Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : ZC09 - ZC13 Full Version

Efficacy of Probiotic and Herbal Chewing Gums on Salivary pH in 6-11 Years Age Group Children: A Randomised Clinical Trial


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/58595.17066
Neeti Tatiya, Kirti Pattanshetti, Shreya Lunia, Sachin Malagi, Saif Ali, Dipaneeta Sarkar

1. Postgraduate Student, Department of Pedodontics and Preventive Dentistry, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India. 2. Head, Department of Pedodontics and Preventive Dentistry, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India. 3. Reader, Department of Pedodontics and Preventive Dentistry, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India. 4. Head, Department of Periodontology, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India. 5. Postgraduate Student, Department of Pedodontics and Preventive Dentistry, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India. 6. Postgraduate Student, Department of Pedodontics and Preventive Dentistry, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India.

Correspondence Address :
Dr. Kirti Pattanshetti,
Anjora, Drug, Chhattisgarh, India.
E-mail: Drkirthipattanshettimalgi@gmail.com

Abstract

Introduction: Saliva is a crucial diagnostic tool to evaluate oral health. Chewing sugar-free gum is an effective method to increase salivary flow and can also be employed a medium for the administration of medicinal ingredients.

Aim: To evaluate and compare the effect of chewing xylitol, herbal and probiotic chewing gums on salivary acidogenicity levels.

Materials and Methods: A single centre, randomised, double-blind, multiple arm parallel clinical trial was conducted on 60 children aged between 6-11 years. Baseline salivary pH was recorded with the pH meter and then the participants were asked to consume chocolate and salivary pH was recorded at an interval of 5, 30, and 60 minutes. Then children were randomly allocated to Group A-Xylitol chewing gum (control group, n=20), Group B-Herbal chewing gum (n=20), and Group C-Probiotic chewing gum (n=20) and instructed to chew gum according to their assigned group and salivary pH was again recorded at an interval of 5, 30, and 60 minutes. The change in salivary pH was evaluated using one-way Analysis of Variance (ANOVA) and Post-hoc Bonferroni’s test.

Results: The mean age of the study population was 9.23±1.38 years. Statistically significant (p<0.001) increase in pH was recorded post consumption of probiotic, xylitol and herbal chewing gums and the mean salivary pH values recorded at 60 minutes were 7.20±0.21, 7.01±0.23 and 6.43±0.22, respectively.

Conclusion: The observations of the study showed that xylitol, herbal and probiotic chewing gums reversed the fall in salivary pH, after an acidogenic challenge with probiotic being better among the three groups.

Keywords

Dental caries, Oral health, Preventive dentistry, Remineralising agent

Dental caries stands out as a leading chronic lifestyle disease. The interaction between substrate and oral microorganisms in the microenvironment provided by the host is the cause of the disease. This multifactorial nature of the disease complicates its preventive strategies in all age groups (1). According to Wincour E et al., (2001), among the preadolescent and adolescent groups chewing usage is a popular practise. It is a superior caries preventative method in children (2). Xylitol has been actively used as a component of gums owing to its caries preventing actions like reduction in overall plaque volume and reduction in oral bacterial load (3). Comparable results were reported with the use of herbal mastic gums. The anti-inflammatory and antioxidant properties of this gum are primarily responsible for subsiding gum inflammations caused by plaque accumulation and thereby secondarily reduce the cariogenic activity (4). A recent modification that comprises the inclusion of probiotics in chewing gums has shown results comparable and even superior to xylitol-based chewing gums. Probiotics are known to alter the microenvironment in which the substrate breakdown by oral bacteria occurs. This helps in limiting cell to cell adhesion and thereafter plaque accumulation on the tooth surface (5). Regulatory agencies such as the World Dental Federation (2015), the United Kingdom Oral Health Foundation (2018), and numerous other national dental organisations throughout the world acknowledge and endorse the oral health benefits of chewing sugar-free gums (6). The literature (7),(8) on mastic gum (Pistacia Lentiscus Linn tree) and probiotic gum (Bacillus coagulans) are scarce.

