Salivary pH changes during soft drinks consumption in children

The Effect of Oral Care Foams and a Spray on Salivary pH Changes after Exposure to Acidic Beverages in Young Adults

Soft drinks may have a deleterious effect on dental health due to a high titratable acidity and a low pH that could be sufficient to induce tooth demineralization. The use of oral care products immediately after acidic challenge may diminish the erosive potential of soft drinks. We assessed the effect of oral care foams and a spray on salivary pH changes after exposure to Coca-Cola® in young adults. Thirty-three consenting eligible patients were recruited in this double-blind, randomized, crossover study performed in six visits. Baseline examination included unstimulated salivary flow rate, stimulated salivary buffer capacity, and the simplified oral hygiene index (OHI-S) assessment. Salivary pH and time for pH recovery were registered after exposure to Coca-Cola® alone or that followed by the application of each of the studied products (an oral foam containing hydroxyapatite and probiotics, an oral foam containing amino fluoride, an alkaline oral spray, and tap water). Thirty-two patients completed the entire study protocol and were included in the final analysis. The mean minimum salivary pH and the mean oral clearance rate after rinsing with Coca-Cola® were 6.3 and 27 min, respectively. Further rinsing with any one of the tested solutions, including tap water, resulted in a significant improvement in these parameters. When the pH curves were plotted, the oral care products demonstrated a lower area under the curve that differed significantly from the area under the curve for Coca-Cola®; tap water did not differ significantly from Coca-Cola® and oral care products. Minimum salivary pH correlated positively with salivary buffer capacity and salivation rate, while salivary clearance correlated with OHI-S plaque scores. In conclusion, the effect of oral care foams and a spray on minimum salivary pH and salivary clearance after exposure to Coca-Cola® did not differ significantly among the tested products and tap water. Trial registration NCT06148662. Funding: none.

Slowly Making Sense: A Review of the Two-Step Venom System within Slow (Nycticebus spp.) and Pygmy Lorises (Xanthonycticebus spp.)

Since the early 2000s, studies of the evolution of venom within animals have rapidly expanded, offering new revelations on the origins and development of venom within various species. The venomous mammals represent excellent opportunities to study venom evolution due to the varying functional usages, the unusual distribution of venom across unrelated mammals and the diverse variety of delivery systems. A group of mammals that excellently represents a combination of these traits are the slow (Nycticebus spp.) and pygmy lorises (Xanthonycticebus spp.) of south-east Asia, which possess the only confirmed two-step venom system. These taxa also present one of the most intriguing mixes of toxic symptoms (cytotoxicity and immunotoxicity) and functional usages (intraspecific competition and ectoparasitic defence) seen in extant animals. We still lack many pieces of the puzzle in understanding how this venom system works, why it evolved what is involved in the venom system and what triggers the toxic components to work. Here, we review available data building upon a decade of research on this topic, focusing especially on why and how this venom system may have evolved. We discuss that research now suggests that venom in slow lorises has a sophisticated set of multiple uses in both intraspecific competition and the potential to disrupt the immune system of targets; we suggest that an exudate diet reveals several toxic plants consumed by slow and pygmy lorises that could be sequestered into their venom and which may help heal venomous bite wounds; we provide the most up-to-date visual model of the brachial gland exudate secretion protein (BGEsp); and we discuss research on a complement component 1r (C1R) protein in saliva that may solve the mystery of what activates the toxicity of slow and pygmy loris venom. We conclude that the slow and pygmy lorises possess amongst the most complex venom system in extant animals, and while we have still a lot more to understand about their venom system, we are close to a breakthrough, particularly with current technological advances.

