Alaska Native Children Do Not Prefer Sugar-Sweetened Fruit Drinks to Sugar-Free Fruit Drinks.

BACKGROUND: Alaska Native children, including children of Yup'ik descent, consume large volumes of sugar-sweetened fruit drinks, which contain added sugars that contribute to obesity, diabetes, and dental caries. To date, taste preference evaluations have not been conducted on commercially available sugar-free fruit drinks. OBJECTIVE: The study tested the hypothesis that children would have equal preference for sugar-free and sugar-sweetened fruit drinks. DESIGN: This was an experimental two-alternative forced-choice paired preference test. PARTICIPANTS/SETTING: The study focused on a convenience sample of Yup'ik children, aged 7 to 10 years, recruited and enrolled from the Yukon-Kuskokwim Health Corporation dental clinic in Bethel, AK (N=89). INTERVENTION: Children evaluated four different commercially available sugar-free fruit drinks paired with the sugar-sweetened versions of each flavor. Order of flavor pair presentation was alternated across children, and order of presentation within each of the four pairs was randomized across pairs. MAIN OUTCOME MEASURES: The outcome was taste preference for the sugar-free versus the sugar-sweetened version of a fruit drink. STATISTICAL ANALYSES PERFORMED: A test of equivalence was run across all four flavors and separately for each flavor using two one-sided tests. RESULTS: The data failed to demonstrate equivalence of the sugar-free and sugar-sweetened fruit drinks across all four flavors (P=0.51) or separately for each flavor. However, this was not because of a preference for sugar-sweetened drinks. The preference for sugar-free drinks overall and for each flavor was >50%. Although the lower bounds of the 90% CIs were within the range of equivalence (40% to 60%), the upper bounds were outside the range of equivalence (>60%). According to post hoc analyses, similar preferences were observed for Yup'ik and non-Yup'ik children, boys and girls, and children of different ages. CONCLUSIONS: Taste preference findings suggest that sugar-free fruit drinks may be a well-tolerated alternative to sugar-sweetened fruit drinks for Yup'ik children in Alaska Native communities.

Chemosensory changes and quality of life in patients undergoing hematopoietic stem cell transplantation.

PURPOSE: To assess magnitude and characteristics of changes in chemosensory function and quality of life (QOL) for patients receiving hematopoietic stem cell transplantation (HSCT). METHODS: Patients (aged 18 years and above) scheduled to undergo HSCT at the Seattle Cancer Care Alliance were tested for chemosensory function at three time points: pre-transplant (baseline), 30 ± 5 days (day 30), and 80 ± 5 days (day 80) post-HSCT. Gustatory function was assessed following procedures developed at the Monell-Jefferson Taste and Smell Clinic. Olfactory testing was conducted using the National Institute of Health Toolbox Odor Identification test. QOL was also assessed. RESULTS: Twenty-nine patients were enrolled in the study between August 2014 and March 2015. Twenty-three patients were included in the analysis, with 16 tested at all three time points (baseline, day 30, and day 80). The primary finding is decreased taste sensitivity for 0.32 M NaCl, 0.0056 M citric acid, and 0.018 M citric acid on day 30 following HSCT. Increased taste sensitivity for 0.32 M sucrose at day 30 was also observed. Taste sensitivity largely recovered by day 80. Olfactory identification scores were unchanged from baseline to day 30. QOL was reduced at day 30 but was restored to an acceptable level of functioning and symptoms by day 80. However, some areas remain impaired. CONCLUSIONS: Alterations in taste perception were confirmed in the early post-transplant period. This was largely resolved within 2.5 months. No obvious impairments were observed in olfactory function. QOL improved by day 80, though some oral symptoms lingered.

A case-control evaluation of fungiform papillae density in burning mouth syndrome.

HYPOTHESIS: It has been hypothesized that high fungiform papillae density may be a risk factor for developing the taste and pain alterations characteristic of burning mouth syndrome. OBJECTIVE: Evaluate whether fungiform papillae density, taste sensitivity, and mechanical pain sensitivity differ between burning mouth syndrome cases and controls. STUDY DESIGN: This case-control study compared cases diagnosed with primary burning mouth syndrome with pain-free controls. METHODS: Participants (17 female cases and 23 female controls) rated the intensity of sucrose, sodium chloride, citric acid, and quinine applied separately to each side of the anterior tongue and sampled whole mouth. Mechanical pain sensitivity was assessed separately for each side of the tongue using weighted pins. Digital photographs of participants' tongues were used to count fungiform papillae. RESULTS: Burning mouth syndrome cases had increased whole mouth taste intensity. Cases also had increased sensitivity to quinine on the anterior tongue, as well as increased mechanical pain sensitivity on the anterior tongue. Fungiform papillae density did not differ significantly between cases and controls. Fungiform papillae density on the left and right sides of the tongue were correlated in controls; however, there was no left/right side correlation in cases. CONCLUSION: Cases had increased pain and taste perception on the anterior tongue. The lack of correlation between left and right fungiform papillae density in cases may be an indication of asymmetrical lingual innervation in these patients. LEVEL OF EVIDENCE: 3b. Laryngoscope, 128:841-846, 2018.

