Demineralization effects of breast milk, formula milk and cow’s milk on the primary teeth. A study of SEM-EDX analysis

Year 2024, , 510 - 519, 05.07.2024

Ceylan Çağıl Ertuğrul

https://doi.org/10.31362/patd.1434306

Abstract

Purpose: It was aimed to investigate demineralization effects of breast milk, formula milk and cow's milk on deciduous teeth with SEM-EDX analysis.
Materials and methods: Demineralization effects of breast milk (Group 1), 3 different formula milks: Aptamil Pronutra-3 (Group 2), Hipp Organic-3 (Group 3), SmA Optipro-2 (Group 4) and cow's milk (Group 5) on newly extracted caries-free primary incisors were investigated on 5 teeth in each group. Each tooth was split in the sagittal direction from the midline and embedded in 2 separate acrylic blocks with their labial surfaces exposed. Half of the teeth was exposed to the milk material for 15 minutes, 4 times a day for 5 days, while the other half was kept in artificial saliva only. After the exposures, Scanning Electron Microscopy (SEM) images of the labial surfaces were taken and Energy Dispersive X-ray Spectroscopy (EDX) analyzes were performed. For the statistical analysis Independent-Samples T test, Man Whitney U and Kruskal-Wallis test were used.
Results: The most increased enamel porosity was seen in Group 2. A significant decrease was observed in the amount of Ca on tooth surfaces exposed to breast milk and formula milks, and a significant increase in the amount of both Ca and P after exposure to cow's milk (p=0.009). The decrease observed in the amount of Ca after exposure to breast milk was significantly higher than that of formula milks (p=0.001).
Conclusion: Formula milk and breast milk are not innocent in terms of causing demineralization, therefore awareness of parents and dentists on this issue should be increased.

Keywords

Breast milk, formula milk, Cow’s milk, demineralization, SEM-EDX analysis

Ethical Statement

Permission was obtained from Pamukkale University Non-Interventional Clinical Research Ethics Committee for the study (permission date:03 March,.2020/number:5).

Supporting Institution

This research is supported by Pamukkale University Scientific Research Projects Department (Project number: 2020BSP008).

Project Number

2020BSP008

Thanks

Lots of thanks to Asst. Prof. Dr. Berna Kavakçıoğlu Yardımcı from Pamukkale University, Faculty of Science, Department of Biochemistry for the preparation of artificial saliva used in the experiments.

Anne sütü, formül süt ve inek sütünün süt dişleri üzerindeki demineralizasyon etkileri. Bir SEM-EDX analizi çalışması

Abstract

Amaç: Bu araştırmada anne sütü, formül süt ve inek sütünün süt dişleri üzerindeki demineralizasyon etkilerinin SEM-EDX analizi ile araştırılması amaçlanmıştır.
Gereç ve yöntem: Anne sütü (Grup 1), 3 farklı formül süt: Aptamil Pronutra-3 (Grup 2), Hipp Organik-3 (Grup 3), SmA Optipro-2 (Grup 4) ve inek sütünün (Grup 5) demineralizasyon etkileri her bir grupta 5 yeni çekilmiş çürüksüz süt kesici dişi üzerinde incelenmiştir. Her diş orta hattan sagittal yönde ikiye bölünerek labial yüzeyleri açıkta kalacak şekilde 2 ayrı akrilik bloğa gömülmüştür. Açıkta kalan diş yüzeyinin yarısı 5 gün boyunca günde 4 kez 15 dakika süreyle incelenecek süt materyaline maruz bırakılırken, diğer yarısı ise sadece yapay tükürük içerisinde tutulmuştur. Deney materyallerine maruziyet sonrası diş yüzeylerinin Taramalı Elektron Mikroskobu (SEM) görüntüleri alınmış ve Enerji Dağılımlı X-ışını Spektroskopisi (EDX) analizleri yapılmıştır. Verilerin istatistiksel analizinde Independent-Samples T testi, Man Whitney U ve Kruskal-Wallis testi kullanılmıştır.
Bulgular: En fazla artan mine pürüzlülüğü Grup 2'de görülmüştür. Anne sütü ve formül sütlere maruz kalan diş yüzeylerinde Ca miktarında anlamlı azalma, inek sütüne maruz kalan diş yüzeylerinde ise hem Ca hem de P miktarında anlamlı artış gözlenmiştir (p=0,009). Anne sütüne maruz kaldıktan sonra Ca miktarında gözlenen azalma, formül sütlere göre anlamlı olarak daha yüksek bulunmuştur (p=0,001).
Sonuç: Bu araştırmanın sonuçlarına göre bebeklik döneminde yaygın kullanılan formül sütler ve anne sütü süt dişlerinde demineralizasyona neden olması açısından şüphe uyandırmaktadır, bu nedenle ebeveynlerin ve diş hekimlerinin bu konuda farkındalığı arttırılmalıdır.

