Conclusions

1. Erosive potential of acid containing candies. • Dien Gambon1, Henk S. Brand2 and Arie V. Nieuw Amerongen2. • 1Bambodino Kinderpraktijk, Rotterdam and2Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, The Netherlands. Table 2 Baseline salivary values of the 3 participating children 4 year 8 year 12 year Unstimulated saliva Secretion rate (ml/min) 0.04 0.2 0.42 pH 6..7 6.4 6.6 Chewing stimulated saliva Secretion rate (ml/min) 0.18 0.46 1.1 pH 7.4 7.1 7.4 buffering capacity (pH) 6.2 6.3 6.6 Figure 4a and b Salivary secretion rate (a) and pH (b) before, during and 4 minutes after use of red winegum, liquorice and strawberry winegum. Introduction Dental erosion in young children is a worldwide problem (Figure 1). For example, in the United States the incidence of dental erosion among children of 12 years old is 41%. The incidence of dental erosion seems to increase rapidly: In 1997 3 % of the Dutch children had sings of dental erosion. This value had increased to 23% in 2002. Frequent consumption of soft drinks and fruit juices is a well-known risk factor for dental erosion, but other factors may contribute as well. A recent study showed that candy sprays and gels are very popular among school children. These sprays have a pH of about 2, and application in the mouth immediately decreased the pH of saliva to a value below 4. This may cause demineralization of enamel, resulting in dental erosion (Gambon et al., 2006). Candies frequently contain organic acids, like citric acid, malic acid or fumaric acid (Table 1). A recent in vitro study demonstrated that crushed candies dissolved in water decreased the pH to < 4 (Davies et al., 2006) Therefore, the aim of the present study was to evaluate the potential effects of acid containing candies on the salivary flow rate and pH in situ. Materials and Methods Three children (age 4, 8 and 12 years) participated in this study with permission by their parents. Before the consumption of a candy, unstimulated whole saliva was collected in a plastic container for 5 minutes. Subsequently, chewing-stimulated whole saliva was collected for 5 minutes while the children chewed on a 5 x 5 cm piece of tasteless Parafilm. The salivary flow rates were determined gravimetrically and the pH value was measured with a Radiometer PHM240. Buffering capacity was defined as the final pH after addition of 1 ml of 5 mM HCl to 1 ml of chewing-stimulated whole saliva. The children tested a variety of candies (Table 1, Figure 2). The acidic candies contained glucose syrup, gelatine, colouring and flavouring agents and organic acids. During the consumption of the candies and 3-5 minutes afterwards, the salivary secretion rate and pH were determined. Between testing different types of candy, the children rinsed their mouth with water and had a five-minute break. Figure 3a and b Mea salivary secretion rate (a) and pH (b) before, during and after use of candy compared with unstimulated and chewing-stimulated saliva (n = 3). Results The salivary flow rate increased in relation to the age of the children (Table 2). All three children had a good salivary buffering capacity (pH after addition of HCl was > 6). Most candies dissolved intra-orally within two minutes. During this time, the secretion rate increased to values of 2 – 3.5 ml/min (Figure 3a). Simultaneously, the pH dropped to < 5 and when strawberry stripes were consumed even to 4.1 (Figure 3b). After consumption of the candy, the salivary secretion rate and pH returned to baseline values within a few minutes (Figures 3a and 3b), Figure 4 illustrates the different effects of three types of candies. The strawberry candy induced a remarkable increase in saliva secretion rate as high as 5.4 ml/min (Figure 4a) in combination with a sharp fall in pH to 4.4 (Figure 4b). Probably, this type of candy contains high levels of both flavour and acids. On the other hand, during the consumption of red wine gum and liquorice, the pH of saliva remained constant. Figure 1 Dental erosion in a 9-year old child Conclusions Consumption of most acid-containing candies induces a rapid decrease in salivary pH to < 5. Therefore, frequent use of these candies may contribute to the development of dental erosion.. Figure 2 Acid containing candies investigated Table 1 Candies investigated in this study and organic acids present in it. Winegum Citric acid Yellow chewy fruit candy Citric acid Red chewy gumball Citric acid Strawberry stripes Citric acid, malic acid Fruit gum peach Citric acid, fumaric acid Sour strawberry candy drops Citric acid, malic acid, lactic acid Winegum (red / liquorice / strawberry) Citric acid/citric acid, lactic acid References Davies R, Hunter ML, Loyn T, Rees JS. Sour sweets: a new type of erosive challenge? Proceedings of the IADR-PEF Meeting (Dublin 13-16 september 2006): P0661, 116. Gambon DL, Keijbus PAM van den, Nieuw Amerongen AV. Candy sprays and -gels: effect on salivary flow and pH. Ned Tijdschr Tandheelkd 2006; 113: 27-32.