Since there are no similar studies carried out before to assess the effect of Bacillus coagulans and mastic chewing gums on salivary pH levels in children. Hence, the present study was conducted with aim to assess and compare the effects of xylitol, herbal, and probiotic-based commercially available chewing gums on salivary acidogenicity levels in children.

Material and Methods

This was a single centre double-blind randomised multiple arm parallel clinical trial conducted on 60 subjects of both genders aged 6-11 years from Primary and Higher Secondary Schools of Raipur city, Chhattisgarh, India from 29th October 2021 to 13th December 2021.

The research protocol was approved by the Ethical Committee of Maitri College of Dentistry and Research Centre (MCDRC/2021/OCT/580). The present research was conducted in accordance with the Declaration of Helsinki as revised in 2013. The trial was registered with the Primary Registries in the World Health Organisation (WHO) Registry Network (CTRI/2021/10/037683). The consent was obtained from school authorities prior to the commencement of the study.

Inclusion criteria:

• Children within the age range of 6-11 years.
• Children with dental caries score of dmft/DMFT <3.
• Children with no history of medication in the past three months.
• Children willing to participate.

Exclusion criteria:

• Medically compromised children
• Children with history of systemic allergies and diseases.
• Children using any prosthetic/orthodontic appliance.

To limit the bias in the present study, the age, dietary habits, oral hygiene measures and time of the day for the collection of all the samples from participants were standardised.

Sample size calculation: G*Power (Version 3.1.9.2, Released in 2014, Kiel University, Germany) was used to estimate the sample size. Sample size estimation was done at 0.05 significance level and at 80% power of the study, with an effect size of 0.50 (9), the sample size obtained was 20 in each group.

Blinding, Randomisation and Allocation Concealment

Enrolled participants in all three arms and study coordinators were blinded to study group. All three chewing gums were provided as identically labelled white packing precoded by the study coordinators intermixed in the box (Table/Fig 1).

Saliva Collection

1. Unstimulated saliva sample: The baseline pH value was determined by taking unstimulated saliva samples from all 60 subjects. The children were refrained from intake of any food or beverage (water exempted) 30 minutes prior the saliva collection. The baseline pH of saliva was measured after collecting 5 mL of unstimulated saliva from each subject in a sterile plastic container.

2. Stimulated saliva sample post acidogenic challenge: After eating a chocolate (Cadbury 5-Star Bar- 16 g), the children’s saliva was collected at 5, 30, 60 minutes intervals to determine the salivary pH.

3. Stimulated saliva sample post chewing gum consumption: Then participants were thereafter, divided into the following three groups:

• Group A (n=20): Xylitol chewing gum: Trident Bubble Gum (control)
• Group B (n=20): Herbal chewing gum: Herbaveda-Gum Mastic
• Group C (n=20): Probiotic chewing gum: BonAyu Mouth Dissolving Strips

The children were asked to chew one pellet of chewing gum of their allocated group each respectively for 15 minutes. After spitting out the chewing gum and properly expectorating the children’s saliva, sample was collected at 5, 30, 60 minutes intervals to determine the salivary pH.

Estimation of Salivary pH

Hannah digital pH metre (HI98127 pHep®4 pH/Temperature Tester with 0.1 pH resolution) was used to record the pH of both unstimulated and stimulated saliva. The pH meter’s bulb was dipped in a plastic container containing saliva to record the salivary pH, after which the pH values were displayed digitally on the pH meter’s body. The outcome variables are change in salivary pH on consumption of chewing gum post acidogenic challenge.

Statistical Analysis

Statistical Package for Social Science software (SPSS) (Version 24.0, Chicago, IL) was used for data analysis. Intragroup comparison of the means of salivary pH levels for all the groups were done using Repeated measures ANOVA and intergroup comparison was done using Post-hoc Bonferroni’s test. The level of significance was set at p<0.05.

