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adults were given controlled diets in which the refined carbohydrate was either sugar, fructose or a sugar substitute, xylitol. The total diet for these people was controlled and therefore the sugar component was either kept standard or substituted, which would have included chocolate as well. The results showed a reduction in caries increment in the xylitol group. However, chocolate does not appear to be a factor in this study.

Intra-Oral Plaque pH Studies

These involve the measurement of pH (acidity) in plaque (the accumulated adhesive mass of bacteria, food debris and mucins that collects on teeth) on or in between the teeth. The ability of a food to encourage or create an acid plaque (acidogenicity) is related to a food's ability to initiate or encourage the development of dental caries. The tests commonly use a pH microelectrode which can be touched on the plaque in situ (touch method), placed within a dental appliance (indwelling method), or where plaque samples are scraped off and tested outside of the mouth (harvesting method).

This is an area of study in which chocolate, or chocolate products, have been more widely tested. The method lends itself very well to the evaluation of specific foods but, of course, cannot test diets. In these studies, a group of volunteers is used to sequentially test various foods for their ability to promote an acidogenic plaque. The maximum drop in pH is recorded as well as the time taken for the plaque to be buffered by the saliva and return to normal. By always using a set of two foods, sucrose and sorbitol (10% solutions), as positive and negative controls, respectively, reasonable comparisons can be made. Using sucrose as the main comparator, and given an arbitrary score of 1.0, each test food can be given a Cariogenic Potential Index (CPI) score.

Large numbers of foods, snack foods and confectioneries have been tested and tables of pH scores for comparison as least or most acidogenic have been devised (Table 13.1) (8, 9).

This comparison of two separate studies shows that chocolate falls in the middle of scores and is therefore only of moderate cariogenicity. What is also interesting is the effect of added ingredients to chocolate. Thus, the chocolate peanuts ranked lower in the acidogenic potential scores than sweet chocolate.

Artificial Mouths

Artificial mouths recreate in a bench-top device the conditions that occur in the human mouth. These closed systems use extracted teeth with natural or artificial plaque, a food source and appropriate bacteria to produce caries-like lesions in the enamel. By using several different foods, such as chocolate, a comparison can

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