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ORIGINAL ARTICLE
Year : 2018  |  Volume : 16  |  Issue : 4  |  Page : 342-345

Assessment of repetitive effect of change in salivary pH and sugar exposure on dentition status among tea vendors


1 Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
2 Department of Conservative Dentistry and Endodontics, Government Dental College and Research Institute, Bengaluru, Karnataka, India

Date of Submission03-Jun-2018
Date of Acceptance05-Nov-2018
Date of Web Publication29-Nov-2018

Correspondence Address:
Dr. V Balasubramanyam
Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_122_18

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  Abstract 

Introduction: Tea is the most common beverage that is consumed by almost every strata of society. Tea, when consumed with sugar, is more detrimental and influences the onset of dental caries. Tea vendors consume tea many times a day that has a detrimental effect toward their oral cavity. Aim: The present study was undertaken to evaluate the effect of salivary ph and sugar exposure on dental caries experience among tea vendors. Materials and Methods: In total, 30 tea vendors were selected who fulfilled the exclusion and inclusion criteria. Saliva sample was collected at three different time intervals (i.e., before tea preparation, 5 min after tea tasting, and 30 min after the last tea tasted). Salivary pH estimation was done using a portable standard digital pH meter. Sugar exposure was recorded using a questionnaire. The dental caries experience of the tea vendors was recorded using the WHO oral health assessment form for adults, 2013. Descriptive statistics, ANOVA and post hoc Tukey test, Kruskal–Wallis ANOVA, and Pearson's correlation were applied for analyzing data using SPSS vs. 16 (IBM, Chicago). Results: Mean and standard deviation of salivary pH at baseline, after 5 min, and after 30 min was 5.85 ± 0.58, 3.86 ± 0.524, 6.38 ± 0.396, respectively, which was statistically significant (P < 0.001). Mean sugar exposure among males and females were 8.36 ± 5.28 and 5.4 ± 1.6. Mean DMFT for male and female was 4.96 ± 5.054, 5.00 ± 2.449, respectively (P = 0.007). Positive correlation was found between number of years as tea vendors and dental caries experience (r = 0.737). Conclusion: Increased frequency of liquid sugar consumption led to repetitive pH drop of the saliva that had a positive correlation on the caries experience among tea vendors.

Keywords: ANOVA, dental caries, salivary pH, sugar, tea


How to cite this article:
Naveen N, Balasubramanyam V, Yunus G Y, Kiran Kumar N, Tiwari R, Patel A. Assessment of repetitive effect of change in salivary pH and sugar exposure on dentition status among tea vendors. J Indian Assoc Public Health Dent 2018;16:342-5

How to cite this URL:
Naveen N, Balasubramanyam V, Yunus G Y, Kiran Kumar N, Tiwari R, Patel A. Assessment of repetitive effect of change in salivary pH and sugar exposure on dentition status among tea vendors. J Indian Assoc Public Health Dent [serial online] 2018 [cited 2018 Dec 11];16:342-5. Available from: http://www.jiaphd.org/text.asp?2018/16/4/342/246350


  Introduction Top


In the modern society, dental caries is one of the most alarming diseases of the oral cavity.[1] Dental caries by definition “Is an infectious microbiological disease of the calcified tissues of the teeth, characterized by demineralization of inorganic portion and destruction of the organic substance of the teeth.”[2] Dental caries does not have any age predilection and is common to all age groups, whereas, the cause of periodontal disease can be attributed to numerous local and systemic factors.[1]

In the modern scenario, dental caries is the most prevalent chronic disease and can be considered as one of the major oral health burden. The disease is prevalent and severe in the developed countries, and there is evidence which shows that the incidence of dental decay is on a rise in many developing countries that previously had very low or moderate caries experience.[3]

Increased prevalence of dental caries among developing countries can be attributed to the high-sugar intake and change in the dietary pattern. The development in the socio-economic strata influences the use of processed sugar products in beverages such as tea and coffee, which increase the intake of sugar, resulting in increased dental caries experience.[4],[5]

