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ORIGINAL ARTICLE
Year : 2006  |  Volume : 24  |  Issue : 2  |  Page : 63-68
 

Genetic sensitivity to the bitter taste of 6-n propylthiouracil: A new risk determinant for dental caries in children


Department of Pedodontics and Preventive Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University, Tamil Nadu, India

Correspondence Address:
Ullal Anand Nayak
18, Faculty Quarters, Annamalai Nagar - 608002, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.26018

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  Abstract 

The aims of the present study were to contrast the prevalence of dental caries in children with different genetic sensitivity levels to the bitter taste of 6-n-propylthiouracil (PROP) and to determine the taste quality and taste intensity preferences of food products among the taster and nontaster groups. Overall caries experience (dmfs/DMFS) was significantly higher for nontasters than tasters. Caries experience on the available surfaces (dfs/DFS) was found to be significantly higher in nontasters than in medium tasters and in medium tasters than in supertasters (r=-0.41, P <0.001). Majority of the nontasters were sweet likers and preferred strong tasting food products, while majority of the supertasters were sweet dislikers and preferred weak tastes. There was a significant increase in the overall caries experience in the population, as the genetic ability to detect PROP taste decreased ( P <0.001). After all associated factors (age, gender, race, number of teeth and OHI-S) were controlled; multiple linear regression analyses revealed that taste was the only variable significantly related to overall caries experience.


Keywords: Genetic taste sensitivity, medium tasters, nontasters, 6-n-propylthiouracil, supertasters


How to cite this article:
Rupesh S, Nayak UA. Genetic sensitivity to the bitter taste of 6-n propylthiouracil: A new risk determinant for dental caries in children. J Indian Soc Pedod Prev Dent 2006;24:63-8

How to cite this URL:
Rupesh S, Nayak UA. Genetic sensitivity to the bitter taste of 6-n propylthiouracil: A new risk determinant for dental caries in children. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2019 Dec 11];24:63-8. Available from: http://www.jisppd.com/text.asp?2006/24/2/63/26018


Dental caries is one of the most prevalent infectious diseases to afflict mankind.[1] The dramatic decline in caries prevalence in the nations of the western world has been the most significant recent epidemiological event. However, unlike this sharp decline in caries experience in Western Europe and North America, caries experience is increasing rapidly in children in developing countries.[2]

The development of dental caries is dependent on critical interrelationships between susceptible tooth surface, specific oral bacteria and dietary carbohydrates.[3] Various risk markers such as salivary counts of streptococci mutans and lactobacilli, socio-economic factors, past caries experience and the frequency and amount of sugar intake have been evaluated to identify children at high risk for dental caries.[4],[5] However, it is difficult, if not impossible, to identify at risk population with currently available caries screening methods.[1]

Recent studies have revealed that higher and more frequent sugar intake may increase the risk of caries formation in children.[4],[6],[7] There is overwhelming evidence to support the link between sugar consumption and dental caries; it has now reached the status of an unequivocal axiom.[8] Lehl et al reported that a high decayed, missing, and filled permanent teeth index (>3) in a group of 4-712 year old children was positively related to sweet scores and total sugar exposures. They also reported that high sugar intake reflects a preference for sweet substances among a majority of children.[6] However, physiological mechanisms that affect a child's craving for sweet substances have not been well documented.[9] Inherited behaviour and taste thresholds may play an important role in the frequency of carbohydrate intake. Genetic sensitivity to taste may be associated with a preference for, or rejection of some foods by children.[10] Sensitivity to taste is an inherited trait in children. Children accordingly may be supertasters, medium tasters or nontasters as determined by the subject's taste threshold.[11]

Taste worlds of humans vary because of taste blindness to phenylthiocarbamide (PTC) and its chemical relative 6-n-

propylthiouracil (PROP).[9] Taste blindness to PTC and PROP was discovered in the 1930s. PROP, however is safer with less sulphurous odour.[12] PROP paper is a useful tool in determining the genetic sensitivity to bitter and sweet tastes as well as the burn sensation.[12],[13] Sensitivity to the bitter taste of PROP is an inherited trait.[14]

