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Effects of Herbal Lollipops On Streptococcus Mutans Levels and The Dental Caries Experience of Children With Asthma Taking B2-Adrenergic Agonish Drugs
Effects of Herbal Lollipops On Streptococcus Mutans Levels and The Dental Caries Experience of Children With Asthma Taking B2-Adrenergic Agonish Drugs
Effects of Herbal Lollipops On Streptococcus Mutans Levels and The Dental Caries Experience of Children With Asthma Taking B2-Adrenergic Agonish Drugs
SubjectsarepatientsofrecordatUNMC,have
medicaldiagnosesofasthmaandaretreatedweekly
with2adrenergicagonistinhalers
Assignmentofsubjectstotheherballollipopor
controlgroupisdeterminedbyarandomizedlist
Determinewhetherornotherballollipopsshouldbe
usedasdirectivetherapyforchildrenwithasthma.
Thedurationofthestudyissixmonthsfrom
enrollmenttocompletionandisconductedasfollows:
Dr.JohnsoncompletesaclinicalDMFT/
dmftscreeningonanasthmapatient.
Bitewingsaretakenfortheradiographic
determinationofDMFT/dmftscores.
Asampleofthepatientssalivaispipetted
ontotheCRTbacteriateststrip.
Thesalivasamplesareculturedat37oC
for48hours.
S.mutanscoloniesarecountedand
recordedafterculture.
Patientsmileswithhisrstround
oforangelollipops.
STUDY
FLOWCHART
Patient
Enrolled
Herbal
Group
S.mutans
Test
DispenseHerbal
Lollipops
Subjectdemographicinformationiscollectedduring
studyenrollment.
GeneralSubjectInformation(n=13):
Placebo
Group
S.mutans
Test
DMFT/dmft
score
DispensePlacebo
Lollipops
GeneralCharacteristics
Male=9,Female=4
AA=7,Caucasian=2,Hispanic=4
9.52.8years
Gender
Ethnicity
AverageAge
AverageYearlyFamilyIncome
ASTHMACLASSIFICATION
17%
RellHerbal
Lollipops
RellPlacebo
Lollipops
Recall
Recall
DMFT/dmft
score
S.mutans
Test
DMFT/dmft
score
S.mutans
Test
Disclose
Outcome
TheDMFT/dmftscoresandS.mutanstestsforeach
grouparecomparedwithregardtothechange
measuredineachoverthesixmonthcourse.
AFFECTSONQUALITYOFLIFE
17% 8%
33%
50%
Moderate
Severe
ASTHMARELATEDSCHOOL
ABSENCESINTHELASTYEAR
8%
PreliminaryresultsareanticipatedinmidApril2010as
theearliestenrolledsubjectscompletethestudyinits
entirety.Enrollmentofeligiblesubjectsisongoingand
willcontinueuntil90subjectssuccessfullycomplete
thestudy.Theecacyofherballollipoptherapyfor
asthmaticchildrenwillthenbedeterminedstatistically.
17%
58%
Alot
Moderate
Alittle
17%
83%
1to7
8to30
Notatall
PARENTKNOWLEDGEOF
DENTALSIDEEFFECTS
42%
50%
Disclose
Outcome
22.8K12.4K
SubjectAsthmaInformation(n=13):
Mild
SubjectsMUST:
*Haveamedicaldiagnosisofasthmaandusea2
adrenergicagonistinhalerasneededforsymptoms
*Bebetweentheagesof4and16years
*Beavailableforrecall
SubjectsMUSTNOT:
*Betakingotherxerostomiacausingmedications
unrelatedtothetreatmentofasthma
*Havehistoryofsevereearlychildhoodcaries(SECC)
CRTbacteria
Streptococcusmutans
testsweremanufactured
byIvoclarVivodent,
Amherst,NY
Thestudyisdoubleblind;boththeresearcherandthe
subjectsareunawareofgroupassignments
DMFT/dmft
score
Determinehoweectiveasixmonthcourseofherbal
lollipopsisonS.mutanslevelsandthedentalcaries
experienceofasthmaticchildrenversusaplacebo
Herballollipopswere
manufacturedby
IntelliherbLLC,
Inglewood,CAandare
FDAapproved
Yes
No
Allphotosweretakenandprintedwithparentalpermission.
