULTS

Subjects with caries had lower median intakes of milk at 2 and 3 years of age than subjects without caries. Subjects with caries had higher median intakes of regular (sugared) soda pop at 2, 3, 4, and 5 years and for 1 through 5 years; regular beverages from powder at 1, 4, and 5 years and for 1 through 5 years; and total sugared beverages at 4 and 5 years than subjects without caries. Logistic regression models were developed for exposure variables at 1, 2, 3, 4, and 5 years and for 1 through 5 years to predict any caries experience at 4 to 7 years of age. Age at dental examination was retained in models at all ages. Children with 0 intake (vs low and high intakes) of regular beverages from powder at 1 year, regular soda pop at 2 and 3 years, and sugar-free beverages from powder at 5 years had a decreased risk of caries experience. High intakes of regular beverages from powder at 4 and 5 years and for 1 through 5 years and regular soda pop at 5 years and for 1 through 5 years were associated with significantly increased odds of caries experience relative to subjects with none or low intakes. Low (vs none or high) intakes of 100% juice at 5 years were associated with decreased caries experience. In general, inadequate intakes (vs low adequate or high adequate intakes) of nutrients (eg, riboflavin, copper, vitamin D, vitamin B(12)) were associated with increased caries experience and low adequate intakes (vs inadequate or high adequate intakes) of nutrients (eg, vitamin B(12), vitamin C) were associated with decreased caries experience. An exception was vitamin E; either low or high adequate intakes were associated with increased caries experience at various ages. Multivariable Tobit regression models were developed for 1- through 5-year exposure variables to predict the number of tooth surfaces with caries experience at 4 to 7 years of age. Age at dental examination showed a significant positive association and fluoride exposure showed a significant negative association with the number of tooth surfaces with caries experience in the final model. Low intakes of nonmilk dairy foods (vs high intakes; all subjects had some nonmilk dairy intakes) and high adequate intakes of vitamin C (vs inadequate and low adequate intakes) were associated with fewer tooth surfaces having caries experience. High intakes of regular soda pop (vs none and low intakes) were associated with more tooth surfaces having caries experience.

CONCLUSIONS

Results of our study suggest that contemporary changes in beverage patterns, particularly the increase in soda pop consumption, have the potential to increase dental caries rates in children. Consumption of regular soda pop, regular powdered beverages, and, to a lesser extent, 100% juice was associated with increased caries risk. Milk had a neutral association with caries. Associations between different types of sugared beverages and caries experience were not equivalent, which could be attributable to the different sugar compositions of the beverages or different roles in the diet. Our data support contemporary dietary guidelines for children: consume 2 or more servings of dairy foods daily, limit intake of 100% juice to 4 to 6 oz daily, and restrict other sugared beverages to occasional use. Pediatricians, pediatric nurse practitioners, and dietitians are in a position to support pediatric dentists in providing preventive guidance to parents of young children.