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INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 2 ISSUE 4 OCT-DEC 2010 30

A comparative study of acidogenic potential of milk and commonly used milk
formulae
Updesh Masih,Manisha prabhakar, J. L. Joshi,Pooja Mahay
Abstract
Aims & Objective: Oral health of an individual has its origin mainly during infancy and early childhood.
The present study was designed with the objectives of comparing the human plaque pH changes after
consumption of milk and infant milk formulae. Materials &methods: The study was carried out on thirty
school going children of 8-12 years. The acidogenic potential of following commonly used milk formulae
was observed i.e. : Lactogen 2 , Lactodex 2 , Amulspray , along with sweetened and plain milk ( verka ) ,
in terms of their effect on the hydrogen ion concentration of human dental plaque. Results: A sharp plaque
pH fall in the case of sweetened milk was observed which was below the critical value of 5.5. Conclusion:
In diet counseling procedures, we recommend usage of all the above mentioned infant formulae, but
Lactodex-2 should be given preference.
Key Words: milk, plaque, infant formulae, caries
Received on: 11/09/2010 Accepted on: 11/10/2010
Introduction
The introduction of fermentable
carbohydrates into the modern diet has been
associated with the increase in the prevalence of
dental caries.Various experimental studies, like
that of Vipeholm, (1) on the relationship between
sugars (carbohydrates) and dental caries, have
led to the conclusion that factors such as physical
form, oral clearance and frequency of meal
consumption are of equal importance as the
causative agents. DIET, thus is the most
important factor to be looked after, as it is not
only essential for a growing child or for
sustaining good health, but also could be a
modifying agent in dental caries. Milk is
universally considered as the ideal food for the
growing child. It is the most popular form of
nutrition from birth to adolescence and beyond,
for peoples both, rich and poor.
Methods
This study was conducted in the
Department of Pedodontics and Preventive
Dentistry, Christian Dental College and Hospital,
Ludhiana, Punjab. The study sample includes
thirty school going children in the age group (8
12 yrs) (3, 4) who were randomly selected. The
acidogenic potential of following commonly
used milk formulae was observed i.e. Lactogen
2, Lactodex 2, Amulspray, along with sweetened
and plain milk (verka), in terms of their effect on
the hydrogen ion concentration of human dental
plaque. A letter providing all information and
details of the study was given to the guardian
and the study was carried out only after
permission was granted. Inclusion criteria
(5):Healthy, co-operative children with
restoration free labial, buccal and lingual
surfaces having DFT / dft not more than
3.Exclusion criteria: (6) Children having:-
Xerostomia, Lactose intolerance, General allergy
to milk and children on antibiotic therapy in the
past three months. Selected tooth surfaces: (7)
a)Palatal surface # 16, b) Lingual surface #
46, 44\84, c) Lingual Surface # 36, 34\74
The study was done under the following
three stages. Stage1 (Pre-study Preparation) at
the commencement of the study, the children
were given thorough oral prophylaxis so as to
obtain zero plaque score to ensure uniform
baseline (5). This was determined with the help
of a disclosing solution (Basic Fuchsin 0.075
%) (8) and the following instructions were given
to the children: They were asked to abstain from
brushing their teeth or performing any method of
oral hygiene for 48 hours to allow sufficient
plaque deposition(9). On the day of the study (3
rd

day) the children were brought to the department
of Pedodontics and Preventive Dentistry at 8:00
AM in the morning without eating any form of
breakfast or food, except plain water.
Appointments were always scheduled at the
same time of the day for each subject, between
08:00 & 11:00 hours.
Stage2 (Recording of Resting pH)
Standardization of plaque pH testing apparatus:
This pH meter was fitted with a calomel
combination type of single electrode. The
apparatus was standardized using buffer
solutions 4 and 7 provided by the manufacturer.
This calibration was done every day before the
RESEARCH ARTICLE
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INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 2 ISSUE 4 OCT-DEC 2010 31
experiments commenced. The electrodes were
cleaned in a stream of distilled water, and blotted
dry with filter paper. This ensured stable
readings from the meter and constant check on
the drift. All readings were taken 60 seconds
after the placement of plaque suspension on the
electrode system to standardize the time allowed
for the electrode reading to stabilize.
When the child reports back to the
department, the supra gingival plaque samples
were collected from the palatal surface of # 16
with the help of a standardized excavator using
the plaque sampling technique. The plaque was
dissolved in 2 ml of double distilled water,
sufficient enough to submerge the glass of the
electrode, completely. This entire procedure was
completed within 1 minute. Recordings were
taken from the digital display of the pH meter
directly. This first reading served as baseline or
resting plaque pH.
