A Randomized Controlled Trial to Evaluate the Effects of Different Forms of Orange Juice on Dental Plaque Ph

Aim: To study the acidogenic response in human dental plaque in vivo with fresh orange juice compared to orange fruit drink with no added sugar and regular orange fruit drink that were currently available in the market. Materials and Methods: Ninety subjects aged 18-30 years were allocated randomly into 3 groups. 10 ml of each experimental drink was given to the subjects in each group and instructed to keep in mouth for 2 minutes before swallowing. Intrinsic pH of the test drinks was measured by the Digital pH meter. Plaque pH was measured at the baseline, immediately after consumption and at 1,15 and 30minutes post consumption. Result: Inter group comparison by ANOVA showed significant difference among mean pH values and time intervals. There was significant drop in plaque pH in all the three groups after 1minute. Tropicana group showed drop in pH even after 30 minutes while in other two groups, pH returned to initial levels at the end of 30minutes. Conclusion: The results of our study showed that, plaque pH dropped rapidly after 1 minute of consumption of all the three fruit juices. Plaque pH returned to initial levels in two groups while in tropicana group, it declined.

Study protocol for a randomized clinical trial to evaluate the effect of the use of Xylitol gum in the prevention of caries lesions in children living in Ladakh—the Caries Prevention Xylitol in Children (CaPreXCh) trial

Background Xylitol use is reported to be able to reduce dental plaque amount and cariogenic bacteria and, as a consequence, the caries increment. Only few data on the oral health of Ladakh’s population are available. The aim of the present protocol will be to record the caries prevalence of primary and permanent molars of schoolchildren living in Ladakh and to implement a school-based Xylitol programme, named the Caries Prevention Xylitol in Children (CaPreXCh) trial, using chewing gums. Methods The protocol is designed as a triple-blind randomized, controlled, parallel-group clinical trial in children aged 5–14 years. The study should have been carried out from August 2021 to August 2024 in Zanskar Valley (Ladakh), but the COVID-19 pandemic does not allow today to make predictions on the exact start. Participants will be randomly allocated into two groups: subjects who will receive a chewing gum with Xylitol (70% w/v) as only sweetener, and those who will receive a sugared chewing gum containing Maltitol (23% w/v). The subjects will be instructed to chew a total of 6 pellets for 5 min divided into 3 intakes a day (2 in the morning, 2 after the midday meal and 2 in the afternoon) for one school year. Clinical examination will comprise an oral examination in which caries index (ICDAS scores), bleeding on probing and plaque pH evaluation after sucrose challenge will be recorded at baseline (t0); the clinical examination will be repeated after 12 months since the beginning of the chewing gum administration period (t1), after another 12-month period (t2) and finally after further 12 months (t3) (24 months from the end of the chewing gum use). The primary outcome will be the caries increment measured both at enamel and dentinal levels on primary and permanent molars. Data analysis will be conducted through Kaplan-Meyer graphs to evaluate caries increment. A comparison of the methods will be carried out with Cox regression with shared frailty. The net caries increment for initial, moderate and severe caries levels, using ICDAS (Δ-initial, Δ-moderate and Δ-severe), will be calculated. Discussion This trial will be the first trial conducted in India assessing the efficacy of a school-based caries preventive programme through the use of chewing gum containing only Xylitol as a sweetener. The findings could help strengthen the evidence for the efficacy of Xylitol use in community-based caries prevention programmes in children. Trial registration Clinical trials.govNCT04420780. Registered on June 9, 2020

Effect of Consuming Milk Tea with Stevia on Plaque pH among Dental Students: Cross-Over RCT

Background: Stevia is a natural, healthy, unconventional replacement to the table sugar and artificial sweetener. Phytochemicals present in it exerts an influence on the microbial flora of the mouth. Hence, study was planned to compare the effects of stevia with different sugars on the plaque pH. Methodology: The present study was carried in department of Public Health Dentistry between 9am-12pm. It was a triple blinded Crossover Randomized Controlled Clinical Trial with LSD design. All the 40 subjects were exposed to all four interventions sequentially, at weekly intervals with 1 week wash out period. (Intervention: A- Table sugar, B- Jaggery, C- Stevia, D- Milk tea without sugar). Inferential statistics was done using Repeated measures of ANOVA followed by Post hoc pairwise comparison and Three-way RMANOVA to determine relationship between SUGAR * WEEK * TIME interaction. Level of significance was set at p value at 0.05. Results: Plaque pH assessments were performed at 4 points of time intervals (at baseline, 1 min, 20min, 60 min). Overall significance differences were seen in plaque pH at different time intervals for all interventions. Intergroup comparison showed potential efficacy of stevia in maintaining plaque pH. Conclusion: In the present study, it was found that stevia has the least cariogenic potential when compared with jaggery and refined sugar. Jaggery also did not show a significant reduction in plaque pH. Therefore, Stevia and Jaggery can be compared for their anti-cariogenic properties. This study has been registered under the Clinical Trial Registry of India CTRI/2020/12/03003