PROP is a medication used in the treatment of Grave's disease (hyperthyroidism), and the therapeutic dosage is 150 to 200 mg daily for adults and 50 to 150 mg daily for children aged 6-10 years. However, PROP can be tasted at very low concentration and the filter paper used for taste research contains only approximately 1.6 mg of PROP.[15] The subset of population who rate PROP paper as intensely bitter are identified as supertasters. A supertaster child is able to perceive stronger bitter and sweet tastes as compared to medium and nontasters.[9],[16] Anatomically, supertasters also have a higher density of fungiform papillae and taste receptors on the anterior portion of the tongue than medium tasters and nontasters.[9],[12],[13],[17]

Supertasters are thus able to perceive taste in a lower concentration of bitter or sweet substance than nontasters. In contrast, nontasters may not be able to perceive sweet or bitter taste in the same concentration as supertasters and hence, require a higher concentration to perceive taste in the food products. Nontaster children may therefore have higher concentration and frequencies of sugar intake compared to children who are medium or supertasters and are therefore more susceptible to dental caries.[10]

Understanding what motivates the preference for and selection of foods may have important dental health implications in terms of risk for dental diseases. There is a relative paucity of studies in the dental literature in this regard. It was hypothesized that a higher prevalence of dental diseases would be observed among nontaster children as compared to children who were medium and supertasters.[15]

This study was carried out with the following aims and objectives:

1. To contrast the prevalence of dental caries in children with different genetic sensitivity levels to the bitter taste of PROP.

2. To determine the taste quality and taste intensity preferences of food products among the taster and nontaster groups.


  Materials and Methods Top


This study was carried out at the Division of Pedodontics and Preventive dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University, Tamil Nadu, India.

The study population

Subjects consisted of a convenience sample, randomly selected from consecutive children who were taking part in the school dental health program at the Division of Pedodontics and Preventive dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University. A group of 340 children were selected for the study based on the following selection criteria:

1. Age group of 6-12 years.

2. ASA physical status I/II and stable mental condition.

3. No medical/ hereditary condition or long term/ recent/ current regimen of medication that can affect salivary flow, alter the taste sensation or necessitate diet modification.

4. No known allergy/ history of adverse reactions to 6-n-propylthiouracil.

5. No acute dental distress, requiring emergency dental treatment.

6. No history of recent or current antibiotic usage.

7. No orthodontic appliance worn.

8. Participant cooperation and acceptance of the study procedures.

9. No fluoride mouth rinse program being currently being practiced in the school from which the participants were chosen.

10. No current participation in other trials.

The sample population comprised of 340 healthy schoolchildren aged 6-12 years. Among these, 80 sibling groups were identified, of which 69 groups had two siblings and 11 groups had three siblings. Informed consent forms were obtained from the parent/guardian prior to beginning the research procedure, after the nature of the study was fully explained.

Clinical examination

A single trained and calibrated examiner performed a comprehensive clinical examination with the assistance of one recorder. All the teeth were examined according to the Pitts and Fyffe criteria (1988, UK) [18] for coronal surface caries and restorations. The number of decayed, missing and filled surfaces (dmfs/DMFS) in the coronal portion of each tooth and the percentage of decayed, missing and filled surfaces (dmfs/DMFS%) were determined. Both primary and permanent dentitions were included. Diagnosis of interproximal caries was confirmed with bitewing radiographs wherever necessary. Codes for sound primary caries, secondary (recurrent) caries, preventive restorations, permanent restorations, crowns, defective/temporary restorations and unerupted/ inaccessible areas were assigned to each coronal tooth surface. Soft tissue lesions and the simplified Oral Hygiene Index (OHI-s) were recorded.[19] The dental examinations were performed in a lighted operatory with direct visual inspection and tactile sensation with a dental explorer and mouth mirror.

The subject's taste quality (sweet/ bitter/ spicy/others) and taste intensity (weak tastes/moderate tastes/strong tastes) preferences of food products were recorded with the help of a simple subjective questionnaire.

PROP testing

The PROP test was carried out by another trained examiner with the help of one recorder. At no point in the study was this examiner aware of the caries scores and oral hygiene status of any of the study participants.

