BUFFERING CAPACITY AS AN INDICATOR OF THE CARIOGENIC POTENTIAL

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1 International Journal of Civil Engineering and Technology (IJCIET) Volume 8, Issue 12, December 2017, pp , Article ID: IJCIET_08_12_108 Available online at ISSN Print: and ISSN Online: IAEME Publication Scopus Indexed BUFFERING CAPACITY AS AN INDICATOR OF THE CARIOGENIC POTENTIAL Dr. Shanthi Kiran Pais Research Scientist, CRD, PRIST University, Thanjavur, Tamilnadu, India Dr. Ronald Menezes Professor, Fr.Muller s Medical College, Mangalore, India Dr. Bakrudeen Ahmed Research Scientist, CRD, PRIST University, Thanjavur, Tamilnadu, India Dr. Mukesh Goel Research Scientist, CRD, PRIST University, Thanjavur, Tamilnadu, India Dr. Ashutosh Das Research Scientist, CRD, PRIST University, Thanjavur, Tamilnadu, India ABSTRACT The "Early Childhood Caries" is a serious oral condition that occurs during the first 3 years of life and is associated with the early intake of sugary foods, drinks, milk and snacks. The carbohydrates present within the infant formula may be utilized by the oral microorganisms, especially the mutans streptococci to form a sticky plaque matrix that enables the microorganisms to adhere to the teeth and produce organic acids which with time can demineralize the teeth 1. Although infant formula forms an important part of an infants diet, nevertheless, information regarding its cariogenecity or buffering capacity property is remarkably sparse 2. Our study included estimation of the buffering capacity of the 14 infants formulas available commercially and 3 control solution namely water, 10% sucrose and bovine whole milk. The conclusion of our results showed that buffer capacity varied among the infant formulas, with some formulas unable to buffer the addition of acid. Further research is needed to more fully understand the relationship of infant formulas to ECC. Key words: Early Childhood Caries, Buffering Capacity, Infant Formulas. Cite this Article: Dr. Shanthi Kiran Pais, Dr. Ronald Menezes, Dr. Bakrudeen Ahmed, Dr. Mukesh Goel, Dr. Ashutosh Das, Buffering Capacity as an Indicator of the Cariogenic Potential. International Journal of Civil Engineering and Technology, 8(12), 2017, pp editor@iaeme.com

2 Buffering Capacity as an Indicator of the Cariogenic Potential 1. INTRODUCTION "You are what you eat! read the top lines of a famous cereal advertisement, which of course is a classic understatement for, not only are we what we eat, but when and how we eat our food too! Being in the new millenium, we have not yet fine-tuned the diet of our children to healthy living and the menace yet persists...it is the "Early Childhood Caries"(ECC). ECC is a serious oral condition that occurs during the first 3 years of life and is associated with the early intake of sugary foods, drinks and snacks While infant formulas may support acid production in dental plaque, the buffering systems present within the oral cavity, primarily the salivary buffers and of the food consumed, are important in controlling the ph of the oral fluids bathing the teeth. In ECC condition, the salivary buffering effect is essentially diminished. This is due to the reduced salivary flow seen at the night time caused by the alterations in the circadian system". With children forming 30-42% of our nation's population and 80% of this child population suffering from the scourge of dental caries, prevention seems the only solution. The following study will therefore go a long way in creating awareness of the possible role of the infant formula in the development of ECC in our country. 2. AIM AND OBJECTIVE To measure the buffering capacity of the infant formula (in vitro) 3. MATERIALS Test Samples 14 infant milk formulas were tested. They were divided into 2 categories Regular infant formulas, (recommended for normal healthy infants) Special infant formulas, (recommended for infants with specific dietary restrictions) Table 1 The brands of the milk formulations used for the study Regular Infant Formula Lactogen Lactogen Lactodex Latcodex Dexolac Dexolac Amulspray Special Infant Formulas Lactonil - Lactose free formula Nusobee - Soya based, lactose free formula Simyl - MCT - Lactose and Sucrose free formula Prosoyal - Soya based, Lactose and Sucrose free formula Table 2 Special Infant Formulas Medical conditions wherein used Lactose intolerance Lactose intolerance Lactose and Sucrose into clearance Lactose and sucrose intolerance editor@iaeme.com