Validation of a Two-Item Food Security Screening Tool in a Dental Setting.

Purpose: The United States is typically viewed as a wealthy country, yet not all households have access to enough food for an active, healthy life. The purpose of this study was to validate a two-item written food security screen that health providers may use to identify food insecurity in their patient populations.Methods: Data were obtained from 150 parents or guardians who brought a child to a dental appointment at The Center for Pediatric Dentistry, University of Washington, Seattle, Wash., USA. The sensitivity and specificity of two written questions were determined by comparing with the United States Department of Agriculture Six-item Short Form of the Food Security Survey Module.Results: The sample consisted of 141 surveys after those with critical questions left blank were removed. The prevalence of food insecurity was found to be 31 percent at the Center for Pediatric Dentistry. The six-item screen identified 44 foodinsecure families with an affirmative response to two or more questions. Compared with the six-item screen, the two-item screen was found to have 95.4 percent sensitivity and 83.5 percent specificity.Conclusions: The two-item food security screen was found to be sensitive and reasonably specific, providing a quick and accurate method to identify food-insecure families.

Socioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examination Survey, 2007-2008.

OBJECTIVES: We examined associations of household socioeconomic status (SES) and food security with children's oral health outcomes. METHODS: We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES-caries relationship. RESULTS: About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES-caries relationship. CONCLUSIONS: Interventions and policies to ensure food security may help address the US pediatric caries epidemic.

The bad taste of medicines: overview of basic research on bitter taste.

BACKGROUND: Many active pharmaceutical ingredients taste bitter and thus are aversive to children as well as many adults. Encapsulation of the medicine in pill or tablet form, an effective method for adults to avoid the unpleasant taste, is problematic for children. Many children cannot or will not swallow solid dose forms. OBJECTIVE: This review highlights basic principles of gustatory function, with a special focus on the science of bitter taste, derived from studies of animal models and human psychophysics. We focus on the set of genes that encode the proteins that function as bitter receptors as well as the cascade of events that leads to multidimensional aspects of taste function, highlighting the role that animal models played in these discoveries. We also summarize psychophysical approaches to studying bitter taste in adult and pediatric populations, highlighting evidence of the similarities and differences in bitter taste perception and acceptance between adults and children and drawing on useful strategies from animal models. RESULTS: Medicine often tastes bitter, and because children are more bitter-sensitive than are adults, this creates problems with compliance. Bitter arises from stimulating receptors in taste receptor cells, with signals processed in the taste bud and relayed to the brain. However, there are many gaps in our understanding of how best to measure bitterness and how to ameliorate it, including whether it is more efficiently addressed at the level of receptor and sensory signaling, at the level of central processing, or by masking techniques. All methods of measuring responsiveness to bitter ligands-in animal models through human psychophysics or with "electronic tongues"-have limitations. CONCLUSIONS: Better-tasting medications may enhance pediatric adherence to drug therapy. Sugars, acids, salt, and other substances reduce perceived bitterness of several pharmaceuticals, and although pleasant flavorings may help children consume some medicines, they often are not effective in suppressing bitter tastes. Further development of psychophysical tools for children will help us better understand their sensory worlds. Multiple testing strategies will help us refine methods to assess acceptance and compliance by various pediatric populations. Research involving animal models, in which the gustatory system can be more invasively manipulated, can elucidate mechanisms, ultimately providing potential targets. These approaches, combined with new technologies and guided by findings from clinical studies, will potentially lead to effective ways to enhance drug acceptance and compliance in pediatric populations.

Validation of edible taste strips for assessing PROP taste perception.