Dentalcariesandasthmaaretwoofthemost
commonchronicdiseasesofchildhood
Presently,9.3%ofchildrenintheUnitedStatessuer
fromsomeformofasthma
Childrenwhoaretreatedwith2adrenergic
agonistinhalersforasthmahavebeenshowntohave:
*Decreasedsalivaryoutowwhichlimits
theprotectivebuerofsaliva
*DecreasedplaquepHbelowthecriticalpH
forenameldemineralization
*HigherDMFT/dfmtscores
Studiesstronglyrecommendadditionalpreventative
programsforchildrenwithasthmatokeepdental
cariesrisksundercontrol
HerballollipopscontainGlycyrrihizauralensis,a
compoundextractedfromChineselicoriceroot,which
hasdemonstratedantibacterialactivityagainst
Streptococcusmutans(S.mutans),anoralpathogen
responsiblefordentalcaries
Itishypothesizedthatasixmonthcourseofherbal
lollipopswillreduceS.mutanspopulationsinsaliva
ofchildrenwithasthma,andthereby,improveDMFT/
dmftscores
SpecialthankstoJeeryPayneDDS,PeterGiannini
DDS,MS,MichaelMolvarDDS,MSandCarenBarnes
RDH,MSofUNMCCollegeofDentistry.Also,thanks
toMaxwellH.AndersonDDS,MS,MEdandJustin
HsiaoofC3Jian,Inc.
above.
All
fifty
subjects
were
drawn
from
the
University
of
Nebraska
Medical
Center
in
Omaha,
Nebraska.
Oral
hygiene
instructions
were
given
to
all
participating
subjects
at
the
onset
of
the
study.
Entrance
Streptococcus
Mutans
levels,
Lactobacilli
levels
and
DMFT/dmft
scores
were
determined
on
the
subjects
and
changes
over
the
six
(6)
month
study
were
compared
and
evaluated.
The
significance
of
this
study
is
that
adjunctive
oral
hygiene
therapy
that
employs
herbal
lollipops
may
prove
to
help
children
who
suffer
from
bronchial
asthma
lower
their
dental
caries
risks
and
have
healthier
oral
environments
unburdened
by
the
effects
of
their
medications
and
condition.
It
was
concluded
in
this
study
that
compliance
contributed
to
a
completion
of
only
thirty-one
children.
The
use
of
the
lollipops
in
a
more
controlled
environment
would
have
provided
a
stronger
and
more
accurate
study.
The
data
did
not
show
results
that
were
statistically
significant.
Introduction:
Dental
caries
and
childhood
asthma
are
the
two
of
the
most
common
chronic
diseases
of
childhood(1,2)
and
are
two
leading
causes
of
school
absenteeism.
A
majority
of
the
studies
that
have
examined
the
effects
of
asthma
on
the
oral
environment
have
associated
childhood
asthma
with
increased
dental
caries
incidence.
(3,5,6,7,8,10)
Some
adverse
changes
in
the
oral
environment
can
be
attributed
directly
to
frequent
usage
of
beta2-adrenergic
agonist
drugs,
which
can
lead
to
an
increased
risk
of
dental
caries
in
children
with
asthma.
McDerra
et
al
(1999)
showed
that
British
children
taking
an
inhaler
for
asthma
had
a
higher
incidence
of
dental
caries
in
both
permanent
and
primary
teeth
compared
to
a
control
group.
However,
only
the
incidence
in
caries
in
the
permanent
dentition
was
shown
to
be
statistically
significant.(7)
In
a
U.S.
study,
Milano
et
all
(1999)
found
asthmatic
children
experienced
more
decay
than
non-asthmatic
children
in
both
primary
and
mixed
dentitions,
although
only
primary
dentition
results
were
significant.(8)
Another
study
from
Texas,
compared
asthmatic
children
in
two
age
groups
(4-10
and
11-16)
to
a
control
group.
They
found
similar
DMFT
scores
in
the
4-10
asthma
group
and
the
control
group,
and
lower
DMFT
scores
in
the
11-16
asthma
group
compared
to
the
control
group.
However,
of
the
1,129
subjects
in
the
study
only
52%
reported
using
a
beta2-adrenergic
agonist
inhaler
to
control
their
asthma
(34%
were
severe
asthmatics,
15.4%
were
moderate
asthmatics
and
3.0%
were
mild
asthmatics.)(9)
Milano
et
al
(2006)
examined
the
relationship
between
types
of
asthma
medications,
length
of
use,
frequency
of
use
and
dosing
time
of
day,
and
dental
caries.