In a study conducted by Jamel et al. found that people in urban area consumed more sugar in their tea than rural population.[6] Similarly, a study conducted in Finland and USA in 1980 and 2000, respectively, to explore the relationship between sugar-sweetened beverage and dental caries, found a positive correlation between sugar consumption and dental caries of crown and root region of tooth.[7]

A complex relationship exists between sugar consumption and oral health. Intake of sugar-sweetened diet has an adverse effect on the teeth bio-structure, pH and composition of saliva and plaque pH.[7] Tooth demineralization is a process that is caused by the hydrolysis of sugar and a fermentable carbohydrate by salivary amylase that acts as a substrate for the oral bacteria that lowers the salivary pH. Sugar, being a carbohydrate, is easily fermented by the oral bacteria that lead to acid formation and has a potential to promote dental caries activity. Fermentable carbohydrate remain in the oral cavity for a longer period of time, adhere to tooth surface and are more likely to cause dental caries.[8],[9],[10]

During tea tasting, the tea vendors usually sip the prepared tea which usually remains in the mouth for approximately 30–60 s without swishing with water to neutralize the effect of the sugar thus increasing the risk of enamel and dentine erosion. The acidity of the beverages diminishes the buffering capacity of saliva and also the ability to form a protective enamel pellicle, and as a result, it hampers the beneficial effect of saliva.[11] The critical pH at which enamel dissolves is reported to be 5.0–5.7 pH. The increased exposure to acidic beverage for a long duration results in tooth erosion and demineralization.[12],[13],[14]

It is also found that dental caries increment is noted with more use of sugar-sweetened beverage consumption without any specific age, sex, educational criteria, and more importantly use of fluoridated toothpaste.[7] The present study was undertaken to evaluate the effect of salivary pH and sugar exposure on dental caries experience among tea vendors of Durg-Bhilai cities of Chhattisgarh.


  Materials and Methods Top


The present descriptive cross-sectional study was conducted to assess the effect of repeated sugar exposure on the oral health of tea vendors of Durg-Bhilai Chhattisgarh. The study was conducted for a period of 15 days from September 15 to 30, 2017. Ethical approval was obtained from the Institutional Ethical Review Board (RCDSR/IEC/MDS/2017/D10).

The detailed explanation of the study in the language that the study participants could understand was used. Only those participants who gave consent were considered to be a part of the study. On the day of data collection, the study participants were explained verbally about the study before the examination. A convenient sampling technique was used to derive the sample for the current study, a total of 30 tea vendors were taken as the final sample size.

Inclusion criteria

Following inclusion criteria were established for the present study:

  • All the tea vendors of Durg-Bhilai cities in Chhattisgarh were included in the study
  • Tea vendors preparing tea more than 3–5 times a day.


Exclusion criteria

  • Participants not willing to take part in the study
  • Participants who are physically handicapped
  • Tea vendors with systemic disease (such as hypertension,  Parkinsonism More Details, on antihistamine and participants who had antibiotic therapy in the past 1 month).


Collection of demographic details was followed by collection of saliva sample and detailed clinical examination was carried out by a single trained and calibrated examiner. Demographic details (name, age, gender, and address) along with the details including the number of tea preparation in a day, number of tea tasting in a day, oral hygiene practices, and sugar exposure were recorded by the use of personal interviewing using a self-designed pro forma.

A brief description of the aim and objective along with study protocol and examination procedure was explained to all participants before obtaining written informed consent from each study participants before the oral examination and collection of saliva sample. Saliva samples were collected at 3 time intervals i.e (at baseline, 5 min after tea tasting, and 30 min after last tea being tasted in the day). Unstimulated saliva was collected using drool method.[15] The saliva sample was subjected for salivary pH analysis using a standard portable digital pH meter (Cpixen, Part no. SB-124, UPC-762137029643, manufacturer in India). A thorough examination of the study participants using the World Health Organization (WHO) type III clinical examination was done to identify carious lesions in the oral cavity and was recorded in “WHO oral health assessment form for adults 2013” using mouth mirror and Community Periodontal Index probe.[16]

Statistical analysis

Thus, obtained data were arranged in Microsoft Office Excel spreadsheet 2007 and analyzed by SPSS vs. 16 (IBM, Chicago, IL, USA). Descriptive statistics, ANOVA with Tukey's post hoc analysis, and Pearson's correlation were obtained from the Existing data. The statistical significant level was fixed at P < 0.05.


