The composition of dental plaque formed in the presence of sucrose or glucose and fructose and its relation to cariogenicity was evaluated. Twelve adult volunteers took part in this crossover study done in three phases of 28 days each. For each phase, an acrylic resin appliance containing four human dental enamel blocks was constructed for the volunteers. Solutions containing 20% sucrose or 10% glucose + 10% fructose were dripped onto the enamel blocks 8 times a day, while in the control group no solution was used. Enamel surface and cross–sectional microhardness results showed that dental plaque formed in the presence of sucrose was more cariogenic than that formed in the presence of glucose + fructose (p<0.05). The concentration of alkali–soluble carbohydrates in dental plaque was higher in the sucrose group than in the control and glucose + fructose groups (p<0.05). Although concentrations of Ca, P and F were lower in plaque formed in the presence of sucrose than glucose + fructose and the control, significant differences (p<0.05) were only observed in relation to control. The electrophoretic profile of the matrix proteins of dental plaque showed distinct patterns when it was formed in the absence or presence of the different carbohydrates. Although the results suggest that the high cariogenicity of dental plaque formed in the presence of sucrose can be mainly explained by the high concentration of insoluble glucans of its matrix, the low inorganic concentration and its protein composition may have some contribution.

Since the effect of the combination of methods of fluoride use on enamel demineralization and on plaque composition is not clearly established, this study examined the effect of the combination of acidulated phosphate fluoride (APF) application and F dentifrice on enamel demineralization and on plaque composition. In this crossover study, 16 volunteers, wearing a palatal appliance containing bovine enamel blocks, were subjected to 4 treatment groups: non-fluoridated dentifrice (PD), FD, APF+PD, and APF+FD. The APF was applied to the enamel before the 14-day experimental period. During the experimental period, test dentifrices were applied 3x/day, and a 20% sucrose solution was applied 4x and 8x/day by being dripped on the blocks. Although APF application was able either to increase F concentration in plaque or to reduce the % of mutans streptococci, its combination with F dentifrice use neither reduced enamel mineral loss nor changed any other measured plaque variable with respect to the FD group alone.

Since in vitro and animal studies suggest that the combination of starch with sucrose may be more cariogenic than sucrose alone, the study assessed in situ the effects of this association applied in vitro on the acidogenicity, biochemical and microbiological composition of dental biofilm, as well as on enamel demineralization. During two phases of 14 d each, fifteen volunteers wore palatal appliances containing blocks of human deciduous enamel, which were extra-orally submitted to four groups of treatments: water (negative control, T1); 2 % starch (T2); 10 % sucrose (T3); and 2 % starch þ 10 % sucrose (T4). The solutions were dripped onto the blocks eight times per day. The biofilm formed on the blocks was analysed with regard to amylase activity, acidogenicity, and biochemical and microbiological composition. Demineralization was determined on enamel by cross-sectional microhardness. The greatest mineral loss was observed for the association starch þ sucrose (P,0·05). Also, this association resulted in the highest lactobacillus count in the biofilm formed (P,0·05). In conclusion, the findings suggest that a small amount of added starch increases the cariogenic potential of sucrose. Among dietary carbohydrates, starch has been pointed out as noncariogenic or slightly cariogenic when used as the sole source of carbohydrate in the diet. This observation has been supported by experiments on dental biofilm acidogenicity (Stephan, 1940;Imfeld, 1977;Lingström et al. 1989), experimental studies with animals (König & Grenby, 1965;Green & Hartles, 1967;Hefti & Schmid, 1979;Bowen et al. 1980), controlled studies in man (Gustaffson et al. 1954), epidemiological data (Marthaler & Froesch, 1967;Fisher, 1968;Newbrun et al. 1980) and in situ experiments (Lingström et al. 1994), which demonstrated that starch is less cariogenic than sucrose.However, while in primitive diets starch was consumed as the main energy source, in contemporary ones it is consumed simultaneously or interspersed with sucrose (Lingström et al. 2000). This combination, which is consumed by both adults and children, may influence dental biofilm composition and consequently dental caries. Thus, a greater prevalence of caries lesions was found in children who consume milk supplemented with a combination of cereal and sucrose (Mattos-Graner et al. 1998). Such observation in human subjects is supported by the results of experimental caries studies in animals (Firestone et al. 1982;Mundorff-Shrestha et al. 1994), suggesting that starch would enhance the cariogenic potential of sucrose.The explanation for the greater cariogenicity of the association of dietary starch with sucrose may reside in the dental biofilm formed. It is well known that the biofilm formed in the presence of sucrose is more cariogenic due to its high concentration of extracellular insoluble polysaccharides (IP), which alter the matrix of the biofilm, making it more porous (Dibdin & Shellis, 1988). These polysaccharides are produced from sucrose by bacterial enzymes named glucosyltransferases....