3 Dr. Shanthi Kiran Pais, Dr. Ronald Menezes, Dr. Bakrudeen Ahmed, Dr. Mukesh Goel, Dr. Ashutosh Das Lactodex - LBW - Whey protein formula Special care - Whey Protein containing lactose free formula Lactodex - Low fat - Low milk fat formula Low birth weight Low birth weight Fat intolerance 3.1. Control Solutions Water 10% Sucrose solution Bovine whole milk 3.2. Materials used for measuring the Buffering Capacity of the Infant Formulas Buffering tablets of ph 4, ph 7, ph 9.2 Conc. HCl solution Deionised water Micropipette ph meter Refrigerator Table 3 Composition of the Infant Formulas and Control Solutions No. Test Samples Control Solutions Carbohydrate Protein Fat Iron Calcium Phosphorus 1 (0) (0) (0) (0) (*) (*) 1. Water Sucrose Bovine Milk Infant Formulas 1. Lactogen Lactogen Lactodex Lactodex Dexolac Dexolac Amul spray Special Infant Formulas 8. Lactonil Nusobee Simyl - MCT Prosoyal Lactodex LBW Special care Lactodex-Low fat (0) expressed as mg / ml (*) expressed as g / ml editor@iaeme.com

4 Buffering Capacity as an Indicator of the Cariogenic Potential 3.3. Methods Preparation of the Infant Formulas and Control Solutions The test sample was prepared by mixing, 7 scoops of the milk powder in deionised water and volume made up to 210 ml. (according to the manufacturer's direction) 10 % W/v sucrose control 3 was made by dissolving 4 gm of sucrose in deionised water to a final volume of 40 ml. Bovine milk (Cow's whole milk) was purchased fresh daily for use Buffering Capacity of the Infant Formulas Each test solution was tested in two assays. The ph of each infant formula and control solution was measured and denoted as...d (ph). 3 ml of each infant formula or control solution of the first assay was mixed with 3 ml of M HC1 and denoted as...(a). 3 ml of each infant formula or control solution of the second assay was mixed with 3 ml of 0.01 M HC1 and denoted as...(b) Concentrated HC1 was added, to both A and B, to bring the ph fall by 2 units. The amount of concentrated HC1 added to A was measured and denoted as d (x,). The amount of concentrated HC1 added to B was measured and denoted as d (x 2 ). The buffering capacity 157 ' d9 was calculated as follows. Table 4 Procedure Protocol to Measure the Buffering Capacity For each Infant formula and control solutions, ph was recorded 3 ml of this was mixed with 3ml of 0.01 M HC1 and M HC1 ph was recorded respectively Conc. HC1 was added to bring the ph fall by 2 units Amount of Conc. HCl added was measured Formula to calculate the buffering capacity was calculated as follows Buffering Capacity (B) d (ph) d(x) B= d(x) x 100 d(ph) Figure 1 Portable standard digital ph meter with glass micro combination electrode editor@iaeme.com

5 Dr. Shanthi Kiran Pais, Dr. Ronald Menezes, Dr. Bakrudeen Ahmed, Dr. Mukesh Goel, Dr. Ashutosh Das 4. STATISTICAL ANALYSIS Statistical analysis was done in the PC statistical package SPSS, 6.0 version. The graphical representation of buffering capacity can be observed in Fig Observations Test Samples Table 5 ph Response of the Infant formulas to the addition of HCL. ph of the Test solution (ph) d 3 ml of Test solution + 3 ml of M HC1 Cone. HCI (ml) required to bring ph fall by 2 units d(x 1 ) 3 ml of Test solution + 3 ml of 0.01 M HCI Cone, of HCI (ml) required to bring ph fall by 2 units d (x 2 ) Water Sucrose Bovine milk Lactogen Lactogen Lactodex Lactodex Dexolac Dexolac Amulspray Lactonil Nusobee Simyl MCT Prosoyal Lactodex (LBW) Special care Lactodex - Low Fat 5. CALCULATIONS Buffering capacity Table 6 Buffering capacity values of the infant formulas Test Samples Buffering Capacity B= dx/d (ph) x100 Water 0.05% Sucrose 0.08% Bovine Whole milk 23.88% Lactogen %) Lactogen % Lactodex % Lactodex % Dexolac % Dexolac % Amulspray % Lactonil 9.21% Nusobee 18.56% Simyl MCT 15.29% Prosoyal 15.25% Lactodex (LBW) 9.15% Special care 19.17% Lactodex -Low Fat 18.03% editor@iaeme.com