Effects of Carbonated Beverage Consumption on Oral pH and Bacterial Proliferation in Adolescents: A Randomized Crossover Clinical Trial

Sugary soft drinks modify salivary pH and favor bacterial proliferation and are associated with the development of caries. Information on the effects of consuming carbonated drinks without sucrose is limited. Methods: In this crossover clinical trial, salivary and dental biofilm pH were determined at 0, 5, 10, 15, 30, 45, and 60 min after the participants (n = 18) ingested a soft drink with sucrose, a soft drink with aspartame/acesulfame K, carbonated water, and plain water on different days. Dental biofilm cultures were conducted at 0- and 120-min. Results: Salivary pH decreased significantly after ingestion of the sucrose-containing soft drink when compared with the other types of beverages (median difference, -0.3--0.4, p ≤ 0.05), and the greatest difference was found with mineral water. A greater bacterial proliferation (Colony Forming Units [CFU]) was observed after ingestion of the drink with sucrose (↑310 × 103 CFU, p ≤ 0.01), followed by the drink with aspartame/acesulfame K (↑160 × 103 CFU, p ≤ 0.01) and carbonated water (↑60 × 103 CFU, p ≤ 0.05). No significant changes in bacterial proliferation were observed after the consumption of natural water. Conclusions: Ingestion of sucrose-containing soft drinks favors the acidification of salivary pH and the bacterial proliferation of dental biofilm. Although to a lesser extent, soft drinks containing aspartame/acesulfame K also favor bacterial proliferation.

Review of paediatric gastrointestinal physiology relevant to the absorption of orally administered medicines

Despite much progress in regulations to improve paediatric drug development, there remains a significant need to develop better medications for children. For the design of oral dosage forms, a detailed understanding of the specific gastrointestinal (GI) conditions in children of different age categories and how they differ from GI conditions in adults is essential. Several review articles have been published addressing the ontogeny of GI characteristics, including luminal conditions in the GI tract of children. However, the data reported in most of these reviews are of limited quality because (1) information was cited from very old publications and sometimes low quality sources, (2) data gaps in the original data were filled with textbook knowledge, (3) data obtained on healthy and sick children were mixed, (4) average data obtained on groups of patients were mixed with data obtained on individual patients, and (5) results obtained using investigative techniques that may have altered the outcome of the respective studies were considered. Consequently, many of these reviews draw conclusions that may be incorrect. The aim of the present review was to provide a comprehensive and updated overview of the available original data on the ontogeny of GI luminal conditions relevant to oral drug absorption in the paediatric population. To this end, the PubMed and Web of Science metadatabases were searched for appropriate studies that examined age-related conditions in the oral cavity, esophagus, stomach, small intestine, and colon. Maturation was observed for several GI parameters, and corresponding data sets were identified for each paediatric age group. However, it also became clear that the ontogeny of several GI traits in the paediatric population is not yet known. The review article provides a robust and valuable data set for the development of paediatric in vitro and in silico biopharmaceutical tools to support the development of age-appropriate dosage forms. In addition, it provides important information on existing data gaps and should provide impetus for further systematic and well-designed in vivo studies on GI physiology in children of specific age groups in order to close existing knowledge gaps and to sustainably improve oral drug therapy in children.

Effect of phytosphingosine on staining resistance and microhardness of tooth enamel

OBJECTIVE

To evaluate the protective effect of phytosphingosine (PHS) against staining on dental enamel.

MATERIALS AND METHODS

Ninety-six specimens of bovine teeth (6 mm × 6 mm × 2 mm) were cut, and initial color (Easyshade, VITA), microhardness (HMV-2, Shimadzu) and fluorescence (Matlabs software, Matworks) measurements were performed. Specimens were separated into four groups according to the treatments: Distilled water (control); Human saliva (HS); PHS; PHS + HS. Specimens (n = 6) were submitted to staining procedures: Distilled water (immersion for 30 days-control); Coffee (15 minutes, twice a day/for 15 days); Black tea (as described for Coffee) and cigarette smoke (20 cigarettes/sample). Final measurements were performed, and data were analyzed (Color-CIEDE2000, fluorescence-2-way ANOVA, Tukey, and microhardness-Kruskal-Wallis Dunn, P < .05).

