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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 1  |  Page : 29-33

Microbiological comparison of efficacy of two chewing gum on salivary levels of Streptococcus mutans count in caries active children – An in vivo study


Department of Pedodontics and Preventive Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission17-Apr-2022
Date of Acceptance18-May-2022
Date of Web Publication16-Jul-2022

Correspondence Address:
Dr. Gayathri Gopinath
Department of Pedodontics and Preventive Dentistry, Rajarajeswari Dental College and Hospital, No. 14, Ramohalli Cross, Mysore Road, Kumbalgodu, Bengaluru - 560 074. Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohs.ijohs_10_22

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  Abstract 


Aim: The aim of this study was to assess, evaluate, and compare the efficacy of xylitol chewing gums and immunoglobulin Y (IgY) chewable tablet on Streptococcus mutans by microbiological culture method in caries-active children.
Materials and Methods: A total of 30 children were selected from two residential schools, situated in kumbalgodu, Bengaluru, aged between 5 and 8 years with DMFT/dmft index of 3–6. The children were randomly divided into two groups by lottery method, each consisting of 15 children per group. IgY chewable tablet – Group I (test group) and xylitol chewing gum – Group II (control group). The children were given IgY no decay chewable tablet and xylitol chewing gum, respectively, and were instructed to chew one pellet each two times a day after a meal for 30 days. Preintervention salivary samples were collected at baseline, 30 days after chewing gum use as postintervention sample, for microbiological analysis.
Results: IgY no decay chewable tablet two times a day for 30 days can successfully reduce salivary S. mutans counts than the xylitol chewing gum group.
Conclusion: This study concluded that IgY in the form of chewable tablet has shown a maximum beneficial effect against salivary S. mutans for children who are at high risk of caries than xylitol chewing gum.

Keywords: Chewing gum, dental caries, immunoglobulin Y, salivary Streptococcus mutans, xylitol


How to cite this article:
Ramachandra JA, Gopinath G. Microbiological comparison of efficacy of two chewing gum on salivary levels of Streptococcus mutans count in caries active children – An in vivo study. Int J Oral Health Sci 2022;12:29-33

How to cite this URL:
Ramachandra JA, Gopinath G. Microbiological comparison of efficacy of two chewing gum on salivary levels of Streptococcus mutans count in caries active children – An in vivo study. Int J Oral Health Sci [serial online] 2022 [cited 2022 Aug 17];12:29-33. Available from: https://www.ijohsjournal.org/text.asp?2022/12/1/29/350987




  Introduction Top


Dental caries is the most common chronic disease of childhood and is widespread, multifactorial, and infectious, which causes major public health problems for a large segment of society both as an illness and as an economic burden.[1] The etiology for dental caries, mainly involves substrate, host, microorganism, and time as described by Keyes, and later modified by Newbrun. The mutans streptococci (MS), a group of acidogenic, dental plaque-inhabiting streptococcal species, are still recognized as major constituents of most active dental caries lesions.[2]

The prevention of dental caries is very important as it has a significant impact on self-esteem, mastication, nutrition, and health. Hence, the dental health-care team needs to apply preventive care strategies beyond restoration placement. Chewing sugar-free gum has potential beneficial effect on dental health. Xylitol chewing gum has suggested to reducing caries rates and it relates to the effect on tooth decay in human subjects, human dental plaque reduction, and inhibition of the growth and metabolism in the MS group.[3] Efforts to prevent dental caries using the passive immunoglobulin method are ongoing, immunoglobulin Y (IgY), an antibody found in chicken eggs has been reported to inhibit the adhesion of Streptococcus mutans to the tooth surface.[4] Research on the IgY no tooth decay chewable tablet is also in progress to enhance the effectiveness of Igy in various forms of delivery. Hence, the aim of this study is to assess, evaluate, and compare the efficacy of xylitol chewing gums and IgY chewable tablet on S. mutans by microbiological evaluation in caries-active children.