The PROP paper used in this study was a circular piece of Whatman no: 3 filter paper (3 cm diameter) containing approximately 1.6 mg of 6-n-propylthiouracil (PROP); prepared at the Department of Pharmacy, Annamalai University, Tamil Nadu (India). Following data collection, the filter paper containing PROP was placed on the dorsal surface of the subject's tongue for 30 seconds to determine the genetic ability to taste a bitter or sweet substance. It was ensured that the subjects abstained from consumption of any form of diet at least two hours prior to the PROP testing. When the bitter taste was at a maximum, the subject would rate the intensity of bitterness on the modified Green's scale (20,21) and would be classified into groups of supertasters (>60), medium tasters (12-60) and nontasters (<12). All clinical examinations and PROP testing were carried out at the same time of the day (mid-morning) throughout the study.

All the cross sectional data were entered into a data base on Microsoft Excel and analyzed with SPSS software using ANOVA with Duncan's multiple range test, Mantel-Haenszel chi square, multiple linear regression analysis and Pearson's coefficient of correlation.


  Results Top


The study population

The sample population comprised of 340 healthy schoolchildren aged 6-12 years [Table - 1]. Among these, 63 subjects were nontasters (19%), 168 were medium tasters (49%) and 109 subjects were supertasters (32%). Supertasters accounted for approximately one-third of the sample population and medium tasters accounted for approximately half of the sample population. Male subjects predominated in both nontaster and medium taster groups, while female subjects made up the majority of the supertasters. Among female subjects, supertasters comprised more than one-third (38%) of the group. The mean age was equivalent for nontasters (8 years), medium tasters (9 years) and supertasters (8 years). For nontasters, the mean number of natural teeth present was 23. Supertasters tended to have more teeth (24 teeth). However, the difference was not statistically significant. The mean OHI-s for nontasters was 2.05. The mean OHI-s score decreased in medium tasters (1.47), and was even lower in supertasters (0.91), which showed that supertasters had better oral hygiene. The difference was statistically significant ( r = -0.44, P <0.0001)

Taste preferences

Subject's taste quality and taste intensity preferences were recorded with a subjective questionnaire [Table - 2]. Percentage of subjects who preferred sweet taste (sweet likers) was highest among nontasters (76%) as compared to medium tasters (51%) and was lowest among the supertasters (33%). The difference was statistically significant among the three groups ( r = 0.13, P <0.0001). Supertaster group tended to have a higher percentage of subjects (67%) who preferred other tastes (sweet dislikers) as compared to medium tasters (49%) and nontasters (24%). The difference was statistically significant ( r = 0.85, P <0.05). Strong tasting food products were preferred by 29% of nontasters while only 9% of medium tasters and 5% of supertasters preferred strong tastes. However, the difference was not statistically significant. Subjects who preferred food products with weak/mild tastes constituted more than half (62%) of the supertaster group, as compared to medium taster (35%) and the nontaster group (35%). The difference was statistically significant ( r = 0.62, P <0.001).

Sibling groups

Eighty sibling groups participated in the study. Among these, 69 groups had two siblings and 11 groups had three siblings [Table - 3]. Within the sibling groups, more than half (61%) of the sibling groups were in the same taste category (9 sibling groups in the nontaster group, 25 in the medium taster group and 15 in the supertaster group). Since the sample characteristics were similar among populations with and without siblings, the contrast of caries experiences among supertasters, medium tasters and nontasters was only analyzed in the total sample population (N=340).

Supertasters vs medium tasters vs nontasters among the sample population

The prevalence of coronal caries experience was contrasted among supertasters, medium tasters and nontasters by one-way ANOVA tests [Table - 4]. Both primary and permanent dentition surfaces were included in the data analyses. Five surfaces of each tooth were evaluated and the number of decayed, missing and filled coronal surfaces (dmfs/DMFS) was determined. Overall caries experience (dmfs/DMFS) was significantly higher for nontasters than tasters. In order to address the potential bias in recording the teeth missing in primary dentition due to natural exfoliation, the caries experience on the available surfaces (dfs/DFS) was also determined. When caries experience was expressed as the percentage of available surfaces (dfs/DFS%), the significant difference persisted ( r = -0.41, P <0.001). A pattern of increasing overall caries experience, as the genetic ability to detect PROP taste decreased, was also noted ( r = -0.54, P <0.0001). The Pearson ( r ) correlation coefficient showed a negative (inverse) correlation between the two variables (level of PROP taste and dmfs/DMFS index). When individual components of dmfs/DMFS were assessed separately and expressed as a percentage of available surfaces, ds/DS%, ms/MS% and fs/FS% were consistently greatest in nontasters, decreased in medium tasters and were even lower in supertasters. The differences were statistically significant among the three groups. Nontasters had higher number of decayed surfaces (ds/DS%) than the medium tasters and supertasters. The difference was statistically significant in ds/DS% ( r = -0.38, P <0.0001); however, Duncan's multiple range tests revealed that the difference observed in fs/FS% was significant only between supertasters and nontasters ( r = -0.22, P <0.0001). Nontasters also had a higher percentage of missing surfaces (ms/MS%) than medium tasters and supertasters and the difference was statistically significant between the nontaster and the supertaster groups ( r = -0.16, P <0.0001).