The relationship between sucrose concentration and cariogenic potential was studied in situ. Adult volunteers wore intraoral palatal appliances containing human dental enamel blocks, which were extraorally submitted 8 times a day for 14 days, to the treatments: deionized distilled water and sucrose solutions from 1 to 40%. The biofilm formed was analyzed with respect to acidogenicity and biochemical composition; enamel demineralization was evaluated by microhardness. The results showed that 1% sucrose is less cariogenic than 5% or higher concentrations, although sucrose solution at 40% was still able to increase the concentration of insoluble polysaccharide in the biofilm formed. The findings suggest that the threshold of sucrose solution concentration for the formation of a cariogenic biofilm is 5%, which provided the same cariogenic potential as that observed for 10 and 20% sucrose solution.

Since in vitro pH-cycling models are widely used to study dental caries, they should allow evaluations of fluoride effect on early stages of caries development. Therefore, acid etching on enamel surface must be avoided, enabling surface microhardness (SMH) analysis. In the present study, the pH-cycling model originally described by Featherstone et al.9 (1986) was modified to preserve the enamel surface and to produce early carious lesions that could be evaluated using SMH and cross-sectional microhardness (CSMH) measurements. In order to validate this modified model, a dose-response evaluation with fluoride was made. Human enamel blocks with known SMH were submitted to such regimen with the following treatments: distilled deionized water (DDW; control) and solutions containing 70, 140 and 280 ppm F. Data from %SMH change and deltaZ (mineral loss) showed a statistically significant negative correlation between F concentration in treatment solutions and mineral loss. In conclusion, the modified pH-cycling model allowed the evaluation of changes on the outermost enamel layer during caries development, and a dose-response effect of fluoride reducing enamel demineralization was observed.

It has been suggested that enamel would resist higher frequencies of sucrose exposure if fluoride from water or dentifrice is being used. However, the effect of increasing frequencies of sugar on dental biofilm composition is not well known. Ten volunteers living in a fluoridated area wore palatal appliances bearing human enamel slabs during 14 days. The slabs were exposed to 20% sucrose solution 0 (control), 2, 4, 6, 8 or 10 times/day and the volunteers used fluoride dentifrice 3 times/day. Enamel demineralization was significantly greater than control for sucrose frequencies higher than 6 times/day. However, biofilm mass, total microbiota, total streptococci, lactobacilli counts and insoluble extracellular polysaccharide concentration increased, while Ca, P_i and F concentration in whole biofilm decreased significantly, with frequencies of sucrose exposure lower than 6 times/day. The findings confirm that fluoride can reduce enamel demineralization if sucrose consumption is not higher than 6 times/day, but changes in the biochemical and microbiological composition of the biofilm are observed with lower frequencies of sucrose use.

Since the effect of iron (Fe) on the cariogenicity of sucrose in humans is unexplored, this study assessed in situ the effect of Fe co-crystallized with sucrose (Fe-sucrose) topically applied in vitro on the acidogenicity, biochemical and microbiological composition of the dental biofilm formed in vivo and on the demineralization of the enamel. During two phases of 14 days each, 16 volunteers wore palatal appliances containing blocks of human enamel, which were submitted to four groups of separate treatments: (1) water; (2) 20% sucrose; (3) 20% (w/v) sucrose plus 18 µg Fe/ml, and (4) 20% (w/v) sucrose plus 70 µg Fe/ml. The solutions were dripped onto the blocks 8 times per day. The biofilms formed on the blocks were analyzed with respect to acidogenicity, biochemical and microbiological composition. Mineral loss was determined on enamel by surface and cross-sectional microhardness. Lower demineralization was found in the blocks subjected to Fe-sucrose (70 µg Fe/ml) than in those treated with sucrose (p < 0.05). This concentration of Fe also reduced significantly the populations of mutans streptococci in the biofilm formed on the blocks. In conclusion, our data suggest that Fe may reduce in situ the cariogenic potential of sucrose and the effect seems to be related to the reduction in the populations of mutans streptococci in the dental biofilm formed.

These findings suggest that mouthrinses can reduce morning bad breath, and that such a reduction is not attributable only to the reduction of supragingival plaque formation.