RESULTS

Coffee caused the highest color change (ΔE₀₀ ), followed by black tea, regardless of the treatment employed. Distilled water and cigarette smoke produced similar color changes (P > .05) for the groups control (water = 1.0 + - 0.5/ cigarette = 2.3 0.3) and PHS (water = 0.8 0.4/ cigarette = 2.3 0.4). PHS + HS demonstrated intermediate means than PHS and HS when stained with coffee and tea. After treatments, the least fluorescence alterations occurred for the groups treated with distilled water and cigarette, regardless of the treatment, with no difference (P > .05) between them. There was a significant difference (P < .05) on microhardness between all the groups, as PHS + HS > PHS > HS > Distilled water.

CONCLUSIONS

It was concluded that PHS treatment did not protect the staining of the enamel by coffee and tea, but increased the microhardness, both in the presence and absence of a salivary pellicle.

PRACTICAL IMPLICATIONS

Phytoshingosine is a novel agent and considered a promising component for anti-biofilm and anti-erosion properties by the formation of a diffusion barrier on the dental enamel. In line, PHS might be considered for anti-staining purposes.

Biomolecular uptake effects on chitosan/tripolyphosphate micro- and nanoparticle stability

Colloidal chitosan/tripolyphosphate (TPP) particles have attracted significant attention as potential delivery vehicles for drugs, genes and vaccines. Yet, there have been several fundamental studies that showed these particles to disintegrate at physiological pH and ionic strength levels. To reconcile these findings with the published drug, gene and vaccine delivery research where chitosan/TPP particle disintegration was not reported, it has been postulated that the particles could be stabilized by their bioactive payloads. To test this hypothesis, here we examine whether the association of chitosan/TPP particles with model anionic proteins, α-lactalbumin (α-LA) and bovine serum albumin (BSA), and polynucleotides (DNA) enhances chitosan/TPP particle stability at physiological ionic strengths, using 150 mM NaCl (pH 5.5) and 1× PBS (pH 6.0) as the dissolution media. Light scattering and UV-vis spectroscopy revealed that anionic protein uptake had no impact on particle stability, likely due to the relatively weak protein/particle binding at near-physiological ionic strengths, which caused the protein to be rapidly released. This result occurred regardless of whether the protein was loaded during or after particle formation. Conversely, DNA uptake (at least at some compositions) increased the chitosan fractions persisting in a complexed/particulate form in model dissolution media, with the DNA remaining largely complexed to the chitosan at all investigated conditions. Collectively, these findings suggest that, while most bioactive payloads do not interact with chitosan strongly enough to stabilize chitosan/TPP particles, these chitosan particles can be stabilized to dissolution through the incorporation of polyanions.

Regular Physical Activity as a Potential Risk Factor for Erosive Lesions in Adolescents

Tooth erosion is becoming an increasingly common dental problem among teenagers. The study aimed to determine risk factors for erosive lesions in young sports professionals. Participants were 155 students—102 physically active and 53 controls. The method included dental examination (including Basic Erosive Wear Examination) and a questionnaire concerning sports activity, dietary and hygienic habits. The sporting activity significantly correlated with erosive lesions (R_Spearman = 0.344). The regression model incorporating the kind of sports activity, special diet and (non-)drinking water was statistically significant (p = 0.922 for the Hosmer–Lemeshow test) and strong enough to predict erosive lesions in young athletes (AUC = 0.758). Water sports professionals were almost 14 times more likely to suffer from erosive lesions than control students. Drinking water as the main beverage decreased the odds by about 70%. The graphical interpretation of multidimensional correspondence analysis confirms the predictive value of these factors. The kind of sports activity adjusted by the main beverage and a special diet was the best variable to predict erosive lesions among teenagers. Early proper diagnosis with defined risk factors leads to better prevention and successful treatment.