Effect of drops containing Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) on plaque acidogenicity and other caries-related variables in orthodontic patients

Background The purpose of the study was to investigate the effect of probiotics on biofilm acidogenicity and on the number of salivary Streptococcus mutans and lactobacilli in orthodontic patients. Methods This RCT was conducted on 28 young adults who were undergoing orthodontic treatment. The short-term prospective clinical trial lasted for three weeks. The test group rinsed daily with drops containing two Lactobacillus reuteri strains diluted in water, while the placebo group used drops without probiotics. The subjects were enrolled eight months since the beginning of orthodontic treatment. Plaque-pH, saliva and dental biofilm samples were obtained at baseline, one week and three weeks post intervention. Results Twenty-seven subjects successfully completed the trial period, only one drop out in the test group. No side effects were reported. A statistically significant increase in plaque pH at three weeks post-intervention was found for the test group (p < 0.05), while insignificant changes in the pH value were found for the placebo group in comparison to baseline (p > 0.05). In addition, the AUC7.0 showed a significant difference at three weeks between the test and placebo (p = 0.00002). The three-week samples of stimulated whole saliva showed a statistically insignificant difference in the number of S. mutans and lactobacilli between the two groups (p > 0.05). The qPCR analysis showed the ability of the two strains to get colonized in the dental biofilm without a significant effect on the microbial counts. Conclusion/clinical implications A mixture of Lactobacillus reuteri has the ability to reduce the pH fall at the three-week follow-up. However, the short-term use of probiotics does not appear to have an effect on the number of salivary Streptococcus mutans and lactobacilli in saliva and on the dental biofilm. Trial registration Clinicaltrial.gov (Identifier: NCT04593017/ (19/10/2020)).

Biofilm formation following chitosan-based varnish or chlorhexidine-fluoride varnish application in patients undergoing fixed orthodontic treatment: a double blinded randomised controlled trial

Background Orthodontic treatment poses an increased risk of plaque accumulation and demineralisation of enamel leading to white spot lesion around the brackets. This parallel arm trial aims to assess the degree of bacterial plaque formation adjacent to orthodontic brackets, following the application of a chitosan-based varnish or chlorhexidene-fluoride varnish. Methods A total of 200 teeth from 20 patients undergoing fixed orthodontic therapy were assessed and biofilm formation around the brackets were recorded using the Bonded Bracket Index (Plaque index) at baseline and weekly for 6 weeks. The bacterial count and plaque pH at corresponding weekly intervals were also recorded. Following bracket bonding, the patients were cluster randomised to receive chitosan-based varnish-CHS (UNO Gel Bioschell, Germiphene corp., Brantford, Canada) or chlorhexidine-fluoride varnish-CFV (Cervitec F, Ivoclar Vivadent, Schaan, Liechtenstein) every week on the representative teeth respectively. BBI proportions were compared between groups at all time intervals using Chi square test. Mean plaque bacterial count and plaque pH were compared using Mann Whitney U test and Tukey’s HSD test respectively. Results Baseline characteristics were similar between the groups: Mean age was CHS = 23 and CFV = 21; male to female ratio was CHS = 5/5, CFV = 7/3. At the end of 6 weeks, chitosan-based varnish performed equal to chlorhexidine-fluoride varnish (P > 0.05) with 98% and 95% of teeth with acceptable scores respectively. The plaque bacterial count significantly reduced at 6 weeks for both varnish compared to the baseline; The value for CHS was 0.43 ± 0.4 × 104 and CFV was 0.77 ± 0.64 × 104 CFU (P < 0.05), with no difference between both the varnishes. Both varnishes had no effect on the plaque pH that remained neutral. Conclusion This trial showed that both chitosan-based varnish and chlorhexidine-fluoride varnish reduced bacterial count, while the plaque pH remained neutral over a period of six weeks in patients undergoing fixed orthodontic therapy. The anti-plaque effects of the natural biopolymeric chitosan-based varnish was similar to that of chlorhexidine-fluoride varnish, a known chemotherapeutic agent. Registration: This trial protocol was registered with https://www.ctri.nic.in (CTRI/2019/05/018896). (Date of registration 02/05/2019). Protocol: The protocol was not published before trial commencement.