This
study
fond
that
among
children
with
asthma
those
who
used
medication
more
than
twice
daily
were
more
prone
to
dental
caries
in
the
primary
and
mixed
dentitions.(10)
The
most
frequently
used
medication
in
this
study
was
a
beta2-adrenergic
agonist
inhaler
(73%)
while
the
others
(27%)
used
a
combination
of
beta2-adrenergic
agonist
drug
and
other
medications.
While
not
all
studies
show
statistical
significance,
the
general
consensus
is
that
beta2-adrenergic
agonist
medications
have
adverse
effects
on
the
oral
cavity
and
can
contribute
to
an
increased
dental
caries
incidence
in
children
with
asthma.
Many
studies
have
recommended
that
children
with
asthma
adopt
more
precautionary
oral
hygiene
habits
and
visit
their
dental
care
providers
on
a
more
frequent
basis
to
keep
their
dental
caries
risks
under
control.
An
additional
precautionary
step
that
could
be
utilized
for
the
control
of
dental
caries
in
asthmatic
children
is
herbal
lollipops.
The
beneficial
effects
of
herbal
lollipops
on
the
oral
environment
are
a
newer
development
and
have
only
just
begun
to
be
explored
in
the
literature.
The
active
ingredient
in
herbal
lollipops
comes
from
the
roots
of
Glycyrrhiza
uralensis
or
Chinese
licorice.
The
therapeutic
effects
of
Glycyrrihiza
uralensis
have
been
utilized
by
mainland
China
and
other
eastern
countries
for
thousands
of
years.(11)
Over
the
past
few
decades,
researchers
have
sought
to
isolate
the
active
compounds
in
Glycyrrihiza
uralensis
responsible
for
its
therapeutic
effects,
and
specifically,
the
compound
shown
to
have
antibacterial
activity
against
Streptococcus
Mutans.
In
2006,
researchers
at
the
UCLA
School
of
Dentistry
identified
Glycyrrhizol
A
to
be
the
compound
with
very
potent
antibacterial
activity.(11)
This
compound
was
shown
to
have
an
in
vitro
minimum
inhibitory
concentration
(MIC)
of
15.6
ug/mL
against
Streptococcus
Mutans.
(11)
MIC
is
defined
as
the
lowest
concentration
that
visibly
inhibits
bacterial
growth
after
incubation
at
thirty-seven
degrees
Celsius
(37)
for
sixteen
(16)
to
twenty
(20)
hours.
Later
researchers
at
the
same
institution
incorporated
Glycyrrhizol
A
into
a
sugar-free
herbal
lollipop
carrier
to
evaluate
its
effectiveness
on
oral
Streptococcus
Mutans
in
human
subjects.(12)
In
a
ten
(10)
day
trial,
subjects
were
given
the
herbal
lollipop
twice
a
day
and
in
the
majority
of
subjects,
dramatic
reductions
in
salivary
Streptococcus
Mutans
levels
were
seen.(12)
The
total
number
of
subjects
in
the
UCLA
study
was
twenty-six(26).
Twenty
(20)
of
those
subjects
were
patients
at
the
UCLA
Childrens
Dental
Clinic.
The
study
does
not
mention
any
adverse
events
and/or
study
outcomes.
Additionally,
correspondence
with
Maxwell
H.
Anderson
D.D.S.
,
M.S.,
M.Ed.,
President
and
CEO
of
C3
Jian
Inc.
(the
company
of
which
Intelliherb
LLC
is
a
wholly-owned
subsidiary)
stated
that
of
the
hundreds
of
patients
enrolled
in
past
and
present
trials,
there
is
yet
to
be
any
cases
of
allergy
to
the
licorice
root.
Further
research
is
being
planned
by
Intelliherb
LLC
to
determine
the
exact
anti-
bacterial
mechanism
by
which
Glycyrrhizol
A
exerts
its
effects
intra-orally.
Because
Streptococcus
Mutans
is
an
oral
pathogen
responsible
for
dental
caries,(13)
if
herbal
lollipops
can
reduce
their
levels,
a
resultant
effect
should
be
lowered
DMFT/dmft
scores
and
increased
tooth
remineralization.
This
avenue
has
not
yet
been
explored.