Keywords

Anne sütü, formül süt, inek sütü, demineralizasyon, SEM-EDX analizi

Project Number

2020BSP008

References

• 1. Ripa LW. Nursing caries: a comprehensive review. Pediatr Dent 1988;10:268-282.
• 2. Erickson PR, Mazhari E. Investigation of the role of human breast milk in caries development. Pediatr Dent 1999;21:86-90.
• 3. Mazhari F, Talebi M, Zoghi, M. Prevalence of early childhood caries and its risk factors in 6-60 months old children in Quchan. Dent Res J 2008;4:96-101.
• 4. Schroth RJ, Halchuk S, Star L. Prevalence and risk factors of caregiver reported severe early childhood caries in Manitoba First Nations children: results from the RHS Phase 2 (2008-2010). Int J Circumpolar Health 2013;72:21167. https://doi.org/10.3402/ijch.v72i0.21167
• 5. Lee MR, Lee CJ, Park JH. The Roughness & micro-hardness on the deciduous teeth according to formula milk or human milk. Int J Clin Prev Dent 2011;7:179-188.
• 6. Birkhed D, Ohlsson A, Svensson C, Edwardsson S, Imfeld T. Milk and lactose-acid production in human dental plaque. J Dent Res 1981;60:1245.
• 7. Bowen WH, Lawrence RA. Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose. Pediatrics 2005;116:921-926. https://doi.org/10.1542/peds.2004-2462
• 8. Martin CR, Ling PR, Blackburn GL. Review of infant feeding: key features of breast milk and infant formula. Nutrients 2016;8:279. https://doi.org/10.3390/nu8050279
• 9. Moynihan PJ, Wright WG, Walton AG. A comparison of the relative acidogenic potential of infant milk and soya infant formula: a plaque pH study. Int J Paediatr Dent 1996;6:177-181. https://doi.org/10.1111/j.1365-263X.1996.tb00238.x
• 10. Grenby TH, Andrews AT, Mistry M, Williams RJH. Dental caries-protective agents in milk and milk products: investigations in vitro. J Dent 2001;29:83-92. https://doi.org/10.1016/S0300-5712(00)00061-0
• 11. Danchaivijitr A, Nakornchai S, Thaweeboon B, Leelataweewud P, Phonghanyudh A, Kiatprajak C. The effect of different milk formulas on dental plaque pH. Int J Paediatr Dent 2006;16:192-198. https://doi.org/10.1111/j.1365-263X.2006.00722.x
• 12. Chaudhary SD, Chaudhary M, Singh A, Kunte S. An assessment of the cariogenicity of commonly used infant milk formulae using microbiological and biochemical methods. Int J Dent 2011;320798. https://doi.org/10.1155/2011/320798
• 13. Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am 2013;60:49-74. http://dx.doi.org/10.1016/j.pcl.2012.10.002
• 14. Rugg Gunn AJ, Roberts GJ, Wright WG. Effect of human milk on plaque pH in situ and enamel dissolution in vitro compared with bovine milk, lactose, and sucrose. Caries Res 1985;19:327-334. https://doi.org/10.1159/000260863
• 15. Bowen WH, Pearson SK. Effect of milk on cariogenesis. Caries Res 1993;27:461-466. https://doi.org/10.1159/000261581
• 16. Rollema HS. Casein association and micell formation. In Advanced Dairy Chemistry: Proteins (ed. Fox PF). London: Elsevier Applied Science, 1992;1:111-140.