  Results Top


A total of 30 tea vendors participated in the current study of which 25 (83.3%) were males and 5 (16.7%) were females. The mean age of the study participants was found to be 38.4 ± 12.00 years.

The work experience of tea vendors participating in the study was determined which represents 13 (52%) were professional tea vendor's from past 10 years and 10 (40%) males were working as tea vendors from 15 years [Table 1].
Table 1: Distribution of study participants according to number of years as tea vendors

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The average tea tasting per day among study participants showed that 12 males tasted tea for around 6–10 times/day, however, among females, number of tea tasting as about 11–15 times per day [Table 2].
Table 2: Distribution of study participants according to average numbers of tea tasting per day

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Intergroup comparison of mean salivary pH showed highly significant results (P < 0.001) when compared with salivary pH at baseline, 5 min after tea tasting, and 30 min after last tea being tasted in a day [Table 3].
Table 3: Intergroup comparison of salivary pH at Baseline, 5 min after tea tasting and 30 min after last tea tasted

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Mean DMFT among males was highest in the age group of 46–60 years (8.44 ± 6.93) and total DMFT among study participants was found to be 4.97 ± 4.68. However, among females, the mean DMFT was 6 ± 4.2 accounting for age group of 15–30 years [Table 4].
Table 4: Gender-wise and age-wise comparison of decayed missing filled teeth among study participants

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There was a positive correlation between number of years as tea vendors and DMFT [Table 5].
Table 5: Correlation between number of years as tea vendors and decayed-missing filled teeth

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  Discussion Top


Tea vendors are said to taste tea many times a day which has a deleterious effect on their oral cavity. The present study involved tea vendors of Durg-Bhilai city; it was evident that on an average tea vendors had 10 times tea tasting in a day.

The study showed that there was significant correlation in number of years as tea vendors and total DMFT. These findings of the present study had similarities with other studies in which it was found that a positive correlation exists between sugar exposure and dental caries experience.[5] This can be attributed to the fact that recurrent demineralization of tooth structure is observed due to the increased activity of acidogenic bacteria's which is caused by recurrent fall in salivary pH. However, there were some negative studies also which contradicted the results of the present study and found that there was no such correlation between sugar-sweetened beverages and dental caries.[13]

It was also found that a positive dose-related response exists between sugar-sweetened beverages and caries increment in adults.[7] Similar finding was seen in the current study, which showed that tea vendors who tasted tea many times a day had higher dental caries experience. However, there were some contradictory results that suggested that there was no such relationship between sugar-sweetened beverage and dental caries.[17]

One of the key variables assessed in the study was the evaluation of salivary pH at baseline, 5 min after tea tasting and 30 min after last tea tasted in a day. It was found that there was drastic change in the salivary pH level when evaluated after 5 min after tea tasting, which can be attributed to the findings from Stephen's Curve which suggests that after sugar exposure there is fall in pH that is encountered between 5 and 20 min.[18] Acidogenic bacteria rapidly metabolize fermentable carbohydrates, producing lactic acid as the end products, in the oral cavity, these changes occur due to cariogenic food over a period is called as the Stephan responses or Stephan curves. When no food or sugar-sweetened beverage is consumed, the pH of dental plaque and saliva under resting conditions is fairly constant, and however, some difference may exist when considering physiological variation in individuals.[18]

The response of exposure of dental plaque and saliva to a fermentable carbohydrate can be explained through various changes in events that usually incorporate as the pH decreases rapidly, reaching to a minimum level in approximately 5–10 min. This is followed by a gradual recovery to its starting value, usually over 30–60 min, although this can be longer in some individuals considering the physiological variation among them. Since tea vendors prepare tea many times a day and also taste it during its preparation their salivary pH fall is observed recurrently, which has an effect on their dental caries experience.[11],[19],[20]

The accessibility of dental services and time factors associated among the study participants is one of the major problems to seek dental care which is reflected in their poor oral health status. It is important that these communities are made aware of the detrimental effect of tea tasting.[21] An ideal method to prevent this detrimental effect of tea tasting may include a combination of frequent oral health check-ups and providing adequate oral health-care information and counseling. As a part of the study, all the participants were provided with information and method to prevent or decrease the detrimental effect of tea. The participants were issued with oral health check-up card to avail dental treatment. Information was provided to swish with water after tea tasting that would aid the buffering capacity of saliva.