  Materials and Methods Top


A total of 30 children were selected from two residential schools, aged between 5 and 8 years situated in kumbalgodu, Bengaluru. The children were randomly divided into two groups by lottery method, each consisting of 15 children per group. IgY no decay chewable tablet – Group I (test group) and xylitol chewing gum – Group II (control group) with DMFT/dmft score 3–6.

Ethical clearance before the study was obtained from the institutional ethical committee of RajaRajeswari Dental College and Hospital. Written informed consent was obtained from the head of the institution of all the children who were selected for the study. The children were instructed not to eat or drink 1 h before the sample collection. The children were asked to continue their normal dietary and oral hygiene habits during the study period. DMFT/dmft index was recorded according to the WHO criteria.[5] The baseline sample of resting unstimulated saliva was collected from each subject for 5 min in cryovials. Moreover, the salivary samples were sent to the laboratory within half an hour of collection.

The Group I children (test group) were given IgY no decay chewable tablet and Group II children (control group) were given xylitol chewing gum and asked to chew one pellet each two times a day after a meal for 30 days. The postintervention saliva sample was collected using the same method as baseline on the 31st day and sent to assess S. mutans count using mitis-salivarius-bacitracin (MSB) agar media microbiological culture method and results obtained were subjected to statistical analysis.

Microbiological assay

S. mutans count was evaluated using MSB agar media containing 1% potassium telluride and 10% sucrose. MSB plates were incubated in 5% CO2 candle jar for 24 h at 37°C.[9] Following incubation, the colonies of S. mutans were identified by gram stain and culture morphology, colony count was done with a magnifying glass and the count of S. mutans was expressed as the number of colony-forming units per millimeter of saliva (CFU/ml) [Figure 1].[6]
Figure 1: Showing the growth of Streptococcus mutans on mitis-salivarius-bacitracin agar

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Statistical analysis

The Statistical Package for the Social Sciences (SPSS) for Windows, version 22.0 released in 2013, Armonk, NY, USA: IBM Corp., was used to perform statistical analyses. Mann–Whitney test was used to compare the mean S. mutans levels (CFU/ml) between IgY and xylitol group at Pre- and Postintervention period. Similarly, the gender-wise comparison was performed for the mean S. mutans levels (CFU/ml) in the IgY and xylitol group at pre- and postintervention period [Table 1]. Wilcoxon signed-rank test was used to compare the mean S. mutans levels (CFU/ml) between pre- and postintervention period in each study group. Kruskal–Wallis test was used to compare the mean S. mutans levels (CFU/ml) in the IgY and xylitol group at pre- and postintervention period based on the age of the individuals. The level of significance (P value) was set at P < 0.05.
Table 1: Age and gender distribution between IgY and xylitol study groups

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[Table 2] showing Mann–Whitney test was done to compare the mean S. mutans level between IgY and xylitol group at preintervention period. The mean value of the IgY no decay tablet group was 3.10E+ 05 and the xylitol chewing group was 6.50+04 [Graph 1].
Table 2: The comparison of mean Streptococcus mutans levels between IgY and xylitol group at preintervention period using Mann–Whitney test

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[Table 3] shows Mann–Whitney test was done to compare the mean S. mutans level between IgY and xylitol group at postintervention period [Graph 2]. The mean value of IgY no decay tablet group was 2.94E+02 and the xylitol chewing group was 5.19E+03 that there as a significant reduction from baseline mean value of S. mutans of both the groups and the result suggested that IgY no decay chewable tablet led to greater reduction in S. mutans counts than xylitol-containing chewing gum which was found to be statistically significant.
Table 3: Comparison of mean Streptococcus mutans levels (colony-forming unit/ml) between IgY and xylitol group at postintervention period using Mann–Whitney test