After all associated factors (age, gender, race, number of teeth and OHI-s) were controlled, multiple linear regression analyses revealed that taste was the only independent variable significantly related to the overall caries experience ( P <0.0001).


  Discussion Top


Studies have identified several indicators for an increased risk of dental caries; however, the influence of taste sensation, which leads to the preference for, or rejection of food products on dental caries in children, has not been well documented. Knowledge of an individual's taste threshold may facilitate the identification of children who are at high risk for developing dental caries.[15]

The majority of the children who participated in the study were medium tasters (49%), followed by supertasters (32%) and nontasters (19%). All the subjects who took part in the study belonged to lower socioeconomic strata of the society. The results indicated, in general, that overall caries experience was significantly higher for nontasters than for tasters. The dmfs/DMFS index was used to determine the coronal caries experience. This index is very sensitive but is more likely to produce inconsistencies in diagnosis. Hence, a single trained and calibrated examiner examined all the subjects and bitewing radiographs supplemented the diagnosis of interproximal caries wherever necessary. In the subjects of this study, missing deciduous teeth, lost as a result of normal exfoliation were differentiated from teeth lost due to caries. The dfs/DFS index was also used to determine the coronal caries experience of the available surfaces to get around the exfoliation problem.

A pattern of increasing overall caries experience was observed, as the genetic sensitivity to detect bitterness of PROP paper decreased. While nontasters had more decayed and filled surfaces (dfs/DFS) as compared to tasters, the largest contrast was found between nontasters and supertasters. A pilot study by Lin in a group of 150 children (6-12 year old) also indicated that the overall caries experience was significantly higher for nontasters than for tasters. A pattern of increasing overall caries experience as the genetic ability to detect bitterness of PROP was also suggested.[15]

Women are more likely to be supertasters than men. Anatomical data revealed that women have more fungiform papilla than men.[9] The gender distribution of subjects in the present study showed that male subjects were more in both nontaster and medium taster groups than female subjects. Among female subjects, supertasters comprised more than one-third of the group.

Genetically mediated sensitivity to the bitter taste of PROP has long been associated with enhanced sensitivity to other sweet and bitter compounds. Studies suggest that tasters and supertasters of PROP may also differ from nontasters in their taste preferences and in their patterns of food rejection and food acceptance.[22] Looy et al reported that PROP nontasters (both children and adults) were almost always sweet likers whereas sweet dislikers were almost always PROP tasters.[23] In the present study, majority of the nontasters preferred sweet to other tastes, while only one-third of the supertasters were sweet likers.

The development of video-microscopy revealed an association between PROP tasting and tongue anatomy.[24] Supertasters tended to have the most fungiform papillae and taste buds.[9] Psychophysical data indicated that supertasters perceive intense bitterness and sweetness from a variety of compounds, the most intense burn from oral irritants and the most intense tactile sensations from viscous solutions.[12] While about one-third of the nontasters (29%) in the present study preferred strong tasting foods, very few supertasters (5%) preferred strong tastes. Infact the majority of the supertasters (62%) preferred weak tastes. There were also a few nontaster children who preferred extremely spicy foods. These results are in agreement with the observations of Anliker et al who evaluated 34 children aged 5-7 years. They found that the tasters had less preference for food products with stronger tastes than nontasters.[10] In the present study, bitterness was the most identified sensation among tasters. Several taster subjects identified the PROP taste to be actually sweet, while a few even reported of a burning sensation.