In the present study, participants who brushed only once daily were advised to brush twice daily. The participants in the study were informed about the advantages of using toothbrush, mouthwash and toothpaste that would prevent the plaque accumulation and thus prevent the growth of cariogenic bacteria. All the participants were encouraged to opt for dental treatment or have a regular dental visit so that the dental problems are diagnosed at early stage and treated appropriately.[21]

Limitation

The limitation of the present study was that it was a descriptive study that described the disease, small sample size was included in the study, and many factors such as age, systemic condition can be potential confounders in the present study. Thus, it is recommended that further analytical studies should be conducted to confirm the results.


  Conclusion Top


The study provided an insight of the detrimental effect of recurrent tea consumption by tea vendors in a day. Thus, it is recommended from the present study that oral health check-ups for this community should be planned by oral health professionals and also provides counseling so as to improve the oral health. Further, analytical studies should be conducted to confirm the results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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6.
Jamel HA, Sheiham A, Watt RG, Cowell CR. Sweet preference, consumption of sweet tea and dental caries; studies in urban and rural Iraqi populations. Int Dent J 1997;47:213-7.  Back to cited text no. 6
    
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Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr 2003;78:881S-92S.  Back to cited text no. 8
    
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Gustafsson BE, Quensel CE, Lanke LS, Lundqvist C, Grahnen H, Bonow BE, et al. The vipeholm dental caries study; the effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontol Scand 1954;11:232-64.  Back to cited text no. 9
    
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Heijden KV, Younes M, Miller S. International Food Safety Handbook: Science, International Regulation, and Control. New York: Marcel Kekker; 1999. p. 131-2.  Back to cited text no. 10
    
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Buzalaf MA, Hannas AR, Kato MT. Saliva and dental erosion. J Appl Oral Sci 2012;20:493-502.  Back to cited text no. 11
    
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Newbrun E. Dietary carbohydrates: Their role in cariogenicity. Med Clin North Am 1979;63:1069-86.  Back to cited text no. 12
    
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Szpunar SM, Eklund SA, Burt BA. Sugar consumption and caries risk in schoolchildren with low caries experience. Community Dent Oral Epidemiol 1995;23:142-6.  Back to cited text no. 13
    
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Mandel L. Dental erosion due to wine consumption. J Am Dent Assoc 2005;136:71-5.  Back to cited text no. 14
    
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Yamuna PK, Muthu PK. Methods of collection of saliva – A review. Int J Oral Health Dent 2017;3:149-53.  Back to cited text no. 15
    
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World Health Organization. Oral Health Survey: Basic Oral Health Survey. 5th ed. Geneva: World Health Organization; 2013.  Back to cited text no. 16
    
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Forshee RA, Anderson PA, Storey ML. Sugar-sweetened beverages and body mass index in children and adolescents: A meta-analysis. Am J Clin Nutr 2008;87:1662-71.  Back to cited text no. 17
    
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Bowen WH. The Stephan curve revisited. Odontology 2013;101:2-8.  Back to cited text no. 18
    
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Smales R, Yip K. Prevention and control of tooth erosion. In: Yip K, Smales R, Kaidonis J, editors. Tooth Erosion: Prevention and Treatment. New Delhi, India: Jaypee Brothers; 2006. p. 36-46.  Back to cited text no. 19
    
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Brand HS, Tjoe Fat GM, Veerman EC. The effects of saliva on the erosive potential of three different wines. Aust Dent J 2009;54:228-32.  Back to cited text no. 20
    
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Steele L, Pacza T, Tennant M. Rural and remote oral health, problems and models for improvement: A Western Australian perspective. Aust J Rural Health 2000;8:22-8.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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