Given
the
oral
health
benefits
of
herbal
lollipops,
this
study
examined
the
effectiveness
of
an
herbal
lollipops
regimen
among
children
using
beta2-adrenergic
agonist
drugs
for
asthma.
Past
studies
regarding
Streptococcus
Mutans
levels
and
caries
rates
in
children
with
asthma,
regardless
of
the
specific
results,
strongly
instructions.
It
was
recommended
that
each
subject
brush
twice
daily
(once
in
the
morning
and
once
before
bed)
with
a
fluoride-containing
toothpaste
and
floss.
The
initial
exam
included
2
to
4
bitewing
radiographs
used
to
diagnose
interproximal
caries.
Thus,
all
subjects
participating
in
this
study
underwent
additional
radiation
exposure
due
to
radiographs
at
the
beginning
and
end
of
this
study.
The
six
(6)
month
interval
between
radiographic
sessions
is
normal
for
children
experiencing
high
caries
rates
but
is
more
frequent
than
necessary
for
children
experiencing
a
low
caries
rate.
Thus,
those
potential
risks
were
discussed
with
the
parent/legal
guardian.
The
subjects
then
chewed
on
paraffin
wax
supplied
by
CRT
bacteria
Streptococcus
mutans
tests:
Manufacured
by
Ivoclar
Vivodent,
Amerherst,
NY
in
order
to
stimulate
saliva
production.
The
subjects
spit
into
a
cup
and
then
1
mL
of
saliva
was
placed
onto
the
agar
test
strip
provided
by
the
CRT
bacteria
test
kit.
The
vial
including
the
test
strip
was
then
placed
into
an
incubator
at
thirty-seven
degrees
Celsius
(37
C)
for
forty-eight
(48)
hours.
A
clinical
exam
was
also
performed
by
one
practioner
at
the
initial
appointment
to
check
for
any
other
visual
caries.
Decayed,
missing,
and
filled
teeth
(DMFT/dmft)
scores
for
both
the
primary
and
permanent
dentitions
were
used
to
describe
the
severity
of
dental
caries
in
each
participant.
The
sum
of
the
component
parts
of
DMFT/dmft
scores
equals
the
overall
DMFT/dmft
score,
which
means
a
DMFT/dmft
score
cannot
decrease
even
if
a
primary
tooth
is
exfoliated.
Those
component
parts
included
the
number
of
teeth
that
had
carious
lesions
(D
or
d
for
decayed),
the
number
of
teeth
that
have
been
lost
due
to
tooth
decay
(M
or
m
for
missing),
and
the
number
of
teeth
that
have
been
filled
or
crowned
(F
or
f
for
filled.)
In
this
study,
entrance
and
exit
DMFT/dmft
scores
were
collected
by
one
researcher
to
eliminate
individual
biasis.
The
researcher
was
blind
to
which
participants
were
receiving
the
herbal
lollipop
regimen
and
which
were
receiving
the
placebo
lollipops.
The
control
group
lollipops
were
placed
in
a
paper
bag
with
a
start
attached.
The
study
group
lollipops
were
placed
in
a
paper
bag
with
a
heart
attached.
This
allowed
the
researcher
to
give
the
patients
the
lollipops
and
keep
the
two
groups
separate
while
remaining
blind
to
which
group
was
which.
The
control
group
can
be
interchanged
with
the
star
group
and
the
study/experimental
group
can
be
interchanged
with
the
heart
group.
Herbal
lollipops
were
provided
to
the
participants
in
the
study
group
and
each
member
was
instructed
to
dissolve
two
(2)
lollipops
by
mouth
every
day
for
ten
(10)
days
at
the
onset
of
the
study
and
again
after
a
three
(3)
month
period.
It
was
recommended
that
each
member
in
the
study
group
dissolve
the
herbal
lollipop
in
their
mouth
(without
chewing)
in
the
morning
after
breakfast
and
in
the
evening
after
dinner.
It
was
instructed
that
it
should
take
approximately
ten
(10)
to
fifteen
(15)
minutes
for
the
lollipops
to
dissolve
completely.
Parents/Guardians
of
the
study
group
were
given
a
chart
on
which
to
document
the
delivery
of
the
twice-daily
herbal
lollipops.
It
was
the
hope
that
this
chart
would
have
a
positive
influence
on
compliance
and
would
be
able
to
be
reviewed
for
inclusion
of
the
subject
in
the
final
data
set.