A novel delivery method is described that incorporates taste stimuli into edible strips for determining n-propylthiouracil (PROP) taster status. Edible strips that contained 400 or 600 nanomoles of PROP were prepared for psychophysical studies. Using these strips, we measured taste intensity, taste hedonics, and taste quality responses in a sample of healthy volunteers (n = 118). Participants were also asked to assess a single NaCl strip, a quinine strip, 3 NaCl solutions, and 3 PROP solutions. All psychophysical data were subsequently analyzed as a function of TAS2R38 genotype. The use of PROP strips for distinguishing between individuals with at least 1 PAV allele and individuals with other genotypes was assessed and compared with the use of PROP solutions for making this same distinction. For the 2 PROP strips and PROP solutions, individuals who expressed at least 1 PAV allele could perceive the bitter taste of PROP. Individuals who expressed 2 AVI alleles responded similarly to 400 nanomole PROP strips and blank strips. Furthermore, individuals with 2 AVI alleles responded to 0.032 and 0.32 mM PROP solutions at intensities that were similar to water, though intensity ratings to 3.2 mM PROP solution exceeded water. In general, those with at least 1 PAV allele rated the bitter taste of PROP as unpleasant in both delivery methods (strips or solutions). Psychophysical data from PROP strips and solutions were consistent with TAS2R38 genotype. These results support the validity of edible taste strips as a method for assessing PROP taste perception in humans.

Gustation assessment using the NIH Toolbox.

The NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox) is a set of brief measures for the assessment of cognitive function, emotional health, motor function, and sensory function for use in clinical trials and in epidemiologic and longitudinal studies. Gustatory perception is assessed as 1 of 6 areas of sensory function. A team of 11 scientists with expertise in taste perception selected 2 gustatory measures, 1 of which can be used in young pediatric populations. The measure selected for young pediatric populations assesses sucrose (sweet) taste preference and can also be used across the age span of 5 to 85 years. For adult populations, the selected measure is a regional test, which assesses variability in perceived intensity of quinine hydrochloride (bitter) when applied to the tongue tip as well as perceived with the whole mouth. The team also recommends the regional test for assessing other tastants, such as sodium chloride (salty). Validation studies have demonstrated that the measures modified for the NIH Toolbox correlate with more traditional assessments, and can identify known population differences in gustation.

Development of labeled magnitude scales for the assessment of pain of dentin hypersensitivity.

AIMS: To develop and test labeled magnitude (LM) scales that are sensitive to variations in pain associated with dentin hypersensitivity (DH). METHODS: Qualitative methods were used first to obtain words that describe the pain of DH. Magnitude estimation was then used to determine the position of these descriptive terms by relative magnitude along four vertical LM scales. To assess their DH, patients used the four LM scales following dentin stimulation with 4°C and 25°C water. The LM scales were then compared to visual analog scale (VAS) ratings by using eight pain scenarios of varying severity. Finally, participants with DH completed the four horizontal LM scales and VAS after dentin stimulation with 4°C and 25°C water. Within-subject t tests were used for comparisons between scales and water temperatures, and between-subject t tests were used for comparisons between participants with and without DH. RESULTS: Participants showed comparable differentiation between 4°C and 25°C water on VAS and three of the LM scale measures. Responses on the fourth LM scale showed better differentiation than VAS between the two water temperatures. Participants used a greater portion of the LM scales than VAS when rating low-level pain scenarios. CONCLUSION: LM scales were shown to provide some advantages compared to standard VAS when used to evaluate DH-associated pain. These advantages may be generalized to other low-level pain conditions.

A community-based randomized trial of postcard mailings to increase dental utilization among low-income children.

PURPOSE: Increasing awareness about the importance of preventive dental care among low-income families has been considered to be key to overcoming nonfinancial access to care barriers for children. The purpose of this randomized, controlled trial was to measure the impact of postcard mailings on dental utilization by low-income children through a dental society program designed to increase access to dental care. METHODS: Five thousand eight hundred and seven low-income 2- to 4-year-olds were randomly assigned to 1 of 3 groups: (1) Group 1 (n=2,014) received postcards containing information on how to enroll in the Yakima County Access to Baby and Child Dentistry program; (2) Group 2 (n=2,014) received the enrollment information as well as additional information on the availability of fluoride varnish and the need to visit the dentist by the age of 1-year-old; and (3) Group 3 (n=1,779) did not receive postcards. RESULTS: Preventive services utilization rates were not different among the groups: 61% for Group 1, 62% for Group 2, and 60% for Group 3, although rates were high for a Medicaid population. CONCLUSIONS: Postcard mailings did not significantly increase utilization of preventive dental services. Other strategies to increase utilization of preventive oral health measures are needed.