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[Table 4] shows Wilcoxon signed-rank test was done to compare the means of the S. mutans levels (copy number of DNA/ml) preintervention and postintervention. The mean value of S. mutans of the IgY group baseline was 3.10E+05 which is decreased to 2.94E+02 that there was a significant reduction in the IgY group which was found to be statistically significant [Graph 3].
Table 4: Comparison of mean Streptococcus mutans levels (colony-forming units/ml) between pre- and postintervention periods in the IgY group using Wilcoxon signed-rank test

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[Table 5] shows Wilcoxon signed-rank test was done to compare the means of the S. mutans levels (copy number of DNA/ml) preintervention and postintervention [Graph 4]. The mean value of S. mutans of the xylitol group baseline was 6.50E+05 which is decreased to 5.19E+03 that there was a significant reduction in the xylitol group which was found to be statistically significant.
Table 5: Comparison of mean Streptococcus mutans levels (colony-forming units/ml) between pre- and postintervention periods in the Xylitol group using Wilcoxon signed-rank test

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  Discussion Top


In recent years, a number of preventive measures are available to deal with dental caries, chewing gum has gained a lot of important in caries prevention. One of which, xylitol is more effective as an anticaries agent other than sugar alcohols. Several in vivo trials have proven the effectiveness of xylitol in the reduction of S. mutans in plaque and saliva.[7] Xylitol is widely researched and globally accepted as a natural sweetener approved by the United States Food and Drug Administration, the American Academy of Pediatric Dentistry (AAPD), and the European Food Safety Agency, and is considered to be safe for use in children.[8]

The mechanism of xylitol has properties that reduce levels of MS in the plaque and saliva. It disrupts the energy production processes of MS leading to a futile energy consumption cycle and cell death.[9] The product was used in the current study of xylitol chewing gum for 1 month demonstrate decrease in caries rate among children. According to the AAPD policy on the use of xylitol 2011, numerous clinical studies have demonstrated a decrease in caries rate, increment, and/or onset among children who were exposed to daily xylitol use for 12–40 months.[9] Hence, xylitol can also promote an ecological shift resulting in a less cariogenic environment, however, in role in actively antagonizing caries is still controversial.

The present study showed a significant reduction of S. mutans count after 1-month intervention after administration of xylitol chewing gum and IgY no decay chewable tablet which was found to be statistically significant. Our study showed no difference in the effectiveness of IgY as well as xylitol between age and gender. However, statistically significant difference was found in intergroup and intragroup of IgY no decay chewable tablet and xylitol chewing gum of pre- and postintervention.

The newer measures to prevent dental caries using the passive immunoglobulin method in humans are ongoing. Passive immunity is the transfer of active humoral immunity in the form of ready-made antibodies from one individual to another. As such, passive immunotherapy by antigen-specific IgY acquires a special value as a tool for infection control and immunologic research with global commercial application as raw material for nutraceutical and pharmaceutical products and for applications in numerous medical and research fields since the 1980 s.[10]

The results of our study were similar to the studies conducted by Mary and Mathew,[11] to evaluate the effect of streptococcal IgY on the quantity of S. mutans in high caries risk children using microbiological culture method. High-risk caries was given one no decay tablet morning and evening for 15 days. S. mutans count was significantly reduced in children who have taken no decay tablets and it was found that IgY was able to reduce S. mutans count after 2 months. Similar results were reported by Batchiar et al.,[4] Zhou et al.[12] have shown to cause reduction in S. mutans count with varying delivery systems and duration of administration in humans and animals. According to Carlander et al.[13] studied the residual activity and the results suggest that the anti-S. mutans IgY antibodies may bind to the pathogen and prevent it from adhering to the oral cavity. The reason for reduction is IgY specific to S. mutans can prevent tooth decay by immobilizing bacteria and disabling bacteria's ability to convert sugar into acid, thereby preventing dental caries from developing.

