Citation Information :
Sharma W, Bhola M, Bajaj N, Brar GS. Comparative Evaluation of Changes in Salivary pH and Streptococcus mutans Count in Saliva by Natural Sugar Substitutes: An In Vivo Study. Int J Clin Pediatr Dent 2023; 16 (5):728-733.
Aim: The purpose of this study was to compare the effect of natural sugar substitutes—stevia, jaggery, and honey on salivary pH and Streptococcus mutans (S. mutans) count in saliva.
Materials and methods: Children aged between 7 and 12 years with no active carious lesion were selected. A total of 80 subjects were randomly selected and divided into three experimental groups and one control group, with 20 subjects in each group. Prior to rinsing with the respective solutions, the baseline pH and S. mutans count were evaluated for each individual. All solutions were freshly prepared whenever required. After rinsing with the respective solutions, saliva samples were collected to evaluate pH and S. mutans count. The pH was analyzed at different time intervals, that is, 0 (immediately after rinsing), 15, and 30 minutes. The S. mutans count was analyzed after 30 minutes of rinsing with the respective solutions.
Results: The results were tabulated and statistically analyzed using one-way analysis of variance (ANOVA) and post hoc tests. The results depicted that group I (stevia) showed a maximum increase in salivary pH, followed by group III (honey) and group III (jaggery) at different time intervals (0, 15, and 30 minutes). The maximum number of subjects who had shown a decrease in S. mutans count were from group III (honey), followed by group I (stevia), and group II (jaggery) after 30 minutes of rinsing with the respective solutions when compared to baseline S. mutans count.
Clinical significance: It is a universally known fact that dental caries is a multifactorial disease process, one of the key factors of which is the consumption of sugar. Of all the fermentable carbohydrates, sucrose is considered the archcriminal in the carious process. Hence, this advocates the need for developing suitable sugar substitutes that help in controlling dental caries. An ideal sugar substitute should not only minimize the risk of dental caries but also should have nutritional benefits.
Conclusion: Natural sugar substitutes (stevia, jaggery, and honey) have the ability to reduce caries risk in children.
Newbrun E. Dietary carbohydrates: their role in cariogenicity. Med Clin North Am 1979;63(5):1069–1086. DOI: 10.1016/s0025-7125(16)31660-1
Janakiram C, Antony B, Joseph J, et al. Prevalence of dental caries in India among the WHO index age groups: a meta-analysis. J Clin Diag Res 2018;12(8): ZE08–ZE13. DOI: 10.7860/JCDR/2018/32669.11956
Nikiforuk G. Understanding Dental Caries: Etiology and Mechanisms, Basic and Clinical Aspects. Basel: Karger; 1985.
Zero DT. Sugars–the arch criminal? Caries research 2004;38(3): 277–285. DOI: 10.1159/000077767
Jayadevan A, Chakravarthy D, SN P, et al. Comparative evaluation of cariogenic potential of natural and unrefined sweeteners on Streptococcus mutans biofilm formation and enamel demineralization-in vitro study. IOSR J Dent Med Sci(IOSR-JDMS) 2019;18(3):63–70. DOI: 10.9790/0853-1803086370
Newbrun E. Cariology, 3rd edition. 1975.
Giacaman RA, Campos P, Munoz-Sandoval C, et al. Cariogenic potential of commercial sweeteners in an experimental biofilm caries model on enamel. Arch Oral Biol 2013;58(9):1116–1122. DOI: 10.1016/j.archoralbio.2013.03.005
Das S, Das AK, Murphy RA, et al. Evaluation of the cariogenic potential of the intense natural sweeteners stevioside and rebaudioside. A Caries Res 1992;26(5):363–366. DOI: 10.1159/000261469
Nayaka MAH, Sathisha UV, Manohar MP, et al. Cytoprotective and antioxidant activity studies of jaggery sugar. Food chemistry 2009;115(1):113–118. DOI: 10.1016/j.foodchem.2008.11.067
Takara K, Ushijima K, Wada K, et al. Phenolic compounds from sugarcane molasses possessing antibacterial activity against cariogenic bacteria. J Oleo Sci 2007;56(11):611–614. DOI: 10.5650/jos.56.611
Ahmadi-Motamayel F, Rezaei-Soufi L, Kiani L, et al. Effects of honey, glucose, and fructose on the enamel demineralization depth. J Dent Sci 2013;8(2):147–150. DOI: 10.1016/j.jds.2012.02.004
Abdelmegid F, Al-Agamy M, Alwohaibi A, et al. Effect of honey and green tea solutions on Streptococcus mutans. J Clin Pediatr Dent 2015;39(5):435–441. DOI: 10.17796/1053-4628-39.5.435
Yadav N, Garla BK, Reddy VK, et al. Antimicrobial effect of honey on Streptococcus mutans of dental plaque. J Oral Health Comm Dent 2014;8(2):72–75. DOI: 10.5005/johcd-8-2-72
Brambilla E, Cagetti MG, Ionescu A, et al. An in vitro and in vivo comparison of the effect of Stevia rebaudiana extracts on different caries-related variables: a randomized controlled trial pilot study. Caries Res 2014;48(1):19–23. DOI: 10.1159/000351650
Mahtani AA, Jayashri P. Comparing the effect of natural and synthetic sugar substitutes on salivary pH–a double-blinded randomized controlled study. Drug Invent Today 2019;11(8):1745–1749.
Ali A, Farooq L, Mahmood A, et al. Comparative evaluation of salivary pH with honey and vinegar mouth rinse in diabetic and healthy adults. JPRI 2021;33(26B):54–59. DOI: 10.9734/jpri/2021/v33i26B31482
Razdan TR, Singh VP, Rav AB, et al. Comparative evaluation of enamel demineralization depth by five sweeteners: an in vitro study. J Int Oral Health 2016;8(6):709. DOI: 10.2047/jioh-08-06-13
Menezes H, Bacci Jr M, Oliveira SD, et al. Antibacterial properties of propolis and products containing propolis from Brazil. Apidologie 1997;28(2):71–76. DOI: 10.1051/apido:19970203
Siow PC, Tan WS, Henry CJ. Impact of isotonic beverage on the hydration status of healthy Chinese adults in air-conditioned environment. Nutrients 2017;9(3):242. DOI: 10.3390/nu9030242
Abou Assi R, Ng TF, Tang JR, et al. Statistical analysis of green laboratory practice survey: conservation on non-distilled water from distillation process. Water 2021;13(15):2018. DOI: 10.3390/w13152018