Comparison of Salivary pH Changes after Consumption of Two Sweetened Malaysian Local Drinks among Individuals with Low Caries Experience: A Pilot Study

Background

Regular consumption of sweetened beverages has been associated with dental caries, which is mediated through salivary pH. The salivary pH changes among individuals with low caries experience after consumption of two local sweetened drinks is compared.

Methods

In this block randomised controlled parallel group, an open-label pilot study of 49 participants aged 21–25 were selected. The participants were randomised into three groups: mineral water, chocolate drink and sirap bandung. One day prior to the test, scaling was done and the participants did not eat or drink anything on the test day till the saliva sample collection was done. Salivary pH was measured at baseline and after the consumption of the drinks with a glass electrode digital pH meter at five-minute interval for half an hour. The statistical significance was assessed at the level of 5%.

Results

After consumption of chocolate drink and sirap bandung, the salivary pH dropped from a baseline of 7.09 for chocolate drink and 7.13 for sirap bandung to 6.69 for chocolate and 6.86 for sirap bandung. This difference was statistically significant (P < 0.001).

Conclusion

Sweetened milk based local drinks can increase the caries susceptibility. In the community, information about limiting the intake of sweetened drinks should be reinforced.

Changes in the physical properties and color stability of aesthetic restorative materials caused by various beverages

This study investigates the effects of various beverages on the wettability, microhardness, and color stability of aesthetic dental restorative materials. A contact angle analyzer, Vickers hardness tester, and spectrophotometer were used to characterize the properties of the materials and a total of 225 specimens were prepared: 75 each for a resin composite, compomer, and giomer. Ingestion of energy drinks and cola caused the greatest deterioration in wettability and microhardness, and coffee caused the most significant color change. In addition, the change in the resin composite was lower than that of the other restorative materials. The extent of change in the restorative materials increased with duration and frequency of contact with the beverages, so a reduction in the frequency of ingestion of these beverages is recommended.

A Comparative Evaluation of Time-dependent Changes on the Surface Hardness of Bulk Cure Composites: An in vitro Study

Objectives

The objective of this in vitro study was to assess the surface hardness through Vickers hardness (VH) test of one conventional hybrid resin composites (Filtek Z350), compared with that of two bulk cure resin composites (SDR™, Tetric N Ceram®).

Materials and methods

Twenty specimens of each material were prepared in cylindrical aluminum molds with an internal diameter of 5 mm and depth of 4 mm, 10 (incremental curing) and 10 (bulk curing).

The surface of each specimen was covered with a transparent plastic matrix strip before light curing with conventional visible light for 40 seconds. The specimens thus obtained were stored in deionized water and transferred to an incubator at 37°C for 24 hours to simulate clinical conditions. After 24 hours, the microhardness of each specimen was measured using a Vickers indenter, with a load of 100 gm and dwell time of 15 seconds (HV 0.2/40).

The specimens were further subjected to VH test in an interval of 7, 30, and 90 days. The data were subjected to statistical analysis—Student’s t test, analysis of variance, and post hoc Tukey’s test.

Results

The present study showed that SDR™ in bulk curing showed consistently greater value of hardness and was comparable to traditional incremental cured Filtek Z350, highlighting the advantages of the new SDR technology.

How to cite this article: Sarma A, Nagar P. A Comparative Evaluation of Time-dependent Changes on the Surface Hardness of Bulk Cure Composites: An in vitro Study. Int J Clin Pediatr Dent 2018;11(3):183-187.

Evaluation of Changes in Salivary pH after Intake of Different Eatables and Beverages in Children at Different Time Intervals

Introduction

Dissolution of the enamel in the form of erosion has increased due to shift in eating habits toward carbonated drinks like soft drink and chocolates.

Aim

The purpose of this study was to evaluate changes in the salivary pH after intake of different eatables and beverages in children at different time intervals.