Validation of edible taste strips for identifying PROP taste recognition thresholds.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to validate the use of edible taste strips for measuring taste recognition thresholds for the bitter-tasting compound 6-n-propylthiouracil (PROP). STUDY DESIGN: Taste recognition thresholds for PROP were obtained by two separate methods. Thresholds were also identified in subjects whose airflow through the nose was blocked. Threshold values were then compared to genotype analysis of the TAS2R38 taste receptor, which is the major determinant for the detection of PROP. METHODS: Edible taste strips were used to examine taste recognition thresholds for PROP. Thresholds were determined by the method of ascending limits and by the method of reversals. Single nucleotide polymorphism analysis of the TAS2R38 gene was used to identify PROP taster status. RESULTS: Taste recognition thresholds for PROP formed two distributions. Thresholds for one group varied from 4 to 219 nmol and represented PROP tasters. The second group could not detect the bitter taste of PROP at ≤800 nmol and represented PROP nontasters. The method of ascending limits and the method of reversals yielded similar threshold results. The expression of a PAV allele permitted detection of PROP, but AVI homozygotes could not detect the bitter taste of PROP. CONCLUSIONS: Edible taste strips were successfully used to detect PROP thresholds at values equal to or lower than those obtained in previous studies using PROP solutions or PROP-impregnated filter papers. This study provides validity evidence for the use of edible taste strips for identifying PROP in the human population.

Additional psychometric data for the Spanish Modified Dental Anxiety Scale, and psychometric data for a Spanish version of the Revised Dental Beliefs Survey.

BACKGROUND: Hispanics comprise the largest ethnic minority group in the United States. Previous work with the Spanish Modified Dental Anxiety Scale (MDAS) yielded good validity, but lower test-retest reliability. We report the performance of the Spanish MDAS in a new sample, as well as the performance of the Spanish Revised Dental Beliefs Survey (R-DBS). METHODS: One hundred sixty two Spanish-speaking adults attending Spanish-language church services or an Hispanic cultural festival completed questionnaires containing the Spanish MDAS, Spanish R-DBS, and dental attendance questions, and underwent a brief oral examination. Church attendees completed the questionnaire a second time, for test-retest purposes. RESULTS: The Spanish MDAS and R-DBS were completed by 156 and 136 adults, respectively. The test-retest reliability of the Spanish MDAS was 0.83 (95% CI = 0.60-0.92). The internal reliability of the Spanish R-DBS was 0.96 (95% CI = 0.94-0.97), and the test-retest reliability was 0.86 (95% CI = 0.64-0.94). The two measures were significantly correlated (Spearman's rho = 0.38, p < 0.001). Participants who do not currently go to a dentist had significantly higher MDAS scores (t = 3.40, df = 106, p = 0.003) as well as significantly higher R-DBS scores (t = 2.21, df = 131, p = 0.029). Participants whose most recent dental visit was for pain or a problem, rather than for a check-up, scored significantly higher on both the MDAS (t = 3.00, df = 106, p = 0.003) and the R-DBS (t = 2.85, df = 92, p = 0.005). Those with high dental fear (MDAS score 19 or greater) were significantly more likely to have severe caries (Chi square = 6.644, df = 2, p = 0.036). Higher scores on the R-DBS were significantly related to having more missing teeth (Spearman's rho = 0.23, p = 0.009). CONCLUSION: In this sample, the test-retest reliability of the Spanish MDAS was higher. The significant relationships between dental attendance and questionnaire scores, as well as the difference in caries severity seen in those with high fear, add to the evidence of this scale's construct validity in Hispanic samples. Our results also provide evidence for the internal and test-retest reliabilities, as well as the construct validity, of the Spanish R-DBS.

The contribution of dietary factors to dental caries and disparities in caries.

Frequent consumption of simple carbohydrates, primarily in the form of dietary sugars, is significantly associated with increased dental caries risk. Malnutrition (undernutrition or overnutrition) in children is often a consequence of inappropriate infant and childhood feeding practices and dietary behaviors associated with limited access to fresh, nutrient dense foods, substituting instead high-energy, low-cost, nutrient-poor sugary and fatty foods. Lack of availability of quality food stores in rural and poor neighborhoods, food insecurity, and changing dietary beliefs resulting from acculturation, including changes in traditional ethnic eating behaviors, can further deter healthful eating and increase risk for early childhood caries and obesity. America is witnessing substantial increases in children and ethnic minorities living in poverty, widening the gap in oral health disparities noted in Oral Health in America: A Report of the Surgeon General. Dental and other care providers can educate and counsel pregnant women, parents, and families to promote healthy eating behaviors and should advocate for governmental policies and programs that decrease parental financial and educational barriers to achieving healthy diets. For families living in poverty, however, greater efforts are needed to facilitate access to affordable healthy foods, particularly in urban and rural neighborhoods, to effect positive changes in children's diets and advance the oral components of general health.