6 Water Sucrose Bovine Whole milk Lactogen 1 Lactogen 2 Lactodex 1 Lactodex 2 Dexolac 1 Dexolac 2 Amulspray Lactonil Nusobee Simyl MCT Prosoyal Lactodex (LBW) Special care Lactodex -Low Fat 6. RESULTS Buffering Capacity as an Indicator of the Cariogenic Potential Buffering capacity of Infant formulas varied from 20.13% for Lactodex - 2 to 9.15% for Lactodex LBW. When the infant formulas were compared with the control solutions, Bovine whole milk showed the greatest buffering capacity i. e 23.88%. The graphical representation of the buffering capacity of the infant formulas can be observed in the graph Table 7 The Infant Formulas are tabulated according to their Caries Inducing Potential Greatest caries inducing potential Least caries inducing potential Buffering Capacity Lactodex LBW Lactonil Dexolac -1 Amulspray Lactogen -1 Prosoyal Simyl MCT Lactodex -1 Lactodex Low Fat Lactogen - 2 Nusobee Special Care Dexolac - 2 Lactodex Controls Least Cariogenic Infant Formula Infant Formulas Most Cariogenic Infant Formula Figure 2 Buffering capacity of infant formula and control solutions editor@iaeme.com

7 Dr. Shanthi Kiran Pais, Dr. Ronald Menezes, Dr. Bakrudeen Ahmed, Dr. Mukesh Goel, Dr. Ashutosh Das 7. DISCUSSION People all over the world, use a wide variety of infant formulas to nourish the infants. These formulas vary in their composition, particularly in the source of protein, carbohydrate and levels of iron. Recent studies have demonstrated the high caries inducing potential of infant formulas 4,5. This indicates a need for awareness of the possible role of the infant formulas in the etiology ECC. This study was carried out, keeping in view the upward trend of dental caries pattern in infants and children in our country. Despite the success of preventive dentistry, there are a growing number of reports of a decline in the quality of young children's teeth 6.7. One frequently mentioned cause, is the use of sweetened fluids in the baby bottle 8. It was Dr. Elias Pass in 1962, who was the first to give a comprehensive description of 'Nursing caries' in infants, the; cause which he attributed to the stagnating milk around the teeth 11,12. Bernick in ,10 reported that prolonged bottle feeding with milk can produce rampant caries 12,13. Buffering capacity is the ability of a solution to resist a change in ph when acid or base is added 14. The ph of a buffer system is based on the equilibrium between the bound hydrogen ions and the free hydrogen ions. To express the buffering capacity of solutions, Van Slyke introduced "Buffer value" or B, in Buffer value is the reciprocal of the slope of the ph neutralization plaque curve, and is useful to demonstrate the rapidity at which the ph of a solution will drop with the addition of acid. After mixing with an equal volume of 0.01 M HC1 and M HCL separately the test solution ph dropped significantly for eight of the infant formulas, with one of the infant formula allowing the ph to fall below the critical ph. Pamela Erickson et al 7 in 1998 reported that, among the 26 formulas tested, 14 formulas allowed the ph to fall below critical ph drop significantly. Furthermore, by measuring the number of moles of acid required to reduce the solution ph by two units, we were able to calculate the buffer value B. The greater the B value (i. e more acid required to drop the ph) means the solution is more resistant to the alterations in ph. While infant formulas may support acid production in dental plaque, the buffering systems present within the oral cavity, primarily the salivary buffers, are important in controlling the ph of the oral fluids bathing the teeth. However in ECC condition, the salivary buffering effect is essentially diminished. This is due to the manner in which the infant sucks the nipple, and reduced salivary flow seen at the night time feedings caused by the alterations in the circadian system". In this study, we observed significant differences in the buffering capacity between the infant formulas. In our findings it was recorded that Nusobee had a very high buffering capacity while the fall in ph (post rinse ph) was found to be maximum. This calls for further research on the effect of the various constituents of the infant formula on its buffering capacity and also their role when consumed orally in presence of saliva. Pamela Erickson et al 15 in 1998 reported that out of the twenty six infant formulas tested, they observed that eight of the formulas did not buffer well, with a buffer value below editor@iaeme.com