Study design

Using standard salivary tests, this study was conducted as a case-control study. Fifty children between ages of 8 and 12 years having strict vegetarian diet were included in the study.

Materials and methods

Oral prophylaxis was done and salivary buffer capacity for stimulated saliva was measured. Before the saliva collection, each of the children was informed not to eat or drink anything for up to 2 hours just before the appointment.

Results

On pairwise evaluation, all the differences were found to be significant statistically except between baseline vs 30 minutes. Maximum mean difference was calculated and observed between baseline and immediately after intake of fruit juice and immediate after 30 minutes, 0.953 and 0.963 respectively, while minimum difference was calculated and observed between baseline and 30 minutes after intake of fruit juice (0.010).

Conclusion

Maximum drop was seen in cold drink when compared with fruit juice. The maximum pH increase was observed in cream biscuits with 7.63 ± 0.20. It was observed that in all the groups, the pH gradually got back to near normal levels due to the buffering mechanism of saliva.How to cite this article: Pachori A, Kambalimath H, Maran S, Niranjan B, Bhambhani G, Malhotra G. Evaluation of Changes in Salivary pH after Intake of Different Eatables and Beverages in Children at Different Time Intervals. Int J Clin Pediatr Dent 2018;11(3):177-182.

The release of silver nanoparticles from commercial toothbrushes

The use of silver nanoparticles (NPs) in commercial products has become increasingly common in the past decade, mostly due to their antimicrobial properties. Using Ag NP-containing articles may lead to particle release, which raises concern of human and environmental safety. The published literature addressing particle release is scarce, especially when it comes to quantifying exposure to NPs specifically. In this study, we have experimentally investigated the release of total Ag and Ag NP from commercially available toothbrushes i.e. biodegradable toothbrushes for adults and toothbrushes for children. Toothbrushes were immersed and abraded in tap water for 24h corresponding to more than the whole intended usage time of a toothbrush. The total amount of released Ag was quantified by inductively coupled plasma-mass spectrometry (ICP-MS) analysis, and the Ag NPs were characterized by single particle ICP-MS and transmission electron microscopy (TEM). The median size of the released Ag NPs ranged from 42 to 47nm, and the maximum total Ag release was 10.2ng per toothbrush. The adult toothbrushes were generally releasing more total Ag and NPs than children toothbrushes. In conclusion, our results indicate that the use of Ag NP-impregnated toothbrushes can cause consumer as well as environmental exposure to Ag NPs.

Effect of Various Sugary Beverages on Salivary pH, Flow Rate, and Oral Clearance Rate amongst Adults

Introduction. Diet is a major aetiological factor for dental caries and enamel erosion. This study was undertaken with the aim of assessing the effect of selected locally available beverages on salivary pH, flow rate, and oral clearance rate amongst adults. Materials and Method. This clinical trial comprised 120 subjects. Test beverages undertaken were pepsi, fruit drink, coffee, and sweetened milk. Statistical analysis was carried out using SPSS version 17. Descriptive statistics, one-way ANOVA, and post hoc Tukey's test were applied in the statistical tests. Results. It was found that salivary pH decreased for all the beverages immediately after consumption and the salivary flow rate increased after their consumption. The oral clearance rate of sweetened milk was found to be the least at 6.5 minutes and that of pepsi was found to be 13 minutes. However, the oral clearance rates of fruit drink and coffee were found to be equal at 15 minutes. Conclusion. Although it was found out that liquids cleared rapidly from the oral cavity, they had a significant cariogenic and erosive potential. Hence, it is always advised to minimise the consumption of beverages, especially amongst children and young adults to maintain a good oral health.

Effect on oral pH changes and taste perception in 10-14-year-old children, after calcium fortification of a fruit juice

AIM

The aim was to determine the effect of calcium fortification of a commercially available mixed-fruit juice on oral pH changes and taste perception in a group of 10 to 14 year-old Indian children.

