Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2018  |  Volume : 36  |  Issue : 1  |  Page : 53--57

A quantitative analysis of total carbohydrate content from the salivary expectorants in young children

Snehalika Ashok More1, Sandya S Patil1, Madhu Kakanur1, Rachna Thakur1, Mihir N Nayak2, S Ravi Kumar1,  
1 Department of Pedodontics and Preventive Dentistry, KLE Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
2 Department of Pedodontics and Preventive Dentistry, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Snehalika Ashok More
5/501, Omroop Niwas, Dattaram Lad Marg, Kalachowki, Mumbai - 400 033, Maharashtra


Background: In this postfluoride era, the concentration of fermentable carbohydrate in saliva after food intake is important to determine the risk of developing dental caries. Aim: The aim of this study is to estimate the total carbohydrate content of salivary expectorants following consumption of commercially processed snacks. Design: Thirty children aged 6–8 years were selected for estimation of total carbohydrate content of salivary expectorants using modified calorimetric anthrone-sulfuric acid-glucose reaction. The test foods analyzed were as follows: Test food A – potato chips, Test food B – glucose biscuits, Test food C – Oreo biscuits, Test food D – cake, and Test food E – cornflakes. The data obtained were analyzed using student's t-test and ANOVA. Results: The difference between the mean carbohydrate values of salivary expectorants of various processed test food groups at 0 and 10 min was statistically significant (P ≤ 0.001). After 10 min interval, cornflakes were found to have highest total carbohydrate content in salivary expectorant (5.186 mg/ml). Conclusion: The foods with high starch content such as cornflakes and potato chips exhibited higher total carbohydrate content, thus depicting lower salivary clearance rate.

How to cite this article:
More SA, Patil SS, Kakanur M, Thakur R, Nayak MN, Kumar S R. A quantitative analysis of total carbohydrate content from the salivary expectorants in young children.J Indian Soc Pedod Prev Dent 2018;36:53-57

How to cite this URL:
More SA, Patil SS, Kakanur M, Thakur R, Nayak MN, Kumar S R. A quantitative analysis of total carbohydrate content from the salivary expectorants in young children. J Indian Soc Pedod Prev Dent [serial online] 2018 [cited 2019 Dec 11 ];36:53-57
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The influence of saliva on carbohydrate food clearance should not be underestimated. The rampant grossly destructive carious process that is observed following altered salivary flow shows the physiological importance of the salivary secretion. The diluting, solubilizing, and cleansing actions of saliva are major factors influencing carbohydrate clearance. It can be seen that little research has been done in this area. Recognizing the essential role of processed foodstuffs rich in carbohydrate in dental caries etiology, it would be desirable to learn more about the oral clearance and retention in different individuals.

Among the extensive literature evidencing the association between the duration of refined carbohydrates retained in the mouth and the prevalence of dental caries,[1] the clearance pattern of food in children is both slower and shows larger variation in the physiologic clearance of oral sugar than older children and adults.[2] Thus, the present study sought to determine the total carbohydrate content of salivary expectorant in children of age 6 to 8 years after consuming commercially available processed snacking foods at different time intervals.

 Materials and Methods

The study proposal was submitted to and approved by the Institutional Ethical Committee (Registration No. ECR/887/Inst/KA/2016).

Test subjects

Thirty healthy children with caries-free status, born during the years 2007–2009 in Bengaluru, Karnataka, were selected to participate in the study. The informed consent was obtained from the parents of the participants.

Test food

A survey was conducted in randomly selected schools of Bengaluru regarding the popularity of snack food consumed by the children of preschool and school age. Salivary carbohydrate content was studied using five different products with total carbohydrates. The food included was of different textures, such as hard, soft, crunchy, moist, dry, and sticky. The test foods chosen were as follows: Test food A – Potato chips (Lays ® 10 g containing 5.16 g), Test food B – Glucose biscuits (Parle-G ® 10 g containing 7.82 g), Test food C – Oreo biscuits (Cadbury ® 10 g containing 7.07 g), Test food D – Cake (Britannia ® 10 g containing 4.8 g), and Test food E – Cornflakes (Kellogg's ® Chocos 10 g containing 8.27 g). The added sugar concentration for 10 g of each test food was as follows: potato chips – 0.26 g, glucose biscuits – 2.55 g, Oreo biscuits – 3.86 g, cake – 2.6 g, and cornflakes – 3.46 g.