A marker of growth differs between adolescents with high vs. low sugar preference.

Sweet preference is higher in childhood than adulthood but the mechanism for this developmental shift is not known. The objective of this study was to assess perceptual, physiological and eating habit differences between children preferring solutions high in sugar (high preference) and children preferring solutions low in sugar (low preference). We tested 143 children (11- to 15-years old) using sip and spit methodology to assess their hedonic profile, detection threshold, and perceived intensity of sucrose. Their plasma concentration of several hormones, a biomarker of bone-growth, body size, puberty stage, and dietary habits were measured. Eighty-eight children were classified as high preference and 53 were classified as low preference based on their hedonic ratings to a series of sucrose solutions. A marker of bone growth measured in urine and plasma leptin adjusted for body weight were significantly lower in the low preference group. Children with high and low preference patterns did not differ in sensory aspects of sucrose perception, nor did they differ in age, body mass index percentile, or dietary restraint. The change in sugar preference from high to low during adolescence appears to be associated with the cessation of growth.

Psychometric properties of Spanish-language adult dental fear measures.

BACKGROUND: It would be useful to have psychometrically-sound measures of dental fear for Hispanics, who comprise the largest ethnic minority in the United States. We report on the psychometric properties of Spanish-language versions of two common adult measures of dental fear (Modified Dental Anxiety Scale, MDAS; Dental Fear Survey, DFS), as well as a measure of fear of dental injections (Needle Survey, NS). METHODS: Spanish versions of the measures were administered to 213 adults attending Hispanic cultural festivals, 31 students (who took the questionnaire twice, for test-retest reliability), and 100 patients at a dental clinic. We also administered the questionnaire to 136 English-speaking adults at the Hispanic festivals and 58 English-speaking students at the same college where we recruited the Spanish-speaking students, to compare the performance of the English and Spanish measures in the same populations. RESULTS: The internal reliabilities of the Spanish MDAS ranged from 0.80 to 0.85. Values for the DFS ranged from 0.92 to 0.96, and values for the NS ranged from 0.92 to 0.94. The test-retest reliabilities (intra-class correlations) for the three measures were 0.69, 0.86, and 0.94 for the MDAS, DFS, and NS, respectively. The three measures showed moderate correlations with one another in all three samples, providing evidence for construct validity. Patients with higher scores on the measures were rated as being more anxious during dental procedures. Similar internal reliabilities and correlations were found in the English-version analyses. The test-retest values were also similar in the English students for the DFS and NS; however, the English test-retest value for the MDAS was better than that found in the Spanish students. CONCLUSION: We found evidence for the internal reliability, construct validity, and criterion validity for the Spanish versions of the three measures, and evidence for the test-retest reliability of the Spanish versions of the DFS and NS.

Using memory restructuring strategy to enhance dental behaviour.

AIMS: This study sought to 'restructure' memory of dental treatment to help children develop positive memories and cooperate more fully with the dentist at future visits. DESIGN: The design compared 'usual care' plus an intervention designed to positively restructure memory with 'usual care' plus a control for 45 children, ages 6-9 years, who were in need of two restorative treatment visits. The intervention occurred at the second visit immediately before the dental treatment and focused on restructuring the child's memory of the first treatment visit. Children were asked to recall how much fear and pain they experienced during the first dental treatment. RESULTS: The child's behaviour improved from the first dental treatment visit to the second in the intervention group but not in the control condition. When compared to the controls, those in the intervention group changed their memory of the fear they experienced at the first treatment and their memory of experienced pain. CONCLUSIONS: Restructuring memory may be effective in reducing fear for future treatment, and is easily adaptable to clinical practice in other healthcare situations.

Development and validation of the Spanish Interval Scale of Anxiety Response (ISAR).

