INTRODUCTION:

Carbonated drinks consumption has became the most visible and devasting public health issue. This along with the fast food consumption is the most important contributing factor for obesity and more health related problems. Soft drinks offer energy with little accompanying nutrition and displace other nutrient sources which are linked to many health conditions such as diabetes and hence reduction in consumption of soft drinks is recommended^[1].

Excessive intake of soft drinks could cause complex dental consequences including dental erosion and caries^[2].

Energy drinks consists of caffeine and some proprietary energy blends that vary between each products. Caffeine has been recognized as safe in doses less than 400 mg by the Food and Drug Administration^[3]. There is a strong relationship between energy drinks and dental erosion^[4]. This is because of the low pH and high sugar content of energy drinks^[5]. It has been found that consuming energy drink can lead to cervical dentin hypersensitivity^[6]. Even though there are many positive beneficial effects on exercise performance, various body parts are negatively affected after consuming energy drinks^[7].

Saliva plays a significant role in the maintenance of oral Health^[8]. Saliva consistency can be watery, thick, sticky or frothy depending on its composition^[9]. The ability to monitor the health and disease status of the patient through saliva is a highly desirable goal for the health professionals^[10]. Saliva has a normal pH of 6.7 ranging between 6.2-7.6. In the oral cavity, the pH is maintained near neutrality (6.7-7.3) by saliva. The saliva maintains the pH by two mechanisms which includes elimination of the carbohydrates which could be metabolized by the bacteria thus acid production by the bacteria is removed and acid produced by food, drinks and microbes neutralized by the buffering activity of saliva^[11]. Thus decrease in the salivary pH provides an acidogenic environment for the growth of aciduric bacteria leading to dental caries which again further lowers the salivary pH leading to a vicious cycle^[12]. Salivary pH is a diagnostic biomarker for periodontal diseases. In patients with generalised chronic periodontitis, pH of saliva was found to be more acidic^[13]. Thus this study is designed to evaluate and compare the effects of carbonated and energy drinks on salivary pH.

MATERIALS AND METHODS:

Study Design:

It is a open-label, parallel group, randomized controlled clinical trial.

Study Population:

Final year dental students and interns of Saveetha Dental College and Hospitals, Chennai were recruited for a open-label, parallel group, randomized controlled clinical trial.

Eligibility Criteria:

Inclusion criteria

a) Subjects who were 18–22 years of age.

b) Subjects who were caries-free, that is, with DMFT score = 0.

c) Subjects who were not suffering from any systemic disease or illness.

Exclusion criteria:

a) Subjects who did not give informed consent.

b) Subjects who were using alcohol or tobacco in any form.

c) Subjects who were using any medication at the time of study or in the period of the last 15 days prior to the study.

d) Subjects who were suffering from any systemic illness.

Sample Size Determination:

Sample size was calculated based on study by Eswara Uma et al. (2018) using a priori by G*Power 3.1.2 software. The minimum sample size of each group was calculated, following these input conditions: power of 0.95 and P≤0.05 and sample size arrived were 10 per group.

Ethical Clearance:

Prior to the start of the study, ethical clearance was obtained from the institutional ethics committee, Saveetha University.

Products tested and its composition:

Refer Table 1

Armamentarium:

The following equipment/instrument/materials were used for the study:

· Dental chair

· Dental operating tool

· Tray sheet

· Disposable head cap

· Disposable Mouth mask

· Disposable gloves- small size

· Disposable cups

· Disinfecting solution

· Kidney tray

· Plane mouth mirror

· Uricol

· Proforma

Study Procedure:

Step 1: Obtaining preoperative details and informed consent from study participants:

Prior to the treatment, a careful medical and dental history was taken. Preoperative data for each participant was recorded in the predesigned proforma which includes age, gender and address. The study design was explained to the qualifying participant and informed consent was obtained from the voluntary patients who were willing to participate in the study.

Step 2: Preparation of participants:

Subjects of each group underwent scaling and polishing one day before study. They were instructed to refrain from eating in morning on the day of study till saliva sample was collected.

Step 3: Collection of salivary sample at baseline:

The participants drooled the saliva sample in a 50mL sterile uricol.

Step 4: Measurement of baseline pH:

The saliva was collected and was ensured that the glass bulb of the electrode sensor was completely immersed in saliva sample to obtain an accurate reading. The glass electrode was cleansed using deionised water carefully and was dried using filter paper before next sample was analysed. Baseline pH was noted.

Step 4: Dispensing the beverage:

A volume of 200mL of the room temperature beverage was dispensed to each group participants. The beverage was given once only and the participants were asked to consume it within 5 minutes of baseline pH measurement.

Step 5: Measurement of pH:

The salivary sample of each subject was collected in separate uricol coded with specific identity number at 5minutes, 10minutes and 15 minutes interval after beverage consumption. pH of each sample noted.

Statistical Analysis:

· Data was entered in Microsoft excel spread sheet and analysed using SPSS software

· (version 17).

· Numerical data were presented as mean and standard deviation values.

· For test, a p value of <0.05 is to be considered statistically significant.

· Kruskal-Waliis test was used to compare the mean differences of pH between the groups.

