Conclusions

1
Erosive potential of acid containing candies.
Dien Gambon1, Henk S. Brand2 and Arie V. Nieuw
Amerongen2 . 1Bambodino Kinderpraktijk,
Rotterdam and 2Department 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 lt 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 gt 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 lt 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 lt 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.