8 Buffering Capacity as an Indicator of the Cariogenic Potential An assessment of the composition of the infant formulas is important to understand the reduced buffering capacity in comparison to the bovine milk. The bovine whole milk demonstrated the greatest buffering capacity, which may explain why the previous studies 16 have failed to implicate bovine milk in the development of dental caries. While the factors associated with the infant formula buffering capacity are unknown it is possible that specific proteins such as Caesin may play a role. The results of our study showed that infant formulas containing a higher concentration of proteins (i.e. Nusobee. Lactodex - 2 and Dexolac - 2) had a higher buffering capacity. Phosphopeptides from casein have also been suggested to play a role in the buffering capacity. Further research is now necessary to explore the possible relationship between casein and the infant formula buffering capabilities. REFERENCES [1] Curzon MEJ' Pollard M. A : Nursing bottle caries: The extent and nature of the problem presented at the workshop: Carbohydrates in infant nutrition and dental health, J Dent Res. 1994, 30 : [2] Bowen W. H.: Biological mechanisms of early childhood caries. Community Dent Oral Epidemiol. 1998; 26: Suppl: Munksgaard. [3] Imfeld T : Cariogenecity Tests. Adv. Dent Res. 1994, Jul; 8(2): [4] Bowen W. H, Pearson K. S, Pedro L, Miguel J. C, Annie Y.S: Assessing the cariogenic potential of some infant formulas, milk and sugar solutions. Jr of Am Dent Assoc 1997, 128 (7); [5] Pamela R. Erickson, Kelly L. McClintock, Nicole Green, Jamilla La Fleur.: Estimation of the caries related risk associated with infant formulas. Pediatr Dent, 1998; 20 (7); [6] WeissM. E., Bibby B. G.:Some protein effects on enamel solubility. Arch Oral Biol , II; [7] Bernick S,What The pediatricians should know about childrens teeth. Clin pedi : atrics. 1971, 10: [8] Ripa LW: Nursing caries: A comprehensive review. Pediatric Dent 1988, 10; [9] Patel P. R. and Brown W. E. : Thermodynamic solubility product of human tooth enamel- Powdered sample. J. Dent. Res. July-August 1975; 54 (4) : [10] Richardson B.D, Cleaton-Jones P.K : Nursing bottle caries. Pediatrics 1977; 60 (5) : [11] Neubrun E. Criteria of cariogenecity for labelling foods. J AmDent Assoc. 1982; 105 (4); [12] Schatele C. F and Jensen M. E. Comparison of methods for monitoring changes in the ph of human dental plaque. J-Dent-Res 1982; 61 (10): [13] Bibby B G, Mundorff S A, Huang C T. Enamel demineralization tests with some standard foods and candies. J Dent Res 1983; 62 (8): [14] Thomas M Devlin: Text book of Biochemistry with clinical correlation. 2 nd edn, 1991, John Wiley and Sons. New York. [15] Pamela R. Erickson, Kelly L. McClintock, Nicole Green, Jamilla La Fleur.: Estimation of the caries related risk associated with infant formulas. Pediatr Dent, 1998; 20 (7); [16] Epwell W.T., and Gidley J.A.F.: Atomic Absorption Spectrophotometry nd edition, Pergamon Press, Oxford. [17] Garima Jain, Dr. Vikram Bisen, Female Literacy & Its Relevance With Maternal And Infant Mortality Rates, International Journal of Management, 3 (2), 2012, pp editor@iaeme.com

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