Background Many active pharmaceutical ingredients taste bitter and thus are aversive to children, as well as many adults. Encapsulation of the medicine in pill or tablet form, an effective method for adults to avoid the unpleasant taste, is problematic for children. Many children cannot or will not swallow solid dosage forms. Objective This review highlights basic principles of gustatory function, with a special focus on the science of bitter taste, derived from studies of animal models and human psychophysics. We focus on the set of genes that encode the proteins that function as bitter receptors, as well as the cascade of events that lead to multidimensional aspects of taste function, highlighting the role that animal models played in these discoveries. We also summarize psychophysical approaches to studying bitter taste in adult and pediatric populations, highlighting evidence of the similarities and differences in bitter taste perception and acceptance between adults and children and drawing on useful strategies from animal models. Results Medicine often tastes bitter, and because children are more bitter sensitive than are adults, this creates problems with compliance. Bitter arises from stimulating receptors in taste receptor cells, with signals processed in the taste bud and relayed to the brain. However, there are many gaps in our understanding of how best to measure bitterness and how to ameliorate it, including whether it is more efficiently addressed at the level of receptor and sensory signaling, at the level of central processing, or by masking techniques. All methods of measuring responsiveness to bitter ligands—in animal models, through human psychophysics, or with “electronic tongues”—have limitations. Conclusions Better-tasting medications may enhance pediatric adherence to drug therapy. Sugars, acids, salt, and other substances reduce perceived bitterness of several pharmaceuticals, and although pleasant flavorings may help children consume some medicines, they often are not effective in suppressing bitter tastes. Further development of psychophysical tools for children will help us better understand their sensory worlds. Multiple testing strategies will help us refine methods to assess acceptance and compliance/adherence by various pediatric populations. Research involving animal models, in which the gustatory system can be more invasively manipulated, can elucidate mechanisms, ultimately providing potential targets. These approaches, combined with new technologies and guided by findings from clinical studies, will potentially lead to effective ways to enhance drug acceptance and compliance in pediatric populations.

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Objectives We examined associations of household socioeconomic status (SES) and food security with children's oral health outcomes. Methods We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES-caries relationship. Results About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES–caries relationship. Conclusions Interventions and policies to ensure food security may help address the US pediatric caries epidemic.

Pigeon subjects received Pavlovian conditioning with stimulus elements and were then tested with compounds of those elements. Experiments 1-3 used localized keylight elements and found no evidence for greater responding to the compound than to the elements. Experiments 4A-4D found evidence for greater second-order conditioning by a compound of two elements than by the elements themselves when the elements consisted of two diffuse stimuli or one diffuse stimulus and one localized keylight. No greater second-order conditioning resulted from a compound of two localized keylight elements, suggesting the possibility of perceptual interactions that reduce identification of the elements in the compound. Experiment 6 found evidence of summation when that interaction was reduced by sequential presentation. However, one attempt to capture this interaction in terms of configural conditioning (Pearce, 1987) failed to receive confirmation. These results suggest that the localized stimuli conventionally employed in autoshaping experiments may show such substantial perceptual interaction as to recommend against their routine use for studying conditioning in compounds.

Frequent consumption of simple carbohydrates, primarily in the form of dietary sugars is significantly associated with increased dental caries risk. Malnutrition (under or over nutrition) in children is often a consequence of inappropriate infant and childhood feeding practices and dietary behaviors associated with limited access to fresh, nutrient dense foods substituting instead, high-energy low cost and nutrient poor sugary and fatty foods. Lack of availability of quality food stores in rural and poor neighborhoods, food insecurity, and changing dietary beliefs resulting from acculturation including changes in traditional ethnic eating behaviors, can further deter healthful eating and increase risk for Early Childhood Caries and obesity. America is witnessing substantial increases in children and ethnic minorities living in poverty, widening the gap in oral health disparities noted in the Surgeon General's Report, Oral Health in America. Dental and other care providers can educate and counsel pregnant women, parents and families to promote healthy eating behaviors and should advocate for governmental policies and programs that decrease parental financial and educational barriers to achieving healthy diets. For families living in poverty, however, greater efforts are needed to facilitate access to affordable healthy foods, particularly in urban and rural neighborhoods in order to effect positive changes in children's diets and advance the oral components of general health.