METHOD

A controlled, blinded, non-randomised clinical trial was adopted, consisting of a sample of 100 healthy children (DMFT <3; age 10-14 years), who were exposed to three test juices one by one [Group A: original fruit juice (control group); Group B: calcium-fortified fruit juice and Group C: calcium + vitamin D fortified fruit juice]. Oral pH, collection of saliva and plaque sampling was undertaken, before and after the juice exposure by each subject at 0, 1, 5, 15, 30 and 45 min. The respective pH was measured with a digital pH meter. For taste perception, a scoring system was used after exposure of the juices to the subjects in a blind manner. The statistical evaluation was done using one-way ANOVA for salivary and plaque pH and Kruskal-Wallis test for buffer capacity and taste perception.

RESULTS

There was a smaller drop in salivary and plaque pH (p < 0.5) and a significant reduction in perceived taste (p < 0.001) by the subjects after calcium modification of fruit juice.

CONCLUSION

The calcium-modified mixed fruit juices was less acidogenic compared with the unfortified juice, and hence will be less cariogenic and erosive towards teeth.

In Vitro assessment of dentin erosion after immersion in acidic beverages: surface profile analysis and energy-dispersive X-ray fluorescence spectrometry study

The aim of this study was to investigate the effects of some acidic drinks on dentin erosion, using methods of surface profile (SP) analysis and energy-dispersive X-ray fluorescence spectrometry (EDXRF). One hundred standardized dentin slabs obtained from bovine incisor roots were used. Dentin slabs measuring 5x5 mm were ground flat, polished and half of each specimen surface was protected with nail polish. For 60 min, the dentin surfaces were immersed in 50 mL of 5 different drinks (Gatorade®, Del Valle Mais orange juice®, Coca-Cola®, Red Bull® and white wine), 20 blocks in each drink. The pH of each beverage was measured. After the erosive challenge, the nail polish was removed and SP was analyzed. The mineral concentration of dentin surfaces was determined by means of EDXRF. Data were analyzed statistically by ANOVA and Tukey's test (α=0.05). SP analysis showed that Red-Bull had the highest erosive potential (p<0.05). EDXRF results exhibited a decrease in phosphate in the groups immersed in Red-Bull, orange juice and white wine (p<0.05), and no significant difference in calcium content between the reference surface and eroded surface. In conclusion, this study demonstrated that all studied beverages promoted erosion on root dentin and Red Bull had the highest erosive potential. There was no correlation between pH of beverages and their erosive potential and only the P content changed after erosive challenge.

Saliva and dental erosion

Dental erosion is a multifactorial condition. The consideration of chemical, biological and behavioral factors is fundamental for its prevention and therapy. Among the biological factors, saliva is one of the most important parameters in the protection against erosive wear.

OBJECTIVE

This review discusses the role of salivary factors on the development of dental erosion.

MATERIAL AND METHODS

A search was undertaken on MeDLINe website for papers from 1969 to 2010. The keywords used in the research were "saliva", "acquired pellicle", "salivary flow", "salivary buffering capacity" and "dental erosion". Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party.

RESULTS

Several characteristics and properties of saliva play an important role in dental erosion. Salivary clearance gradually eliminates the acids through swallowing and saliva presents buffering capacity causing neutralization and buffering of dietary acids. Salivary flow allows dilution of the acids. In addition, saliva is supersaturated with respect to tooth mineral, providing calcium, phosphate and fluoride necessary for remineralization after an erosive challenge. Furthermore, many proteins present in saliva and acquired pellicle play an important role in dental erosion.

CONCLUSIONS

Saliva is the most important biological factor affecting the progression of dental erosion. Knowledge of its components and properties involved in this protective role can drive the development of preventive measures targeting to enhance its known beneficial effects.

