Download 6.1 need for the study - Rajiv Gandhi University of Health Sciences

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES , BANGALORE ,
KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
NAME OF THE CANDIDATE
AND ADDRESS
Dr. SNEHALIKA MORE
POST GRADUATE STUDENT
DEPARTMENT OF PEDODONTICS &
PREVENTIVE DENTISTRY ,
#20, YESHWANTPUR SUBURB,
TUMKUR ROAD,
K.L.E SOCIETY’S INSTITUTE OF DENTAL
SCIENCES,
BANGALORE – 560022.
2
NAME OF THE INSTITUTION
K.L.E.SOCIETY’S INSTITUTE OF DENTAL
SCIENCES, BANGALORE – 22.
3
COURSE OF STUDY AND
SUBJECT
MASTER OF DENTAL SURGERY –
PEDODONTICS AND PREVENTIVE
DENTISTRY
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DATE OF ADMISSION TO
COURSE
10th JUNE 2013
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TITLE OF THE TOPIC
CORRELATION BETWEEN FOOD
RETENTION AND ORAL CARBOHYDRATE
CLEARANCE RATE IN CHILDREN
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6 .BRIEF RESUME OF THE INTENDED WORK :
6.1 NEED FOR THE STUDY :
There has been substantial increase in consumption of refined
foods,carbonated beverages and fruit drinks which are high in fermentable carbohydrates.1
It is widely accepted that all foods containing "fermentable carbohydrates"
have the potential to contribute to caries formation. Fermentable carbohydrates are present
in most starches and all sugars, including those that occur naturally in foods and those
added in processed foods.2
Food particles that become trapped on the surfaces of the teeth serve as
reservoirs of fermentable carbohydrates, thereby permitting plaque microorganisms to
continue to produce acids and prolong the cariogenic challenge to the teeth which
eventually contribute to the development and progression of dental caries.3
Several studies have looked at oral clearance and retention in different
individuals but the clearance pattern of children is different than those of adults. Also the
food was retained in the mouth for longer periods in the children. Thus while attempting to
assess the food’s cariogenicity,it is necessary to measure the length of time that the food is
retained in the mouth.4
The aim of the present study is to estimate the retentive capacity and salivary
carbohydrate clearance rate of various commercially available test foods popularly
consumed by the child on day to day basis.
6.2 REVIEW OF LITERATURE :
•
Assessment of the oral clearance of various foodstuffs(glucose rinse,glucose tablet
and biscuits) in children of different ages was done in comparison with adults.The
study concluded that young children(3yrs-7yrs) have both slower salivary sugar
clearance and larger variation in clearance among various foodstuffs than older
children and adults.5
2
•
A study was conducted on popular cereal based foods and fruits and total
carbohydrate content of salivary expectorants following their consumption(apple,
orange,
banana,
pasta,
wholemeal
bread,
rice,
Alpen,white
bread,branflakes,cornflakes,Weetabix).The results showed that greater percentage
of carbohydrate was retained following consumption of rice and breads.4
•
The occurrence and distribution of mutans streptococci in child population in
Africa, Europe, and North America was compared in the study.They concluded that
the differences in caries experience in children of the three continents cannot be
explained by the prevailing mutans streptococci species but instead should be
attributed to differences in the cariogenicity of the various diets.6
•
A study was done to measure sugars,starches and metabolic acids in retained food
particles.The results showed that high sucrose foods(caramel,milk
chochlate,chochlate-caramel bars) rapidly cleared from the teeth while high starch
foods(oatmeal cookies,potato chips) retained for upto 20 minutes.7
•
One study conducted to rank several reference foods according to their plaque pH
response and carbohydrate retention(apple drink caramel chocolate, cookie,
skimmed milk powder, snack cracker, and wheat flake) showed that apple-flavored
fruit drink and chocolate were the most acidogenic foods and skimmed milk
powder the least acidogenic and caramel followed by wheatflake was the most
retentive and skimmed milk the least retentive.8
•
Evaluation of the association between caries prevalence and intake of
confectionery(mainly sugars), and sweetened baked goods(mixture of starch and
sugars) in one study concluded that high intake of foods containing a mixture of
starch and sugars was associated with an increased prevalence of dental caries in
children.9
•
The relationships among the pH response of coronal plaque-sugar and the caries
status of the tooth surface and the relationship of plaque-flora and caries was
examined in the study. The results indicated that increasing subject caries status is
characterized by increasing plaque levels of highly-acid-tolerant, acidogenic
bacteria and an increasing plaque-pH- lowering potential.10
•
Another study described young children’s intakes of nonmilk extrinsic (NME) and
intrinsic/milk sugars and compared the intakes of sugars by young children with
and without dental caries experience.They found that neither individual nor total
sugars intakes differed between the subjects with and without caries.11
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6.3 HYPOTHESIS
Research hypothesis: There is significant difference in the food retention and
carbohydrate clearance among the test foods.