The status of instruction in interpersonal communication was surveyed in forty U.S and Canadian dental schools. Key faculty members were identified, and syllabi and course descriptions were collected and content-analyzed. The following findings were obtained for responding schools: 1) only one-third of schools had courses specifically focusing on interpersonal communication; 2) more than half of the schools offered these types of courses only during the first two years; 3) the most common topics were communication skills, patient interviewing, and patient education/consultation; 4) the most frequently used method of teaching was lectures; active practice was used less often; 5) written examination was the primary instructional evaluation tool, whereas more sophisticated performance-oriented assessments were used less often; and 6) about half of the teachers did not have a D.D.S. degree; those not dentists were primarily psychologists. At least eight of the forty dental schools surveyed do not appear to meet the accreditation guidelines for predoctoral programs in this area of instruction. Some could not identify a faculty member responsible for such instruction. Schools offering more extensive instruction were more likely to offer active rather than passive teaching and use more sophisticated student evaluation strategies. This research suggests a need for reevaluation of teaching in this subject area.

The NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox) is a set of brief measures for the assessment of cognitive function, emotional health, motor function, and sensory function for use in clinical trials and in epidemiologic and longitudinal studies. Gustatory perception is assessed as 1 of 6 areas of sensory function. A team of 11 scientists with expertise in taste perception selected 2 gustatory measures, 1 of which can be used in young pediatric populations. The measure selected for young pediatric populations assesses sucrose (sweet) taste preference and can also be used across the age span of 5 to 85 years. For adult populations, the selected measure is a regional test, which assesses variability in perceived intensity of quinine hydrochloride (bitter) when applied to the tongue tip as well as perceived with the whole mouth. The team also recommends the regional test for assessing other tastants, such as sodium chloride (salty). Validation studies have demonstrated that the measures modified for the NIH Toolbox correlate with more traditional assessments, and can identify known population differences in gustation. Neurology â 2013;80 (Suppl 3):S20-S24 DEFINITION OF GUSTATION Gustation consists of the perception of sensations that are usually described as having 1 or more basic taste qualities: sweet, salty, sour, bitter, or umami (savory/brothy). These sensations facilitate consumption of nutrients (sweet, salty, umami) and contribute to rejection of toxins (bitter). The gustatory system's key function in guiding food intake makes it important to health and the prevention of chronic diseases and conditions. For example, individual differences in bitter taste perception are known to contribute to differences in food preferences and consumption of certain fruits and vegetables, thereby influencing health.1 Gustation arises from the cellular activation of taste receptors that are localized to the plasma membranes of modified epithelial cells. 2Along with supporting cells, these specialized cells form taste buds that are found inside papillae on the tongue surface or within the tissues of the soft palate and pharynx. Gustatory fibers in the facial, glossopharyngeal, and vagal cranial nerves innervate taste buds in the oral cavity. These fibers carry taste information from the oral cavity to the nucleus of the solitary tract in the brainstem.3 In primates, projections from the nucleus of the solitary tract carry taste information to the thalamus, which in turn projects to gustatory cortex. 3Psychophysical measures characterize different aspects of gustatory perception. These include the responsiveness of the system to taste stimuli as well as the hedonic value of the sensation. Measures of taste function include detection thresholds, just noticeable differences in taste perception, perceived intensity, and taste quality judgments. Measurements involving hedonic value usually consist of estimates of pleasantness, liking, or preference. For children younger than age 5, most ...

Sweet preference is higher in childhood than adulthood but the mechanism for this developmental shift is not known. The objective of this study was to assess perceptual, physiological and eating habit differences between children preferring solutions high in sugar (high preference) and children preferring solutions low in sugar (low preference). We tested 143 children (11-to 15-years old) using sip and spit methodology to assess their hedonic profile, detection threshold, and perceived intensity of sucrose. Their plasma concentration of several hormones, a biomarker of bone-growth, body size, puberty stage, and dietary habits were measured. Eighty-eight children were classified as high preference and 53 were classified as low preference based on their hedonic ratings to a series of sucrose solutions. A marker of bone growth measured in urine and plasma leptin adjusted for body weight were significantly lower in the low preference group. Children with high and low preference patterns did not differ in sensory aspects of sucrose perception, nor did they differ in age, body mass index percentile, or dietary restraint. The change in sugar preference from high to low during adolescence appears to be associated with the cessation of growth.