Figure1:Comparison of salivary pH at different time intervals between the groups

RESULTS:

Table 2 and Figure 1 depicts changing trends of mean pH value before consumption of Group 1,2,3 at baseline and after 5 minutes, 10 minutes and 15 minutes of consumption of each group. No significant change was observed in mean pH value of Group 1 from baseline value of 7 to 6.90 after 5 minutes; at 10 minutes, there was a slight increase observed in mean pH value of Group 1 from the value at 5 minutes of 6.90 to 7.04 and at 15minutes, there was a slight increase in mean pH value of Group 1 from value at 10 minutes of 7.04 to 7.16. Next after consumption of Group 2, a drastic reduction was observed in mean pH value of Group 2 from baseline value of 6.88 to 6.66 after 5 minutes; at 10 minutes, there was a significant reduction observed in mean pH value of Group 2 from the value at 5 minutes of 6.66 to 6.36 and at 15 minutes, there was a significant reduction in mean pH value of Group 2 from value at 10 minutes of 6.36 to 6.22. After consumption of Group 3, a dramatic reduction was observed in mean pH value of Group 3 from baseline value of 7.06 to 6.72 after 5 minutes; at 10 minutes, there was a slight decrease observed in mean pH value of Group 3 from the value at 5 minutes of 6.72 to 6.54 but at 15 minutes, there was a significant increase in mean pH value of Group 3 from value at 10 minutes of 6.54 to 6.94. A statistical significant difference was observed in mean pH value at baseline and after consumption of each group using Kruskal Wallis test. Graph 1 depicts the difference in mean pH value between each groups at baseline and 5 minutes, 10 minutes, 15 minutes after consumption of sample.

GROUP 1 GROUP 1 GROUP 3

Group 1: Bisleri Mineral Water

Group 2: Carbonated Drink (Pepsi)

Group 3: Energy Drink (Monster)

Figure 2: Study Groups

DISCUSSION:

In the present study, a statistically significant reduction in mean pH value was observed in all three groups at baseline and after 5 minutes using Kruskal Wallis test; but after 10 minutes and 15 minutes, mean pH value increased in Group 1 and significant increase in mean pH value after 15 minutes of consumption of Group 3 was found. But there wasn’t any significant change seen in group 1 compared with the baseline. Our study is similar to a study done by Eswara Uma who also observed no significant change in pH in mineral water group after 5 (P = 0.353), 10 (P = 0.388), 15 (P = 0.108), 20 (P = 0.163) and 30 (P = 0.845) minutes compared to baseline. There was slight increase in pH value after 20 minutes of consumption of mineral water which was also seen in our study after 15 minutes^[14]. This finding was similar to a study done by Azrak et al. where he stated that an increase in the salivary pH was attributed to the low buffering capacity of the mineral water and probably to the gustatory stimulus post-consumption^[15]. In our study, after consumption of pepsi there was significant reduction in pH after 5,10,15 minutes. But our study is in contrast with the study done by Rinki Hans where he observed decrease in mean pH value from baseline of 7.18 ± 0.22 to 6.21 ± 0.26 after 5 minutes but it gradually started increasing after 10 minutes to 6.75 ± 0.16 and 7.2 ± 0.20 after 15 minutes^[16]. This finding was also similar with the study done by Balappanavar A. Y. and Moazzez R.^[17][18]. Neha Gupta observed sudden drastic decrease in pH after consuming carbonated drinks but it gradually increased after 5,10 and 15 minutes^[19]. A study done by Katherine Beltran shows that clear demineralization observed at 30 minutes, followed by remineralization at 60 minutes after immersing the enamel specimens in monster drink^[20].

CONCLUSION:

To conclude, there was no significant change in pH after consuming Bisleri mineral water but pH became more acidic after consuming carbonated drinks. On consumption of energy drink even after reduction in pH after 5 minutes, it increased in pH after 10 to 15 minutes and almost reached the baseline. Thus in this century of craving more towards all soft drinks its better to at least consume energy drink compared to carbonated drink even though both are harmful for oral environment. More clinical trials should be conducted with various energy drinks to confirm.

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17. Balappanavar A. Y., Sardana V., Singh M. Comparison of the effectiveness of 0.5% tea, 2% neem and 0.2% chlorhexidine mouthwashes on oral health: a randomized control trial. Indian Journal of Dental Research. 2013; 24(1):26–34.

18. Moazzez R., Smith B. G. N., Bartlett D. W. Oral pH and drinking habit during ingestion of a carbonated drink in a group of adolescents with dental erosion. Journal of Dentistry. 2000; 28(6):395–397.

19. Gupta N, Mutreja S, Kamate SK, Gupta B. Evaluation of change in salivary pH, following consumption of different snacks and beverages and estimation of their oral clearance time. Int J Oral Care Res 2015; 3:25-31.

20. Beltrán K and Cardona W. Erosive effect of energy drinks alone and mixed with alcohol on human enamel surface. An in vitro study. J Oral Res 2017; 6(1): 12-15.

Received on 15.03.2019 Modified on 17.04.2019

Research J. Pharm. and Tech. 2019; 12(10): 4699-4702.

DOI: 10.5958/0974-360X.2019.00809.6