Stage 3 (Recording of pH After
Consumption of Test Food) After recording the
resting pre-consumption plaque pH, each child
was given 10 ml of the prepared test food and
asked to swish it around the mouth for 40
seconds (10) and then either swallow or spit it,
depending on preference of the child. Fresh
samples of the plaque was taken to record the pH
according to the plaque sampling technique (5,
11).Rankine et al (12) viewed a marked
difference in plaque pH in different quadrants of
the mouth in the same individual, revealing the
limitations of any observations on pooled plaque,
so the following teeth were taken which showed
a slightly less acidic plaque accumulation when
compared to the maxillary teeth.(13)The changes
in plaque pH after consuming the test food were
recorded as follows: a) After 5 minutes from #
46, b)After 10 minutes from # 44\84, c)After 20
minutes from # 36, d)After 30 minutes from #
34\74. After each test food experiment in an
individual, the pH meter was again checked and
standardized against buffer of 4.00 and 7.00 pH.
The children were then asked to use the normal
oral hygiene regime for next 5 days and abstain
for 2 days, and then report back to department.
Thereafter the experiment was carried out with
the remaining test foods. The results were
tabulated and put to statistical analysis.
Results
Minimum value for pH was observed
for all drinks at 10 minutes time interval, after
consumption. Mean resting plaque pH of the
children in the test group was 6.82 0.14.Plain
milk showed a mean minimum pH of 6.77
0.15.Sweetened milk showed a mean minimum
pH of 5.48 0.05. Milk caused the least drop in
plaque pH and had a minimum plaque pH of
6.602 0.146, followed by Lactodex 2 (6.487
0.142), Lactogen (6.323 0.131) and Amulspray
(6.024 0.130). The maximum drop in the pH
among those tested was for sweetened milk with
a mean minimum plaque pH of 5.481 0.054.
Discussion
The average resting plaque pH of all the
children was 6.81 0.13. This finding is
comparable to the resting plaque pH seen in
studies conducted by Anderson et al (14), Saigal
et al (4), Jensen et al (11). The importance of the
resting pH lies in the fact that, the children
having less cariogenic potential had high resting
pH approx 6.8 when compared to the children
with active carious lesions (15). .The buffering
capacity of milk is almost twice as compared to
the infant formulae available in India. Buffering
capacity is the ability of a solution to resist a
change in pH when acid or base is added (16)
Though milk has been proven low in
cariogenicity, various reasons can be attributed
to the low cariogenicity of milk. Lactose as
compared to sucrose is metabolized slowly by
oral micro organisms. However if the organism
is adapted to lactose, the acid production takes
place faster and pH fall also increases (17).
When sugar was dissolved in the same milk and
given to the children, a fall of 1.32 units in
plaque pH was observed at 10 minutes time
point. This value is comparable to the value
observed by Rugg-Gunn et al (18) 1985, where
a drop from 6.83 to 5.40 was seen on drinking 7
% sucrose solution
The results of three infant milk
formulae tested showed that Amulspray was
highly acidogenic and the least acidogenic was
Lactodex 2. Though the carbohydrate content
is less in Amulspray than Lactogen 2 and
Lactodex 2 but the maximum drop was seen with
this milk formula. With the Lactodex 2 infant
milk formulae the drop seen was minimum and it
was 0.13 units lower from the baseline plaque
pH (graph - 1). Munshi et al (6) compared the
buffering capacity of all infant formulae
marketed in India and found Amulspray having
the buffering capacity of 11.92 % as compared to
Lactogen2 i.e. 18.48 and Lactodex2 to be
20.13%. This drop in the Lactogen2 is not
attributed to its high carbohydrate content but to
its low protein, fat, sodium and calcium content
as compared to Lactodex 2. It is difficult to
predict the cariogenicity of formulae based on
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INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 2 ISSUE 4 OCT-DEC 2010 32
their carbohydrate content alone as shown on the
product label as either, this information does not
specify the quantum, or the nature of the
carbohydrate. It also appears that
noncarbohydrate constituents may influence the
cariogenicity of the sugars present in the
formula.
The mineral content varies in each of
the test formulae. There have been few notable
studies which concentrate upon the effect of iron
in the cariogenic process. Though iron does not
directly exert its influence on the plaque pH, it is
considered to be cariostatic according to many
researchers (19, 20). Among the three test
formulae studied Lactodex 2 had the highest iron
content (8.0 mg) followed by Lactogen2 (7.9
mg) and Amulspray (5.0 mg).
Authors Affiliations: 1. Dr. Updesh Masih, MDS,
Reader, Dept. of Pediatric Dentistry, 2. Dr. Pooja
Mahay, Lecturer, Pacific Dental College, Rajasthan, 3.