Null hypothesis: There is no significant difference in the food retention and
carbohydrate clearance between the test foods
6.4 OBJECTIVES OF THE STUDY :
The study is designed to,
•
To estimate the total carbohydrate content of saliva collected at various time period
following the consumption of test food in young children using modified anthrone
reagent.
•
To estimate the oral retentive capacity of test foods in children.
7 . MATERIALS AND METHODS :
7.1 Sources of data :
The study group includes a total of 30 children in the age group of 3-8 yrs of
both the sexes visiting to the department of Pediatric and Preventive dentistry K.L.E
Institute of Dental Sciences and children attending preschools.
7.2 METHODS OF COLLECTION OF DATA(INCLUDING
SAMPLING PROCEDURES IF ANY) :
Sample size :
The study sample consists a total of 30 children in the age group 3-8 yrs.
Method of collection of sample :
The study sample comprise of 30 children selected using simple random sampling.
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Inclusion criteria :
Age : 3-8yrs
Exclusion criteria :
•
•
•
•
•
•
Medically compromised children.
Children under chronic medications.
children on antibiotics in last 3 months.
children with deep carious lesions.
children with early chidhood caries.
Children with malocclusion.
STUDY DESIGN :
 A survey was conducted to select the popular test foods which were consumed by
the children (3-6 yrs) on day to day basis.
 Diet history of the child with the help of diet chart will be obtained from the parents
 Subjects consuming those test foods on regular basis will only be included in the
study
 The participating 30 subjects will be subjected to
following test foods in the study
TEST FOODS
crème sandwich cookies
chochlate bars
potato chips
cake
flavoured and sugared cornflakes
Glucose biscuits
Bread group
For retention of the test food:
Same test foods will be chosen for retention of the test food.
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•
Estimation of salivary carbohydrate
 The food chosen to be tested are popularly consumed items commercially available.
Solid food includes crème sandwich cookies, milk chochlate bars, potato chips ,
cake ,flavoured cornflakes,glucose biscuits.All the foods will be possibly taken
from one local store in the chain of supermarkets in Bangalore. The same solid food
will be taken for carbohydrate clearance and retention study. 30 healthy young
children of age 3-8 yrs will be participating in this study.No restrictions will be
imposed on normal oral hygiene practice. The participants will be asked to avoid
drinking/eating(except water) for 2 hr before each experimental session. Baseline
Salivary samples will be collected from each subject before the administration of
food.Each subject will be given 10 gram of test food.Saliva samples will be
collected at 0 min after the last bolus of food swallowed.15 ml of water will be
rinsed around the mouth for 15sec and expectorated. Following this,10, 20 mins
saliva samples will be collected in a sterile container.
 Saliva samples will be collected as single expectorations (<0.5 mL) over ice.The
samples will be centrifuged to clarify the saliva, and the supernatant fluid will be
assayed for total carbohydrate.This sample is directly used for carbohydrate
estimation using modified anthrone reagent.0.5 ml of the samples will be
transferred into the test tubes containing 5ml of conc. sulfuric acid, kept in ice
water to minimize the turbulence produced in reaction. Anthrone. 0.5 ml of
anthrone-ethyl acetate reagent will be carefully layered over the inner side of the
test tubes and gentle swirling used to hydrolyze the ethyl acetate.After proper
mixing the contents will be transferred to a 1000C boiling water bath for 10
minutes, followed by 40C, for 5 minutes and to prevent condensation of moisture
on the optical tubes reading,5minutes in water bath at 200C.The absorbances due to
production of green furfural derivative will be measured at 610 nm on a
photoelectric spectrometer.Results will be expressed in glucose equivalents
calculated from the standard curve of varying glucose concentrations. One test
food will be given to each subject per session and 24 hours gap will be maintained
before introducing the next test food.Following procedure,oral prophylaxis &
topical fluoride application will be done.
•
Estimation of food retention
 30 same subjects will be participating in this study. Food retention will be
evaluated on all of the teeth of each quadrant. The informed consent of all human
subjects will be obtained and possible discomfort and risks will be fully explained
to the subjects. Subjects will receive a preliminary prophylaxis for removal of
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calculus, plaque and stains from all tooth surfaces.Each subject will be consuming
the same test food as used for salivary carbohydrate estimation.Portions of food
will be eaten in normal manner and the time when the last bolus of food is
swallowed will be taken as 0 min.Saliva ejectors will be placed into the subjects
mouths immediately and food particles remaining on all surfaces of the teeth will
be recovered and placed in plastic vials.Removal of retained food will be done by
scalers and curettes.The samples are then lyophilized and weighed.