Test procedure

On the day of estimation, participants received a preliminary prophylaxis for the removal of calculus, plaque, and stain from all tooth surfaces. The participants abstained from food and drinks with the exception of water for 2 h before the test. The test participants were called for testing the food once a week. The test was carried out between 10 and 12 h. At the end of each session, participants were asked to brush their teeth with fluoridated toothpaste and clean the tongue.

At start of the test session, participants were asked to chew the test food in a normal manner. The first saliva sample was obtained by having the participants swallowed the last bolus and then hold their head in the forward position to allow a pool of saliva to collect in the mouth, labeled as 0 min sample. Following this, participants consumed 30 ml of water for swallowing and 2 ml of second salivary expectorants; sample was collected after 10 min and was labeled as 10 min' sample.

Salivary collection/sampling

After 0 and 10 min respectively, whole saliva was dribbled for 1 min into a sterile container. The samples were collected over the ice and processed immediately for the total carbohydrate content.

Sample preparation

Before analysis, the saliva samples were clarified by centrifugation (R-8C, REMI Group, India) at 15,000 rpm for 15 min to obtain the supernatant fluid.

Sample analysis for total carbohydrate content

The supernatant fluid was directly used for carbohydrate estimation. The modified anthrone reagent method as adopted by Beck and Bibby, 1961,[12] which measured carbohydrate as glucose equivalents was used to determine the content of carbohydrate in the saliva. The appropriate dilution of the collected samples was made, and then, the dilutions were dissolved in the anthrone and sulfuric acid reagent. When mixed with the test solution, the strong acid formed furfural derivatives from the carbohydrate, and the anthrone then reacted with the furfural forming green or blue product. After heating and cooling, the samples were compared in quadruplicate with known glucose standard using photoelectric colorimeter (Model-113, Systronic ®, India). The results expressed in glucose equivalent were calculated from the regression equation given by Davies, Beck, and Bibby 1960. The data collected were analyzed using the Statistical Package for the Social Sciences (SPSS version 10.5 IBM Corp, NY).


The mean age distribution of the participants was 6 years (12, 40%), 7 years (9, 30%), and 8 years (9, 30%), respectively, of which 56.7% were males and 43.3% were females. Summarizing the findings of the current study, [Table 1] and [Graph 1] depicted mean carbohydrate values of Test foods A, B, C, D, and E at 0 and 10 min. The results indicated that the glucose biscuits (153.391 mg/ml) yielded the highest of total carbohydrate in the salivary expectorant at 0 min. The values obtained for other processed foods were potato chips (72.746 mg/ml), Oreo biscuits (146.231 mg/ml), cake (99.724 mg/ml), and cornflakes (139.793 mg/ml).{Table 1}[INLINE:1]

At 10 min, it was found that a greater percentage of carbohydrate was retained following consumption of cornflakes (5.186 mg/ml). The values obtained for other processed foods at 10-min interval were potato chips (3.239 mg/ml), glucose biscuits (3.644 mg/ml), Oreo biscuits (3.490 mg/ml), and cake (2.725 mg/ml).

[Table 2] and [Graph 2] summarized the findings of intergroup comparison of the mean carbohydrate values at 0-min interval. There was a statistically significant difference between the mean carbohydrate values of all the test groups (P ≤ 0.05) except for Oreo biscuits and cornflakes (P = 0.928, P = 0.542).{Table 2}[INLINE:2]

[Table 3] and [Graph 3] illustrated intergroup comparison of the mean carbohydrate values at 10-min interval. There was a statistically significant difference between cornflakes and rest of the test groups (P< 0.001).{Table 3}[INLINE:3]