Dr. Manisha Prabhakar, Professor, 4.Dr. J. L. Joshi,
Professor & HOD, Christian Dental College,
Ludhiana, Punjab, India.
References
1. Gustafson B. E et al. The vipeholm dental caries
study. The effect of different levels of
Carbohydrate intake on caries activity on 436
individuals observed for 5 years. Acta Odontol
Scand; 11 (3): 232-264: 1954.
2. Jenkins G. N, Ferguson D.B. Milk and dental
caries. Br Dent J: May; 1966.
3. Gopinath VK, Gupta RK, Tandon S. An
evaluation of pH changes of dental plaque after
consumption of milk formulae and beverages. J.
Indian Soc. Pedo. Prev. Dent. 1997; 15(3):92-6.
4. Saigal A, Tewari A. Cariogenicity of milk, apple
juice and shikanjvi, a dental plaque study. JADA
1979-80;( 51-52):373-7.
5. Edgar WM, Geddes DAM. Plaque acidity models
used for cariogenicity testing. J. Dent. Res.1986
(Spec Iss):65.
6. Munshi AK, Kavita H, Santhi KP. Acidogenic
potential of the infant milk formulas marketed in
India. J. Indian Soc. Pedo. Prev.Dent. 2001
March: 1-8.
7. Weatherell J. A, Robinson C, Nattress B. R. Site
specific variations in the concentrations of
substances in the mouth.Br Dent J; October:
1989.
8. Lehl G, Taneja J. R, Chopra S. L. Evaluation of
the cariogenicity of sugar containing drinks by
estimating changes in pH of human dental plaque
and saliva. J Indian Soc Pedo Prev Dent 1993;
11: 9 14.
9. Edgar W. M. Duration of response and stimulus
sequence in the interpretation of plaque pH data.
J Dent Res 61(10):1126-1129, October 1982.
10. Tandon S, Shankar M, Gopinath V. K, Moorthy
K. Comparative evaluation of cariogenic
potential of different types of milk and milk
formula in pre-school children. J Indian Soc Pedo
Prev Dent 1997; 15: 2: 64 68.
11. Schatele CF, Jensen ME. Comparison of methods
for monitoring changes in the pH of human
dental plaque. J Dent Res.1982;61(10):1117-25.
12. Rankine A. N, Moreno E. C, Vogel G. L,
Margolis H. C. Micro-analytical determination
of pH, calcium and phosphorus in plaque fluid. J
Dent Res 64 (11): 1275-1280, November, 1985.
13. Kleinberg I. and Jenkins G. N. The pH of dental
plaques in the different areas of the mouth before
and after meals and their relationship to the pH
and rate of flow of resting saliva. Arch Oral Biol,
9: 493-516: 1964.
14. Anderson P, Hector M. P, Rampersad M. A.
Critical pH in resting and stimulated whole saliva
in groups of children and adults. Int J Paed Dent
2001; 11: 266-273.
15. Quiroz E. M. A, Lingstrom P, Birkhed D.
Influence of short term sucrose exposure on
Plaque acidogenecity and cariogenicity micro
flora in individuals with different levels of
Mutans streptococci. Caries Res 2003; 37: 51
57.
16. Thomas M Devlin. Text book of Biochemistry
with clinical correlation. 2nd edition. 1991. John
Wiley and Sons, New York.
17. Lingstrom P, Birkhed D, Granfeldt Y, Bjorck I.
pH measurements of human dental plaque after
consumption of starchy foods using the
microtouch and the sampling method. Caries Res
1993; 27: 394-401.
18. Rugg-Gunn AJ, Roberts G. J, Wright W. G.
Effect of human-milk on plaque pH in situ and
enamel dissolution in vitro compared with bovine
milk lactose and sucrose. Caries Res. 1985;
19:327-34.
19. Bowen W. H, Pearson S. K, Rosalen L. P, Miguel
J. C, Shih A. Y. Assessing the Cariogenic
potential of some infant formulas, milk and sugar
solutions. JADA, Vol. 128,865-871: 1997.
20. Miguel J. C, Bowen W. H, Pearson S. K.
Influence of iron alone or with fluoride caries
development in desalivated and intact rats. Caries
Res 1997; 31: 244-248.
Address for Correspondence
Dr. Updesh Masih, MDS,
Reader, Dept. of Pediatric Dentistry,
Pacific Dental College,
Udaipur, Rajasthan, India.
Ph:00919887079887
E-mail : updesh_74@yahoo.com



Source of Support: Nil, Conflict of Interest: None Declared