As increasing attention is paid to disparities in oral health care, cross-cultural means for assessing dental fear, a significant barrier to dental care, are in high demand. There is, however, a surprising shortage of Spanish-language dental fear measures in the literature, despite evidence of dental fear and avoidance in Spanish-speaking populations. The goals of the current series of studies were to develop and validate a Spanish-language version of the Interval Scale of Anxiety Response (ISAR). Magnitude estimation, a technique in which participants are asked to assign a number to indicate the perceived intensity of a stimulus or phrase, was used to compare the Spanish ISAR to the original English ISAR during the development studies. As a result of the 4 initial development studies, modifications were made to both the Spanish and English scales. Once 2 seemingly equivalent scales were established, validation studies were completed with native Spanish- and English-speaking dental patients. The results suggest that both the Spanish and modified English ISAR scales are valid measures of state anxiety associated with dental treatment. Additionally, the results of these studies highlight the importance of thoroughly testing translated measures to ensure they are accurately assessing that which they purport to measure.

Combining alprazolam with systematic desensitization therapy for dental injection phobia.

To determine whether a benzodiazepine facilitates systematic desensitization, 144 subjects with dental injection phobia received systematic desensitization in combination with placebo or one of two doses of alprazolam (0.5mg or 0.75mg). Systematic desensitization therapy included computer-controlled presentation of digitized video segments followed by in vivo exposure segments, culminating in an actual dental injection. Subjects advanced to the next hierarchy segment when low anxiety was reported during a segment. Alprazolam and placebo groups progressed at the same rate. The 0.75mg group had elevated heart rates while watching video segments compared with placebo. In a subsequent behavioral avoidance test (during which subjects were randomized to a new drug condition), there was no indication that state-dependent learning had occurred. Dental fear was reduced similarly in all groups for 1 year after study completion. No advantage was found to combining alprazolam with systematic desensitization for dental injection phobia.

The effectiveness and estimated costs of the access to baby and child dentistry program in Washington State.

OBJECTIVES: The authors estimated the effectiveness of the Access to Baby and Child Dentistry (ABCD) program as a tool to improve the oral health of children, and they measured its costs. ABCD is an effort to increase the utilization of dental care by Medicaid-enrolled children younger than 6 years. METHODS: The authors compared the oral health of third-grade children in Spokane County Wash. (ABCD) with that of children in Pierce County (non-ABCD). They then compared the expenditures of ABCD with those associated with alternative dental care interventions. RESULTS: Children in Spokane County had better oral health than did the children in Pierce County. The authors also found that the ABCD program increased mean dental care costs by $8.17 per user over costs in Pierce County, and the program cost a mean of $5.33 per user in outreach and dentist and staff training costs. CONCLUSIONS: This study found that ABCD improved the oral health of all third graders, including those not eligible or enrolled in the program. Increased expenditures were attributable mainly to outreach and training costs. CLINICAL IMPLICATIONS: Programs such as ABCD, carried out collaboratively by component societies, health districts, dental schools and Medicaid, have the potential to increase access to care and improve health.

Children's acceptance of milk with xylitol or sorbitol for dental caries prevention.

BACKGROUND: Xylitol, a polyol sugar, has been shown to reduce dental caries when mixed with food or chewing gum. This study examines the taste acceptability of xylitol in milk as a first step toward measuring the effectiveness of xylitol in milk for the reduction of dental caries in a public health program. METHODS: Three different types of milk (Ultra High Temperature (UHT), powder and evaporated) were tested for acceptability by 75 Peruvian children (25 per milk group, ages 4 to 7 years). Each group evaluated xylitol and sorbitol in one type of milk. In the first phase, each child was presented with a tray of four plastic cups containing 50 ml of milk with 0.021 g/ml xylitol, 0.042 g/ml xylitol, 0.042 g/ml sorbitol or no sugar. Each child was asked to taste the samples in a self-selected order. After tasting each sample, the child placed the milk cup in front of one of three cartoon faces (smile, frown or neutral) representing the child's response to the taste of each sample. In the second phase, the child was asked to rank order the milk samples within each category (smile, frown or neutral). Ranks within categories were then combined to obtain a rank ordering for all the test samples. RESULTS: The ranking from best to worst for the samples across categories (UHT, powder, evaporated) was xylitol (0.0.042 g/ml), sorbitol (0.042 g/ml), xylitol (0.021 g/ml) and milk alone (Friedman's ANOVA). Xylitol and sorbitol were preferred over milk alone, and xylitol (0.042 g/ml) was preferred to sorbitol (0.042 g/ml)(p < .05 sign test). CONCLUSION: Milk sweetened with xylitol is well accepted by Peruvian children ages 4-7 years.