Sensitivity to the bitter taste of PROP is an inherited trait.[14] The current understanding of bitter taste has advanced from the discovery and study of the TAS2R family of taste receptor genes.[25] Mennella et al classified 143 children and their mothers into three groups based on their TAS2R38 genotype (gene that encodes a taste receptor responsive to bitter taste). Type AA had two bitter insensitive alleles (nontasters), Type PP had two bitter sensitive alleles (supertasters) and type AP had one of each (medium tastes).[26] Family studies show that subjects who could not taste PROP (nontasters) carried two recessive alleles.[12] The data from the present study also revealed a strong genetic component among sibling pairs within the same family. Among the 80 sibling groups, more than half of the sibling groups (61%) belonged to the same taste category. The data is consistent with the observations of Lin who studied 25 sibling groups.[15]

Genetic taste sensitivity to the bitter taste of PROP was evaluated in 6-12 year old children in the present study. There is little information regarding the ability of children to analyze complex sensitivity to somatosensory stimuli in terms of the presence and magnitude of the components. However, Turnbull and Smith pointed out that, children as young as 3 years of age can partake in direct investigations of taste, comply reliably with test procedures and accurately communicate taste perceptions and preferences under test conditions.[27] Recent studies revealed that unlike children, bitter receptor genotype did not influence sweet preferences in adults. Instead, effects of race/ethnicity were the strongest determinants; the forces of experience and culture appeared to have overridden the genetic effect.[26]

A modified Green's scale was the standard labelled magnitude scale used in the present study as a visual analog to determine the subject's genetic sensitivity levels to the bitter taste of PROP.[20],[21] The study sample was of lower socio-economic strata, living in Annamalai Nagar in Tamil Nadu (India). The racial, socio-economic and geographic distribution of these subjects might not be applicable to other populations of children. Hence, future investigations utilizing a more objective and precise genetic indicator of taste as well as correlating other associated factors (e.g.: behaviour, weight, dietary and oral hygiene habits, salivary flow rate) are warranted in children.

The following conclusions were drawn from the results of the present study:

1. Among the 340 healthy school children aged 6-12 years, supertasters accounted for approximately one-third (32%) of the sample population; medium tasters accounted for approximately half (49%); while only 19% of the sample population were nontasters.

2. Majority of the nontasters were sweet likers and preferred strong tasting food products, while majority of the supertasters were sweet dislikers and preferred weak tastes.

3. A strong genetic component among sibling pairs within the same family was observed, with more than half (61%) of the sibling groups in the same taste category.

4. The prevalence of coronal caries experience was significantly higher in nontaster than in taster children.

5. There was a significant increase in the overall caries experience in the population, as the genetic ability to detect PROP taste decreased.

6. After all associated factors (age, gender, race, number of teeth and OHI-s) were controlled; multiple linear regression analyses revealed that taste was the only variable significantly related to overall caries experience.