 Subjects will be asked to brush and floss after the scaling and wait for 10 minutes
before the administration of next food portion.The procedure will be repeated two
times so that the retention could be determined at two minutes and five minutes
after swallowing.Altogether,subjects will consume three portions of each food
during one session.Following procedure,oral prophylaxis & topical fluoride
application will be done.
STATISTICAL TESTS THAT WILL BE USED :
• The results obtained from the study will be compared and analysed statistically
• Comparison in between the test food at 0,10,20 minutes will be carried out using
ANOVA test
• If ANOVA is significant further pairwise comparison between foods will be carried
using Tukey Test(Post Hoc Test)
• For the retention study,comparison between the dry weights of retained food
particles of each test food will be carried using ANOVA test
7.2 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
OTHER INTERVENTION TO BE CONDUCTED ON PATIENTS OR
HUMANS OR ANIMALS ? IF SO PLEASE DESCRIBE BRIEFLY .
No
7.3 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM
YOUR INSTITUTION ?
Yes.
The ethical committee clearance certificate is enclosed
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8. LIST OF REFERENCES :
•
Saha S, Jagannath GV, Shivkumar S, Pal SK. Effect of commonly consumed fresh
fruit juices and commercially available fruit juices on ph of saliva at various time
intervals. J Int Dent Med Res 2011;4(1):7-11.
•
Hegde A, Shetty R, Sequeira A R .The Acidogenicity of Various Chocolates
Available in Indian Market: A Comparative Study. International Journal of Clinical
Pédiatric Dentistry 2009;2(2):20-24.
•
Kashket S, Houte JV, Lopez LR and Stocks S. Lack of correlation between food
retention on the human dentition and consumer perception of food stickiness. J
Dent Res 1991;70:1314.
•
Pollard MA et al. Acidogenic potential and total salivary carbohydrate content of
expectorants following consumption of some cereal based foods and fruits. Caries
Res 1996;30:132-137.
•
Lingström P, Ruyven FOG, Houte JV and Kent R. The pH of Dental Plaque in its
Relation to Early Enamel Caries and Dental Plaque Flora in Humans. J Dent Res
2000;79(2):770-777.
•
Dodds MWJ and Edga WM. The Relationship Between Plaque pH, Plaque Acid
Anion Profiles, and Oral Carbohydrate Retention After Ingestion of Several
'Reference Foods' by Human Subjects. J Dent Res 1988;67(5):861-865.
•
Crossner CG, Hase JC, Birkhed D. Oral sugar clearance in children compared with
adults. Caries Res 1991;25:201-206.
•
Teresa AM , Julie ME, Michelle AL, Warren JJ, Steven ML. Comparison of the
intakes of sugars by young children with and without dental caries experience.
JADA 2007;138:39-46.
•
W.H. van Palenstein Helderman, M.I.N. Matee, J.S. van der Hoeven, and F.H.M.
Mikx. Cariogenicity Depends More on Diet than the Prevailing Mutans
Streptococcal Species. J Dent Res 1996;75(1):535-545.
•
Reina Garcia-Closas. A cross-sectional study of dental caries, intake of
confectionery and foods rich in starch and sugars and salivary counts of
Streptococcus mutans in children in Spain. Am J Cli Nutr 1997;66:1257-63.
•
Kashket S, Zhang J, and Houte JV. Accumulation of Fermentable Sugars and
Metabolic Acids in Food Particles that Become Entrapped on the Dentition. J Dent
Res 1996;75(11):1885-1891.
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9
Signature of Candidate
10 Remarks of the guide
APPROVED
11 Name and designation of
11.1 Guide
Dr. SANDHYADEVI. S. PATIL ,
PROF AND HEAD OF DEPARTMENT
DEPARTMENT OF PEDODONTICS AND
PREVENTIVE DENTISTRY,
K.L.E SOCIETY’S INSTITUTE OF DENTAL
SCIENCES, BANGALORE - 22
11.2 Signature
11.3 Co- Guide ( if any )
11.4 Signature
11.5 Head Of The
Department
Dr. SANDHYADEVI. S. PATIL ,
PROF AND HEAD OF DEPARTMENT
DEPARTMENT OF PEDODONTICS AND
PREVENTIVE DENTISTRY,K.L.E
SOCIETY’S INSTITUTE OF DENTAL
SCIENCES, BANGALORE - 22
11.6 Signature
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12 12.1 Remarks of the Chairman
and Principal
Dr .SRIVATSA
PRINCIPAL ,
K.L.E SOCIETY’S INSTITUTE OF DENTAL
SCIENCES,
BANGALORE - 22
12.2 Signature
10