The cariogenic potential of the foodstuffs is mainly related to the amount of sugar present in the mouth at given time interval. The saliva dilutes any sugar present and is subsequently swallowed, thus eliminating sugar from the mouth, a process referred to as oral sugar clearance.[3],[4] The length of time that carbohydrates are available for bacterial metabolism is also affected by the food inherent retention within the oral cavity. Adhesion in the first place influences the amount of food retained and also the resistance toward physiological cleansing movement of lips, tongue, and cheeks.[5]

Moreover, in young children, the oral clearance process is expected to be less effective than in older age group due to lower salivary flow,[6] less pronounced oral muscular coordination ability,[7] and lack of fully developed interest and ability to eliminate particles retained in the mouth after food intake. This could be the attributing factor for higher caries prevalence in 5–10 years of age groups.[8],[9] Thus, our study investigated the carbohydrate content of salivary expectorants following consumption of various commercially available processed foods consumed by 6–8-year-old children.

The use of anthrone reagent for the analysis and specificity of carbohydrates was first suggested in 1946,[10] and quantitative analysis of carbohydrates in samples was adapted in 1947.[11] Subsequently, it was found that modified calorimetric anthrone-sulfuric acid-glucose reaction under controlled heating and cooling conditions increased the accuracy and reproducibility of the reagent, particularly in the higher glucose range.[12] Thus, the method was used in the present study.

The total carbohydrate content of salivary expectorants at 0 min indicated the amount of remaining soluble carbohydrate incorporated in freshly excreted saliva after initial swallowing of the last bolus of food. In the present study, the difference in the total carbohydrate content of salivary expectorants for all the test groups at 0 min was statistically significant. The highest mean value was shown for glucose biscuits closely followed by Oreo biscuits, cornflakes, cake, and potato chips, respectively.

The second saliva sample was collected at 10 min as the rate of clearance is irregular during the 1st min due to increased salivation.[13] The mean carbohydrate content of salivary expectorant at 10 min in the descending order was cornflakes, followed by glucose biscuits, Oreo biscuits, potato chips, and cake. The total carbohydrate content of salivary expectorant at 10 min was significantly lower than at 0 min for all the test foods, thus indicative of the positive effect of rinse after food consumption.

The difference in the mean carbohydrate content of salivary expectorant at 0 min and 10 min when compared indicated that glucose biscuits and Oreo biscuits had faster clearance from saliva than potato chips and cornflakes. This was in accordance to the previous study in which the foods that were high in cooked starch content exhibited slow salivary carbohydrate clearance rates.[14],[15],[16],[17] Starches which adhere to tooth enamel are known to form adhesives pastes on addition of water. The mere loosening of the bond is enough to allow the retained food particles to drift off the tooth into the saliva rather than liquefaction of starch. Thus delayed clearance can be expected after eating an adhesive starchy food that is slowly soluble in saliva.[5]

The rate of clearance of carbohydrates from saliva was slowest for the most retained food; glucose and Oreo biscuits behaved as exception to this pattern showing higher initial retention followed by rapid rates of clearance. Adding sucrose to the food makes it more brittle, tends to form particles suspended in saliva during chewing,[18] and serves as a gustatory stimulus on the flow rates of parotid and whole saliva.[19],[20] Thus, the speed of removal of the high sugar-containing food is faster than one with low sugar.[21],[22]

At 0 and 10 min interval, the salivary carbohydrate content for cake was lowest as reported in the previous literature. Incorporation of fat in the food softened the food, facilitated chewing, shortened the chewing time, and thus decreased the retention time.[18]


From this study, we concluded that the inherent properties of processed food are one of the key factors in determining the clearance from saliva. The foods that were high in starch content such as cornflakes and potato chips exhibited slower salivary carbohydrate clearance. High sucrose-containing foods (glucose biscuits and Oreo biscuits) exhibited initially high salivary carbohydrate levels followed rapid clearance rates.

Recognizing a pivotal role of the physical properties of the food for the oral carbohydrate clearance, it seems desirable to learn more and more about the factors which influence clearance and retention.


We would like to thank all the schoolchildren, their parents and school authorities involved in the study, the statistician Mr. Jagannath for the meticulous statistical analysis, and Mr. Desai, Head of Department of Biochemistry, K.L.E Institute of Dental Sciences, Bengaluru, for his consistent support and guidance.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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