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Table 13.1 Plaque pH scores to assess the acidogenicity of various snack foods and candies in two separate studies.

Study

Grading

Least acidogenic

Most acidogenic

Sugarless gum

Peanuts

Bread & butter

Potato crisps/chips

Ice lolly/pops

Sugared coffee

Chocolate peanuts

Chocolate-fondant-caramel bar

Apple

Cream-filled biscuit Ice cream

Sweet chocolate Chocolate biscuit

Chewing gum

Plain biscuit Orange drink Toffee

Sugared coffee Boiled sweet/candies

Edgar and Rugg-Gunn (8)*

Caramels

Sugared gum

Chocolate

Liquorice

Sugarless gum

Orange Jellies

Rock candy Clear mints Sourballs Fruit gums Fruit Lollipops

* Candies tested out of 54 different foods.

be made on relative cariogenicity. They have not been used to assess the cariogenicity of chocolate. In Vivo/in Vitro Methods

These seek to combine an intra-oral environment with the effects of foods outside of the mouth. They are therefore known as intraoral cariogenicity tests (ICT). Slabs of human sterile enamel are placed into an intra-oral, denture-like device. These become colonized by oral bacteria and plaque. The device(s) can be removed from the mouth and immersed in a food slurry, such as chocolate, at various times during the day. Over a period of several weeks, caries-like lesions develop in the enamel slabs, which can be measured for an index of cariogenicity. As with artificial mouths, the ICT method has not been used to assess chocolate, although it could readily do so.

Animal Studies

These use an animal model, usually the laboratory rat, to produce in vivo dental caries. By controlled feeding experiments, groups of rats can be fed a nutritional

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diet as well as varying numbers of snacks as experimental foods. After a suitable period of time, 35 days in the case of rats, the animals are sacrificed and the number of dental caries lesions/cavities counted to assess a comparative cariogenicity or CPI of the foods tested. As with other methods described above, it is usual to use sucrose as the control against which foods are tested.

Imfeld et al. (10), using an animal model, recorded the CPI of sucrose at 1.0, apple at 0.6, a chocolate biscuit at 0.7 and a low cariogenic food at 0.4.

A major study of a number of snack foods (11) showed that chocolate gave a CPI value of 0.72, compared with sucrose with a score of 1.0. Morrisey et al. (12) showed that four out of five of the products tested containing chocolate were in the relatively lower half of the cariogenicity table. Reynolds and Black (13) noted that chocolate fed to rats was cariogenic but its effect could be reduced by the addition of calcium caseinate or milk products. An extensive study (14) included 22 snack foods in a series of experiments using rats, but also included milk chocolate as one of two control groups along with sucrose. The results (Table 13.2) showed that chocolate had a comparative CPI of 0.8, which was similar to the finding of Bowen et al. (11).

A study by Navia and Lopez (15) had also shown that chocolate or chocolate

Table 32.2 Cariogenic Potential Indices for various snack foods compared with sucrose (given a score of 1.0).

Snack food CPI

Gelatin dessert 0.4

Corn chips 0.4

Peanuts 0.4

Bologna 0.4

Yoghurt 0.4

Pretzels 0.5

Potato chips (crisps) 0.6

Saltines/crackers 0.6

Natural snack mix* 0.6

Cornstarch 0.7

Rye crackers 0.7

Fried cake 0.7

Graham crackers 0.8

Milk chocolate 0.8

Sponge cake-filling 0.8

Bread 0.9

Sucrose 1.0

Granola cereal 1.0

French fries 1.1

Bananas 1.1

Cupcakes 1.2

Raisins 1.2

* Mixture of nuts, raisins and dried fruits.

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