Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka s46
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS / Dr.ABY J. MATHEW,
POSTGRADUATE STUDENT,
DEPARTMENT OF PEDODONTICS AND PREVENTIVE DENTISTRY,
COORG INSTITUTE OF DENTAL SCIENCES, VIRAJPET.
2. / NAME OF THE INSTITUTION / COORG INSTITUTE OF DENTAL SCIENCES
3. / COURSE OF THE STUDY & SUBJECT / MASTER OF DENTAL SURGERY,
PEDODONTICS AND PREVENTIVE DENTISTRY
4. / DATE OF ADMISSION TO THE COURSE / 25th MAY 2012
5. / TITLE OF THE TOPIC:
EVALUATION OF EROSIVE POTENTIAL OF ACIDIC AND ALKALINE FRUIT JUICES IN THE ORAL ENVIRONMENT OF CHILDREN AGED BETWEEN
3-6YEARS.
6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the study: Dental Erosion is relatively a new risk factor for dental health that is introduced by today’s lifestyle. Dental erosion is defined as loss of tooth structure by chemical processes not involving bacteria and is caused by a number of extrinsic and intrinsic factors.1
The etiology of Dental erosion is conventionally divided into extrinsic and intrinsic factors. Any of the acidic products that we put into the mouth, that is what we eat and drink and also what has been termed occupational related erosion often caused by airborne acids that reach the teeth for example workers in certain industries or wine tasters are considered ‘’extrinsic factors’’ .The most common intrinsic factors include chronic gastro intestinal disorders such as gastro-easophageal disease as well as health issues like anorexia and bulimia while regurgitation and frequent vomiting are common.2
The role of intrinsic and extrinsic factors in the aetiology of dental erosion are well understood as are the chemical events leading the initial mineral dissolution, softening and eventual loss of the dental surface. The diet,various chemical,biological and occupational factors along with the intrinsic factors determine erosion in the oral environment.The biological factors include saliva,acquired pellicle,tooth structure and positioning in relation to soft tissues and tongue play a major role in preventing dental erosion.The pH, titratable acidity, phosphate and calcium concentration, fluoride content of saliva,unstimulated salivary flow rate and buffering capacity have been directly associated with dental erosion.3
The present day lifestyle have included substantial increase in the consumption of fruit juices, carbonated beverages and acid drinks. Fruit juices are marketed aggressively and are promoted as a "health drink". Parents are aware of the deleterious effect of the various carbonated beverages on the teeth, so they prefer more natural and healthful products such as fresh fruit juices which are easy to prepare at home.This exposes the children to an environment susceptible to dental erosion.4
These confounding factors initiated the present study to evaluate the erosive potential of acidic and alkaline fruit juices in the oral environment of children aged between 3-6years.
6.2 Review of literature
The etiology of erosion is related to different behavioral,biological and chemical factors.Behavioral factors such as drinking habits,unhealthy lifestyle factors or occupational acid exposure might modify the extent of dental erosion.5
The capability of different soft drinks (Coca-Cola®-C, Coca-Cola Light®-CL, Guaraná®-G, Pepsi Twist®-P and Sprite Light®-SL) to erode dental enamel, relating to the percentage of superficial microhardness change (%SMHC) to concentrations of fluoride and phosphate, buffering capacity and pH of these drinks was tested.All the tested soft drinks caused surface softening of enamel (erosion). In respect to the chemical variables tested, despite not statistically significant, the pH seems to have more influence on the erosive potential of these drinks.4
The pH and the buffering effect of various soft drinks with their erosive effects and the solubility of apatite in 18 soft drinks, mineral waters and juices available on the Danish market, were determined. The dissolution of enamel increased logarithmically inversely with the pH of the drink and parallel with the solubility of enamel apatite. Orange juice, pH 4.0, supplemented with 40 mmol/l calcium and 30 mmol/l phosphate did not erode the enamel as the calcium and phosphate saturated the drink with respect to apatite. Generally, lower the pH the more NaOH was necessary to bring the pH to neutrality. In particular the buffering effect of the juice was high. For all drinks, no effect of their low fluoride concentrations was observed.6
The loss of deciduous and permanent enamel and dentine following consumption of a single low pH orange drink for 15 days; and loss of deciduous and permanent enamel and dentine following consumption of the product, 2 versus 4 times per day for 15 days was determined. It was observed that significant differences in susceptibility of deciduous and permanent enamel to erosion appear to emerge over time and with increasing frequency of consumption. This is of importance clinically given the reduced dimensions of the deciduous dentition.7
The unstimulated and stimulated saliva was found to provide some protection against dental erosion.Its effectiveness in this role depends partly on salivary factors and may differ according to a person's age and to the severity and site of erosion.8
6.3 Objectives of the study:
1.To evaluate the role of saliva in the erosive potential of acidic fruit juices.