• 17. Reynolds EC. The prevention of sub-surface demineralization of bovine enamel and change in plaque composition by casein in an intra-oral model. J Dent Res 1987;66:1120-1127. https://doi.org/10.1177/00220345870660060601
• 18. Peres RCR, Coppi LC, Volpato MC, Groppo FC, Cury JA, Rosalen PL. Cariogenic potential of cows', human and infant formula milks and effect of fluoride supplementation. Br J Nutr 2009;101:376-382. https://doi.org/10.1017/S0007114508020734
• 19. American Academy of Pediatrics. Breastfeeding and the use of human milk. Work Group on Breastfeeding. Pediatrics 1997;100:1035-1039. https://doi.org/10.1542/peds.100.6.1035
• 20. Aarthi J, Muthu MS, Sujatha S. Cariogenic potential of milk and infant formulas: a systematic review. Eur Arch Paediatr Dent 2013;14:289-300. https://doi.org/10.1007/s40368-013-0088-6
• 21. McKnight Hanes C, Whitford GM. Fluoride release from three glass ionomer materials and the effects of varnishing with or without finishing. Caries Res 1992;26:345-350. https://doi.org/10.1159/000261466
• 22. Amaechi BT, Higham SM, Edgar WM. Factors influencing the development of dental erosion in vitro: enamel type, temperature and exposure time. J Oral Rehabil 1999;26:624-630. https://doi.org/10.1046/j.1365-2842.1999.00433.x
• 23. Nozari A, Ghaderi F, Madadelahi S. pH-value decrement of saliva-plaque solution after mixing with four customary used infant milk formulas: an in vitro study. J Pediatr Dent 2014;2:92-95. https://doi.org/10.4103/2321-6646.145583
• 24. Peres RC, Coppi LC, Franco EM, Volpato MC, Groppo FC, Rosalen PL. Cariogenicity of different types of milk: an experimental study using animal model. Braz Dent J 2002;13:27-32.
• 25. Seow WK. Biological mechanisms of early childhood caries. Community Dent Oral Epidemiol 1998;26:8-27. https://doi.org/10.1111/j.1600-0528.1998.tb02090.x
• 26. Erickson PR, McClintock KL, Green N, LaFleur J. Estimation of the caries-related risk associated with infant formulas. Pediatr Dent 1998;20:395-403.
• 27. Mejia Olea O, Contreras Bulnes R, Zamudio Ortega RM, Morales Luckie RM, Olea Cardoso O, López Castañares R. Scanning electron microscopy and energy dispersive spectroscopy microanalysis applied to human dental specimens under laser irradiation for caries prevention. Formatex 2014:70-77.
• 28. Asaka Y, Miyazaki M, Aboshi H, et al. EDX fluorescence analysis and SEM observations of resin composites. J Oral Sci 2004;46:143-148. https://doi.org/10.2334/josnusd.46.143
• 29. American Academy of Pediatric Dentistry.Fluoride therapy. The Reference Manual of Pediatric Dentistry. Chicago, Ill: American Academy of Pediatric Dentistry 2021:302-305.
• 30. Branger B, Camelot F, Droz D, et al. Breastfeeding and early childhood caries. Review of the literature, recommendations, and prevention. Arch Pediatr 2019;26:497-503. https://doi.org/10.1016/j.arcped.2019.10.004