Intergroup comparison between xylitol (control group) and IgY no decay chewable tablet (test group) suggested that IgY no decay chewable tablet led to greater reduction in S. mutans counts than xylitol-containing chewing gum which was found to be statistically significant. The reason for the reduction of S. mutans in the IgY no decay tablet group may be attributed to the fact that the ingredient used in this product contained mannitol, maltitol, xylitol was also one of components in IgY no decay chewable tablet. This finding suggests that the effect observed in the IgY no decay tablet group may be due to antibacterial action of xylitol,[1] maltitol,[14] mannitol in addition to the salivary stimulation property of chewable tablets due to the act of chewing.[1]

Limitations

Limitation of our study could be small sample size and short duration. Hence, long-term studies with larger sample size should be conducted to evaluate the efficacy of IgY no decay chewable tablet.


  Conclusion Top


IgY in the form of chewable tablets is beneficial for children who are at high risk of developing caries, to maintain a preferable oral ecology by alleviating the bacterial load throughout its consumption.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aluckal E, Ankola AV. Effectiveness of xylitol and polyol chewing gum on salivary Streptococcus mutans in children: A randomized contolled trial. Indian J Dent Res 2018;29:445-9.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Poorni S, Srinivasan MR, Nivedhitha MS. Probiotic Streptococcus strains in caries prevention: A systematic review. J Conserv Dent 2019;22:123-8.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Tanzer JM. Xylitol chewing gum and dental caries. Int Dent J 1995;45 Suppl 1:65-76.  Back to cited text no. 3
    
4.
Batchiar EW, Apritantia D, Sarwono AT, Bachtiar BM, Soejoedono RD, Wibawan IW. The effect of mouthwash combination of immunoglobulin – Y anti comD Streptococcus mutans and chitosan on the formation of Streptococcus mutans biofilm. Int J Appl Pharm 2019;11:110-3.  Back to cited text no. 4
    
5.
Teherani MH, Akhlasi N, Talebian L, Emami J, Keyhani SE. Effect of probiotic drop containing lactobacillus rhamnosus, Bifidobacterium infantis and Lactobacillus reuteri on salivary streptococcus mutans and Lactobacillus levels. Contemp Clin Dent 2016;7:469-74.  Back to cited text no. 5
    
6.
Dhawan R, Dhawan S. Role of probiotics on oral health: A randomized, double-blind, placebo-controlled study. J Interdiscip Dent 2013;3:71.  Back to cited text no. 6
    
7.
Kaur K, Nekkanti S, Madiyal M, Choudhary P. Effect of chewing gums containing probiotics and xylitol on oral health in children: A randomized controlled trial. J Int Oral Health 2018;10:237-43.  Back to cited text no. 7
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8.
Ly KA, Milgrom P, Rothen M. Xylitol, sweeteners, and dental caries. Pediatr Dent 2006;28:154-63.  Back to cited text no. 8
    
9.
American Academy of Pediatric Dentistry. Policy on Use of Xylitol in Pediatric Dentistry. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2011. p. 166-7.  Back to cited text no. 9
    
10.
Rahman S, Van Nguyen S, Icatlo FC Jr., Umeda K, Kodama Y. Oral passive IgY-based immunotherapeutics: A novel solution for prevention and treatment of alimentary tract diseases. Hum Vaccin Immunother 2013;9:1039-48.  Back to cited text no. 10
    
11.
Mary DJ, Mathew MG. Effect of Streptococcal IgY on Quantity of Streptococcus mutans in High Caries Risk Children. JPRI 2020:32:6-11.   Back to cited text no. 11
    
12.
Zhou Z, Zhou R, Tang Z. Effects of topical application of immunoglobulin yolk on mutans streptococci in dental plaque. Hua xi kou qiang yi xue za zhi. Journal of Stomatology 2003;21:295-7.  Back to cited text no. 12
    
13.
Carlander D. Avian Igy Antibody: In Vitro And In Vivo Comprehensive Summaries Of Uppsala Dissertation From The Faculty Of Medicine 2002. p. 53.  Back to cited text no. 13
    
14.
Gupta M. Sugar substitutes: Mechanism, availability, current use and safety concerns-an update. Open Access Maced J Med Sci 2018;6:1888-94.  Back to cited text no. 14
    


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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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