Results

A total of 60 children were enrolled with mean age of group A, B and C as 9.80±2.46, 9.40±2.39 and 8.90±2.32 years, respectively. In our study male participants in group A, B and C were 5 (25%), 18 (90%), 16 (80%) and females were 15 (75%), 2 (10%), 4 (20%) respectively. The mean dmft of group A, B and C was found to be 2.29±1.1, 2.41±1.4 and 2.31±0.8, respectively but the difference of dmft among three groups were statistically insignificant.

The mean pH of unstimulated saliva for group A, B, and C was 7.29±0.21,7.03±0.24 and 7.11±0.18, respectively (Table/Fig 2). There was significant reduction in the salivary pH levels after consumption of chocolate in all the groups at 60 minutes (p=0.001), (Table/Fig 3). On comparison of mean pH of the chewing gum stimulated saliva in three groups at 30 minutes, the mean pH was highest in group C followed by group B then group A (Table/Fig 4).

On intergroup comparison, at 5 minutes the mean salivary pH scores between group A and group B showed no significant difference (p-value=1.00), whereas mean salivary pH values were significantly greater in group C compared to group A and B (p-values=0.028, 0.028, respectively). Group C showed significant increase in mean salivary pH values compared to group A and B (p-values-0.001,0.001 respectively) and insignificant difference was observed between group A and group B (p-value=1.00) at 30 minutes. There was significant increase in the mean salivary pH scores in between the groups at the end of 60 minutes (Table/Fig 5). Intragroup comparison showed that the mean difference in pH scores was not significant in group A and group B from 5 minutes to 30 minutes, whereas significant in group C (p-0.078,0.06 and 0.001, respectively). Mean difference in pH scores was significant in group A and group C and not significant in group B (p-value=0.001, 0.001 and 0.055, respectively) from 30 minutes to 60 minutes. The mean difference in group A and C was significant (p-value=0.0001) and less significant in group B (p-value=0.001) from 5 to 60 minutes compared to other groups (Table/Fig 6). Salivary pH change from baseline to post consumption of chewing is demonstrated using (Table/Fig 7).

Discussion

In present study, among all the chewing gums given post acidogenic challenge, probiotic chewing was found to be most effective followed by xylitol chewing gum and herbal chewing gum.

Children aged 6-11 years belonged to concrete operational period, hence, they understand the concept of rules and follow instructions properly (10). Normal salivary pH is in the range of 6.2-7.6 (11). In the present study, pH ranged between 6.7-7.6. Similar values for unstimulated pH were noted by Murthy GS et al., (2020) (11). It was important to record the unstimulated pH for standardisation of participants and so that the later drop and rise in stimulated salivary pH could be compared to it. According to study, done by Dawes C (1969), the concentration of ions in the saliva keeps changing with time (12). Hence, in the present study, saliva samples were taken at three different time intervals to record the variations in the salivary pH values after acidogenic challenge and consumption of chewing gums.

Acidogenic challenge in the form of chocolate was given to the participants prior to the consumption of chewing gums because it is known to produce acidogenic response in the saliva and plaque and demonstrate children regarding these harmful effects of chocolate. A sudden drop in salivary pH of similar pattern was clearly noted in all the groups. This is similar to the Stephan’s curve which demonstrates the rapid fall in pH due to acid production by plaque bacteria on consumption of sugar (13). In the present study, the pH noted at 30 minutes in all the subjects showed a fall beyond the critical pH (5.5), below which the enamel starts to demineralise (14). However, recovery was made in the next 30 minutes when the pH, still lower than baseline and that after five minutes of chocolate consumption and is comparable with study conducted by Murthy GS et al., (2020) (11). This pattern was again by Stephan’s curve which elaborates that the buffering action of saliva gradually starts neutralising the acids (15),(16).