 
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2.Nikiforuk G. Epidemiology of dental caries. In : Nikiforuk G (editor) Understanding Dental Caries-1 Etiology and mechanisms, 1st ed. Karger: New York; 1985. p. 38-43.  Back to cited text no. 2    
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5.Johnson NW. Introduction: The nature of the caries process and the need for markers at risk. In : Johnson NW (editor) Risk markers for oral diseases - volume 1- Dental caries. 1st ed. Cambridge University Press: Cambridge; 1991. p. 1-12.  Back to cited text no. 5    
6.Lehl G, Bansal K, Sekham R. Relationship between cariogenic diet and dental caries as evaluated from a 5-day diet diary in 4-12 year old children. J Indian Soc Pedod Prevent Dentist 1999;17:119-21.  Back to cited text no. 6    
7.Beighton D, Adamson A, Rugg-Gunn A. Associations between dietary intake, dental caries experience and salivary bacterial levels in 12 year old English school children. Arch Oral Biol 1996;41:271-80.  Back to cited text no. 7    
8.Watt R, Siham A. Inequalities in oral health: A review of the evidence and recommendation for action. Br Dental J 1999;187:6-12.  Back to cited text no. 8    
9.Bartoshuk LM, Duffy VB, Miller IJ. PTC/PROP tasting: Anatomy, psychophysics and sex effects. Physiol Behav 1994;56:1165-71.  Back to cited text no. 9  [PUBMED]  
10.Anliker JA, Bartoshuk L, Ferris AM, Hooks LD. Children's food preferences and genetic sensitivity to the bitter taste of 6-n-propylthiouracil (PROP). Am J Clin Nutr 1991;54:316-20.  Back to cited text no. 10  [PUBMED]  
11.Lucchina LA, Curtis OE, Putnam P, Drewnowski A, Prutkin JM, Bartoshuk LM. Psychophysical measurement of 6-n-propylthiouracil (PROP) taste perception. Annal New York Acad Sci 1998;855:816-9.  Back to cited text no. 11    
12.Bartoshuk LM, Duffy VB, Lucchina LA, Prutkin J, Fast K. PROP (6-n-propylthiouracil) supertasters and the saltiness of NaCl. Annal New York Acad Sci 1998;855:793-6.  Back to cited text no. 12    
13.Duffy VB, Davidson AC, Kidd JR, Kidd KK, Speed WC, Pakstis AJ, et al. Bitter receptor gene (TAS2R38), 6-n-propylthiouracil (prop) bitterness and alcohol intake. Alcoholism. Clini Exp Res 2004;28:1629-37.  Back to cited text no. 13    
14.Drewnoski A, Henderson SA, Fornell AB. Genetic taste markers and food preferences. Drug Metab Dis 2001;29:535-8.  Back to cited text no. 14    
15.Lin BP. Caries experience in children with various genetic sensitivity levels to the bitter taste of 6-n-propylthiouracil (PROP): A pilot study. Pediatr Dentist 2003;25:37-42.  Back to cited text no. 15    
16.Pickering GJ, Simunkova K, Di Battista D. Intensity of taste and astringency sensations elicited by red wines is associated with sensitivity to PROP (6-n-propylthiouracil). Food Qual Prefce 2004;15:147-54.  Back to cited text no. 16    
17.Yackinous CA, Guinard JX. Relation between taste status, taste anatomy and dietary intake measures for young men and women. Appetite 2002;38:201-9.  Back to cited text no. 17    
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19.Green JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:25-31.  Back to cited text no. 19    
20.Green BG, Shaffer GS, Gilmore MM. A semantically labelled magnitude scale of oral sensation with apparent ratio properties. Chem Sens 1993;18:683-702.  Back to cited text no. 20    
21.Green BG, Dalton P, Cowart B, Rankin K, Higgins J. Evaluating the labelled magnitude scale for measuring sensations of taste and smell. Chem Sens 1996;21:323-34.  Back to cited text no. 21    
22.Drewnoski A, Rock CL. The influence of genetic taste markers on food acceptance. Am J Clin Nutr 1995;62:506-11.  Back to cited text no. 22    
23.Looy H, Weingarten HP. Facial expressions and genetic sensitivity to 6-n-propylthiouracil predict hedonic response to sweet. Physiol Behav 1992;52:75-82.  Back to cited text no. 23    
24.Miller IJ, Reedy FE. Variations in human taste bud density and taste intensity perception. Physiol Behav 1990;47:1213-9.  Back to cited text no. 24    
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26.Mennella JA, Pepino MY, Reed DR. Genetic and environmental determinants of bitter perception and sweet preferences. Pediatrics 2005;1115:e216-22.  Back to cited text no. 26    
27.Turnbull B, Smith EM. Taste sensitivity to 6-n-propylthiouracil predicts acceptance of bitter tasting spinach in 3-6 year old children. Am J Clin Nutr 2002;76:1101-5.  Back to cited text no. 27    


    Tables

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


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Journal of Sensory Studies. 2009; 24(3): 354-371
[Pubmed]
17 RELATIONSHIP OF PROP (6-N-PROPYLTHIOURACIL) TASTER STATUS WITH THE BODY MASS INDEX AND FOOD PREFERENCES OF FILIPINO ADULTS
BLANCA J. VILLARINO,CARLENETH P. FERNANDEZ,JUDIT C. ALDAY,CHRISTLE GRACE R. CUBELO
Journal of Sensory Studies. 2009; 24(3): 354
[Pubmed] | [DOI]
18 The use of general anesthesia in pediatric dental care of children at multi-dental centers in Saudi Arabia
BaAkdah, R. and Farsi, N. and Boker, A. and Al Mushayt, A.
Journal of Clinical Pediatric Dentistry. 2008; 33(2): 147-154
[Pubmed]
19 Genetic sensitivity to 6-N-propylthiouracil (PROP) as a screening tool for obesity and dental caries in children
Hegde, A. and Sharma, A.
Journal of Clinical Pediatric Dentistry. 2008; 33(2): 107-112
[Pubmed]



 

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  2005 - Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Wolters Kluwer - Medknow 
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