Effect of Artificial Saliva on the Apatite Structure of Eroded Enamel

Citric acid-induced changes in the structure of the mineral component of enamel stored in artificial saliva were studied by attenuated total reflectance infrared spectroscopy as well as complementary electron probe microanalysis and scanning electron microscopy. The results indicate that the application of artificial saliva for several hours (the minimum time period proved is 4 h) leads to slight, partial recovering of the local structure of eroded enamel apatite. However, artificial saliva surrounding cannot stop the process of loosening and breaking of P–O–Ca atomic linkages in enamel subjected to multiple citric acid treatments. Irreversible changes in the atomic bonding within 700 nm thick enamel surface layer are observed after three times exposure for 1 min to aqueous solution of citric acid having a pH value of 2.23, with a 24-hour interval between the individual treatments. The additional treatment with basic fluoride-containing solutions (1.0% NaF) did not demonstrate a protective effect on the enamel apatite structure per se.

Surface and subsurface erosion of primary enamel by acid beverages over time

This study evaluated the influence of a cola-type soft drink and a soy-based orange juice on the surface and subsurface erosion of primary enamel, as a function of the exposure time. Seventy-five primary incisors were divided for microhardness test (n=45) or scanning electron microscopy (SEM) analysis (n=30). The specimens were randomly assigned to 3 groups: 1 - artificial saliva (control); 2 - cola-type soft drink; and 3 - soy-based orange juice. Immersion cycles in the beverages were undertaken under agitation for 5 min, 3 times a day, during 60 days. Surface microhardness was measured at 7, 15, 30, 45 and 60 days. After 60 days, specimens were bisected and subsurface microhardness was measured at 30, 60, 90, 120, 150 and 200 µm from the surface exposed. Data were analyzed by ANOVA and Tukey’s test (a=0.05). Groups 2 and 3 presented similar decrease of surface microhardness. Regarding subsurface microhardness, group 2 presented the lowest values. SEM images revealed that after 60 days the surfaces clearly exhibited structural loss, unlike those immersed in artificial saliva. It may be concluded that erosion of the surfaces exposed to the cola-type soft drink was more accentuated and directly proportional to the exposure time.

Carbonated beverages and gastrointestinal system: between myth and reality

A wealth of information has appeared on non-scientific publications, some suggesting a positive effect of carbonated beverages on gastrointestinal diseases or health, and others a negative one. The evaluation of the properties of carbonated beverages mainly involves the carbon dioxide with which they are charged. Scientific evidence suggests that the main interactions between carbon dioxide and the gastrointestinal system occur in the oral cavity, the esophagus and the stomach. The impact of carbonation determines modification in terms of the mouthfeel of beverages and has a minor role in tooth erosion. Some surveys showed a weak association between carbonated beverages and gastroesophageal reflux disease; however, the methodology employed was often inadequate and, on the overall, the evidence available on this topic is contradictory. Influence on stomach function appears related to both mechanical and chemical effects. Symptoms related to a gastric mechanical distress appear only when drinking more than 300 ml of a carbonated fluid. In conclusion there is now sufficient scientific evidence to understand the physiological impact of carbonated beverages on the gastrointestinal system, while providing a basis for further investigation on the related pathophysiological aspects. However, more studies are needed, particularly intervention trials, to support any claim on the possible beneficial effects of carbonated beverages on the gastrointestinal system, and clarify how they affect digestion. More epidemiological and mechanistic studies are also needed to evaluate the possible drawbacks of their consumption in terms of risk of tooth erosion and gastric distress.

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.