Chewing gum has been shown to increase salivary flow and pH thereby, lowering the incidence of dental caries (17). Xylitol is a naturally occurring 5-carbon sugar polyol that has been shown to reduce the incidence of dental caries by increasing salivary flow and pH, decreasing plaque formation and bacterial adherence (antimicrobial), inhibiting enamel demineralisation (reduces acid production), and having a direct inhibitory effect on MS (18),(19). According to a recent systematic review, the effect of xylitol on caries incidence in children was small, with very low-quality evidence from randomised controlled trials indicating that xylitol’s protective efficacy is questionable (7). As a result, the authors used herbal and probiotic chewing gums in this investigation to compare their efficacy with xylitol on salivary pH levels in children.

The present study used Herbaveda Gum Matic which consists of terpinen-4-ol and a-terpineol obtained from the leaves and stem of Pistacia Lentiscus Linn tree (8). Aksoy A et al., (2006) (20) and Biria M et al., (2009) (8) reported that chewing mastic gum has been shown to reduce the MS count in saliva and enhance the pace of remineralisation of artificial carious lesions.

Probiotics play a pivotal role in creating better oral health by interfering with formation of biofilm as they compete with microbes for existing substances and produce substances that hinder the growth of microbes responsible in deteriorating oral hygiene (21). Probiotic chewing gum used in the present study was BonAyu Probiotics Mouth Dissolving Strips. Each serving contains spore forming 1.0 billlion Colony-forming Unit (CFU) Bacillus coagulans (Lactobacillus sporogenes). Unlike the vegetative lactobacillus and Bifidobacterium spp. which cannot sustain harsh processes and also require refrigeration, the B. coagulans being a spore-forming probiotic strain sustains the harsh manufacturing procedures and can be easily incorporated in any dosage form without loss of viability (22),(23).

Post acidogenic challenge, children in all three groups demonstrated a significant increase in salivary pH, five minutes after chewing gum consumption, followed by a steady increase at 30 and 60 minutes eventually reaching neutral salivary pH, though the pH values of saliva were still below than the baseline values (unstimulated saliva) except for children in Group C (probiotic chewing gum). This is in accordance with studies conducted by Kumar S et al., (2013) (24), Hegde RJ and Thakkar JB (2017) (25), and Shinde MR and Winnier J et al., (2020) (26) after chewing xylitol gums. A significant increase in the salivary pH levels in children, who consumed probiotic chewing gum was noted compared to xylitol and herbal chewing gum groups in the present study. Probiotics provides a suitable environment for tooth remineralisation by counteracting acidic conditions in the mouth and inhibiting the growth of cariogenic bacteria and increasing the salivary pH (27),(28). Probiotics inhibit the growth of carcinogenic bacteria by production of bactriocin and also buffers acidic pH of oral cavity. Bacteriocins inhibits the growth of bacteria by penetrating the surface of pathogenic bacteria, that leads to leakage of amino acids and inorganic salts from its cell thereby, killing the bacteria (29). Similar studies to present research on efficacy of chewing gums are discussed in the (Table/Fig 8) (8),(20),(21),(23),(24),(25),(26),(30),(31),(32),(33).

Limitation(s)

The fact that, the authors did not standardise all of the participants’ oral hygiene status could be a source of bias in the present study. This may have been avoided, if all of the participants had received oral prophylaxis. Studies with larger sample size and with a prolonged follow-up period need to be conducted in order to generalise results of present study.

Conclusion

Chewing gum has been considered as a medium for the delivery of therapeutic ingredients and can be used as an adjuvant in the prevention of caries. Probiotics provides a suitable environment for tooth remineralisation by neutralising acidic conditions in the mouth and inhibiting the growth of cariogenic bacteria and increasing the salivary pH. Probiotic chewing gums produced the best outcomes, followed by xylitol and lastly herbal chewing gums. Probiotic chewing gums are easy, economic and efficient method of caries prevention in children.

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DOI and Others

DOI: 10.7860/JCDR/2022/58595.17066

Date of Submission: Jun 21, 2022
Date of Peer Review: Jul 23, 2022
Date of Acceptance: Aug 18, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 24, 2022
• Manual Googling: Aug 12, 2022
• iThenticate Software: Aug 17, 2022 (15%)

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