Anti-Plaque and Anti-Gingivitis Efficacy of 0.25% Lemongrass Oil and 0.2% Chlorhexidine Mouthwash in Children

Objectives: Research is ongoing to find safe and effective oral hygiene aids for oral self‑care in children. Mouthwashes are used to complete the process of mechanical plaque control. Lack of affordability and side effects of most commercially available mouthwashes limit their use in children. Hence, the cost-effective and easily available essential oil, lemongrass oil, when formulated as a mouthwash, may possibly serve as an adjunct to oral hygiene maintenance. The main objective of this study was to compare the efficacy of lemongrass oil and chlorhexidine (CHX) mouthwash in children. Materials and Methods: Sixty healthy children between 9-12 years were selected. During the initial visit, the plaque pH, plaque index (PI), and gingival index (GI) were assessed, and oral prophylaxis was performed. The patients were randomized into three groups (n=20) and received 0.25% lemongrass oil mouthwash (group A), 0.2% CHX mouthwash (group B), and oral prophylaxis alone (group C). The patients were recalled after 14 and 21 days. ANOVA with post-hoc Bonferroni and paired t-test were used to analyze the results by SPSS software. Results: Intragroup comparison of PI and GI showed a significant decrease between 14 and 21 days in groups A and B (P≤0.05). Intragroup comparison of the mean plaque pH in group A showed a significant increase at day 21 compared with baseline (P=0.028). Conclusion: The results showed that the lemongrass oil mouthwash was effective in reducing PI and GI in children. Thus, it may be used as a good herbal alternative to CHX mouthwash.

The Impact of Carbohydrate Quality on Dental Plaque pH: Does the Glycemic Index of Starchy Foods Matter for Dental Health?

Sugary carbohydrate foods have long been associated with increased risk of dental caries formation, but the dental health impact of starchy carbohydrates, particularly those with a high glycemic index (GI), has not been well examined. Aim: To investigate the effect of different starchy foods varying in their GI, on acute changes in dental plaque pH. Methods: In a series of sub-studies in healthy adults, common starchy carbohydrate foods, including white bread, instant mashed potatoes, canned chickpeas, pasta, breakfast cereals, white rice, and an oral glucose solution were consumed in fixed 25 g available carbohydrate portions. The change in dental plaque pH was assessed postprandially over 1 h and capillary plasma glucose was measured at regular intervals over 2 h. Results: Higher GI starchy foods produced greater acute plaque pH decreases and larger overall postprandial glucose responses compared to lower GI starchy foods (white bread compared with canned chickpeas: −1.5 vs. −0.7 pH units, p = 0.001, and 99 ± 8 mmol/L min vs. 47 ± 7 mmol/L min, p = 0.026). Controlling for other food factors (food form and nutritional composition), lower GI versions of matched food pairs produced smaller plaque pH excursions compared to higher GI versions of the same food. Using linear regression analysis, the GI value of starchy carbohydrate foods explained 60% of the variation in maximum plaque pH nadir and 64% of the variation in overall acute dental plaque pH excursion (p < 0.01). Conclusion: The findings imply that starchy foods, in particular those with a higher GI, may play a role in increasing the risk of dental caries.

Murine Salivary Amylase Protects Against Streptococcus mutans-Induced Caries

Saliva protects dental surfaces against cavities (i. e., dental caries), a highly prevalent infectious disease frequently associated with acidogenic Streptococcus mutans. Substantial in vitro evidence supports amylase, a major constituent of saliva, as either protective against caries or supporting caries. We therefore produced mice with targeted deletion of salivary amylase (Amy1) and determined the impact on caries in mice challenged with S. mutans and fed a diet rich in sucrose to promote caries. Total smooth surface and sulcal caries were 2.35-fold and 1.79-fold greater in knockout mice, respectively, plus caries severities were twofold or greater on sulcal and smooth surfaces. In in vitro experiments with samples of whole stimulated saliva, amylase expression did not affect the adherence of S. mutans to saliva-coated hydroxyapatite and slightly increased its aggregation in solution (i.e., oral clearance). Conversely, S. mutans in biofilms formed in saliva with 1% glucose displayed no differences when cultured on polystyrene, but on hydroxyapatite was 40% less with amylase expression, suggesting that recognition by S. mutans of amylase bound to hydroxyapatite suppresses growth. However, this effect was overshadowed in vivo, as the recoveries of S. mutans from dental plaque were similar between both groups of mice, suggesting that amylase expression helps decrease plaque acids from S. mutans that dissolve dental enamel. With amylase deletion, commensal streptococcal species increased from ~75 to 90% of the total oral microbiota, suggesting that amylase may promote higher plaque pH by supporting colonization by base-producing oral commensals. Importantly, collective results indicate that amylase may serve as a biomarker of caries risk.