Acidic beverages increase the risk of in vitro tooth erosion

Acidic beverages are thought to increase the potential for dental erosion. We report pH and titratable acidities (ie, quantity of base required to bring a solution to neutral pH) of beverages popular in the United States and lesion depths in enamel and root surfaces after beverage exposure, and we describe associations among pH, titratable acidity, and both enamel and root erosive lesion depths. The pH of 100% juices, regular sodas, diet sodas, and sports drinks upon opening and the titratable acidity both upon opening and after 60 minutes of stirring were measured. Enamel and root surfaces of healthy permanent molars and premolars were exposed to individual beverages (4 enamel and 4 root surfaces per beverage) for 25 hours, and erosion was measured. Statistical analyses included 2-sample t tests, analyses of variance with post hoc Tukey studentized range test; and Spearman rank correlation coefficients. All beverages were acidic; the titratable acidity of energy drinks was greater than that of regular and diet sodas that were greater than that of 100% juices and sports drinks (P < .05). Enamel lesion depths after beverage exposures were greatest for Gatorade, followed by those for Red Bull and Coke that were greater than those for Diet Coke and 100% apple juice (P < .05). Root lesion depths were greatest for Gatorade, followed by Red Bull, Coke, 100% apple juice, and Diet Coke (P < .05). Lesion depths were not associated with pH or titratable acidity. Beverages popular in the United States can produce dental erosion.

Inhibition of Erosive Wear by Fluoride Varnish

It has been suggested that fluoride products with a protective mechanical component are advantageous in the prevention of erosive wear. The aim of this study was to evaluate in situ the effect of fluoride varnish (FV) in the prevention of wear due to erosion and combined erosion and toothbrush abrasion. Eleven volunteers wore for 3 weeks, during working hours, appliances containing 2 control and 2 FV-treated human enamel samples. Erosion took place extraorally 3 times a day (5 min) in the soft drink Sprite. At the end of each experimental day one control and one FV sample (C-er+abr and FV-er+abr) were brushed (5 s) with fluoridated dentrifice. The remaining control and FV sample (C-er and FV-er) were left unbrushed. Enamel volume loss was quantified by optical profilometry at day 5, 10 and 15. A statistically significant progression in enamel loss was found for the C-er, C-er+abr and FV-er+abr groups (p < 0.001, p < 0.001 and p = 0.001, respectively) but not for the FV-er group (p = 0.053). The values of cumulative normalized volume loss (x10(8) mum) at day 15 were: C-er 5.53 +/- 2.14, C-er+abr 5.70 +/- 2.07, FV-er 0.79 +/- 0.67 and FV-er+abr 2.76 +/- 1.35. The FV-er and FV-er+abr groups showed significant lower volume loss than the C-er group (p < 0.001 and p = 0.005, respectively) and the C-er+abr group (p < 0.001 and p = 0.002, respectively). The results indicate that fluoride varnish is effective in the reduction of erosive wear.

Effect of Salivary Stimulation on Erosion of Human and Bovine Enamel Subjected or Not to Subsequent Abrasion: An in situ/ex vivo Study

This in situ/ex vivo study evaluated whether saliva stimulated by chewing gum could prevent or reduce the wear and the percent change in microhardness (%SMH) of bovine and human enamel submitted to erosion followed by brushing abrasion immediately or after 1 h. During 2 experimental 7-day crossover phases, 9 previously selected volunteers wore intraoral palatal devices, with 12 enamel specimens (6 human and 6 bovine). In the first phase, the volunteers immersed the device for 5 min in 150 ml of cola drink, 4 times per day (at 8, 12, 16 and 20 h). Immediately after the immersions, no treatment was performed in 4 specimens, 4 other specimens were immediately brushed (0 min) using a fluoride dentifrice, and the device was replaced into the mouth. After 60 min, the remaining 4 specimens were brushed. In the second phase, the procedures were repeated, but after the immersions, the volunteers stimulated the salivary flow rate by chewing a sugar-free gum for 30 min. Changes in wear and %SMH were measured. ANOVA and Tukey's test showed statistical differences (p<0.05) for the following comparisons. The chewing gum promoted less wear and %SMH. A decreasing %SMH and an increasing enamel wear were observed in the following conditions: erosion only, 60 min and 0 min. The human enamel presented greater %SMH and less wear compared to bovine enamel. The data suggest that the salivary stimulation after an erosive or erosive/abrasive attack can reduce the dental wear and the %SMH.