2. To evaluate the role of saliva in the erosive potential of alkaline fruit juices.
3.To compare the erosive potential of different acidic fruit juices with the alkaline fruit juices.
Materials and Methods:
7.1 Source of data:
a.Study design:Invivo study
b.study source:Children aged 3-6years
7.2 METHOD OF DATA COLLECTION:
a.Inclusion criteria
-children in the age group 3-6years
-def index-0
b.Exclusion criteria
-children below 3years and above the age of 6years.
-def index value greater than zero
-Children with relevant medical history
-uncoperative children
-poor oral hygiene
c.Study sample design
-50 children in the age group of 3-6years will be included in this study .They will be divided into 5groups using Simple Random sampling.
That is
Group1-acidic fruit juice 1( Lemon juice)
Group2-acidic fruit juice 2 (Orange juice)
Group3-alkaline fruit juice 1 (Apple juice)
Group4-alkaline fruit juice 2(Grape Juice)
Group5-Neutral drink (Water)
d.Methodology
The pre salivary sample of unstimulated saliva will be collected using Collins method9 on the first day of the study.The saliva collected will be subjected to assess the salivary calcium,phosphorus,bicarbonate and pH.Then children in each group will be given their respective fruit juices 3times a day for the next 15 days.The first and second post salivary sample will be collected on the 7th and 15th day respectively and the saliva collected will be subjected to assess the salivary calcium,phosphorus,bicarbonate and pH.The children will then be weaned from the fruit juices completely for the next 2weeks and the third post salivary sample will be taken and will be subjected to assess the salivary factors calcium,phosphorus,bicarbonate and pH.
e.Statistical analysis
Based on the data collected Parametric or Non-parametric statistical test will be done using SPSS Software Window Version18.
7.3 Does the study require any investigation or investigations or interventions to be conducted on patients or other humans & animals, If so, please describe briefly
-Yes-
The study involves collection of saliva by Collins method.
7.4 Has the ethical clearance been obtained from your institution in case of 7.3?
-Yes-
8. / LIST OF REFERENCE
1. de Carvalho Sales-Peres SH, Magalhães AC, de Andrade Moreira Machado MA, Buzalaf MA. Evaluation of the erosive potential of soft drinks. Eur J Dent. 2007 Jan;1(1):10-13.
2. Johansson A, Omar R, Carlsson GE, Johansson A. Dental erosion and its growing importance in clinical practice: from past to present. Int J Dent. 2012,2012:1-17
3. Lussi A, editor. Dental erosion from diagnosis to therapy. 1st ed. Basel (Switzerland): S. Karger. 2006; (Monographs in oral science; 20):88-99
4. Nirmala SV, Subba Reddy VV. A comparative study of pH modulation and trace elements of various fruit juices on enamel erosion: an in vitro study. J Indian Soc Pedod Prev Dent. 2011 Jul-Sep;29(3):205-15
5. Magalhães AC, Wiegand A, Rios D, Honório HM, Buzalaf MA. Insights into preventive measures for dental erosion. J Appl Oral Sci. 2009 Mar-Apr;17(2):75-86.
6. Larsen MJ, Nyvad B. Enamel erosion by some soft drinks and orange juices relative to their pH, buffering effect and contents of calcium phosphate. Caries Res. 1999;33(1):81-7
7. Hunter ML, West NX, Hughes JA, Newcombe RG, Addy M. Erosion of deciduous and permanent dental hard tissue in the oral environment. J Dent. 2000 May;28(4):257-63.
8. Piangprach T, Hengtrakool C, Kukiattrakoon B, Kedjarune-Leggat U. The effect of salivary factors on dental erosion in various age groups and tooth surfaces. J Am Dent Assoc. 2009 Sep;140(9):1137-43..9. Edgar W.M.,O‘ Mullane D.M.,editors.Saliva and oral health.2nd ed.London:British Dental Assosciation;1996:43-44.
9. /
Signature of the candidate
10. / Remarks of the guide
11. / Name & Designation of (in block letters)
11.1 Guide
11.2 Signature / Prof. (DR.)B.M. SHANTHALA
PROFESSOR
11.3 Co- guide (if any)
11.4 Signature
11.5 Head of the Department
11.6 Signature / Prof. (DR.) B.M. SHANTHALA
12. / 12.1 Remarks of the chairman & Principal
12.2 Signature