All
ingredients
used
in
the
herbal
lollipops,
manufactured
by
Intelliherb
LLC,
are
FDA-approved
and
safe
for
human
consumption.
The
formula
for
the
lollipops
is:
hydrogenated
starch
hydolysate
(HSH)
(a
solidifying
agent),
citric
acid
and
mint
(for
flavoring),
FD
&
C
Blue
#1,
2:
Red
3,
40;
Yellow
5,
6
(for
coloring),
and
acesulfame
potassium
(a
non-caloric
sweetener).
The
active
ingredient
Glycyrrhizol
A
is
extracted
from
licorice
root,
a
substance
that
has
been
used
for
thousands
of
years
and
has
been
shown
to
be
a
safe
medicinal
herb.
Licorice
root
is
listed
by
the
FDA
as
generally
regarded
as
safe
(GRAS)
when
used
as
a
sweetener
or
flavoring.
Depending
on
the
concentration
of
the
active
ingredient
Glycyrrhizol
A
in
a
batch
of
licorice
root
extract,
licorice
root
extracts
are
added
to
each
lollipop
for
a
standardized
concentration
of
Glycyrrhizol
A.
After
six
(6
)
months
a
final
exam
was
performed,
which
was
identical
to
the
initial
entrance
exam.
All
data
was
collected
in
the
same
manner
described
above.
All
steps
of
the
study
for
the
control
group
were
identical
to
the
study
group
except
the
control
group
consisted
of
twenty-two
(22)
subjects
and
each
subject
was
given
the
placebo
lollipop,
which
was
also
manufactured
by
Intelliherb
LLC
and
is
a
true
placebo,
meaning
that
the
formulation
is
exactly
the
same
as
the
active
herbal
lollipop
except
it
lacks
the
Glycyrrhizol
A.
Data
from
the
DMFT/dmft
scores,
Streptococus
Mutans
CFUs
and
Lactobacilli
CFUs
were
collected
at
the
beginning
and
end
of
the
study
for
all
the
subjects.
Mathematical
changes
in
these
scores
were
compared
for
each
individual
subject
of
the
six
(6)
month
period.
The
mean
change
score
of
the
experimental
group
(i.e.,
the
herbal
lollipop
group)
was
compared
with
the
mean
change
in
the
control
group
using
a
one-way
Multivariate
Analysis
of
Variance
(MANOVA).
The
MANOVA
was
chosen
as
the
method
for
statistical
analysis
to
simultaneously
analyze
all
dependent
variable
change
scores
of
the
lollipop
group
compared
to
the
control
group.
The
MANOVA
allows
for
better
control
of
the
overall
error
in
the
statistical
analysis.
Conducting
separate
comparisons
for
each
of
the
dependent
variables
could
allow
the
error
rate
to
exponentially
rise
and
distort
comparison
results
of
the
lollipop
group
versus
the
control
group.
Results:
Matriculation
in
this
study
was
high.
Twenty-eight
(28)
subjects
in
the
study
group
started
the
study,
however
only
seventeen
(17)
completed
the
six
(6)
month
regimen
of
herbal
lollipops.
Twenty-two
(22)
subjects
in
the
control
group
started
the
study,
however
only
fifteen
(15)
completed
the
six
(6)
month
regimen
of
the
placebo
lollipops.
(See
Table
1)
Twenty-two
(22)
of
the
participants
were
male,
while
ten
(10)
of
the
participants
were
female.
(see
Table
2)
The
ethnic
distribution
of
the
participants
included
forty-seven
percent
(47%)
Hispanic,
thirty-
four
percent
(34%)
African
American,
sixteen
percent
(16%)
Caucasian,
and
three
percent
(3%)
Asian.
(see
Table
2)
No
tests
were
run
to
determine
the
change
in
bacteria
or
DMFT/dmft
for
each
individual
ethnicity.
The
annual
income
distribution
of
the
participants
included
thirty-four
percent
(34%)
with
an
annual
income
of
fifteen
thousand
dollars
to
twenty-four
thousand,
nine
hundred
and
between
the
lollipop
and
control
groups
were
not
statistically
significant,
F(1,30)
=
0.22,
p
=
0.65.
The
study
group
had
an
average
of
an
81.6
decrease
of
Lactobacilli
colony
forming
units
per
1
mL
of
saliva
from
the
pretest
to
the
post
test.
The
control
group
had
an
average
of
a
36.1
decrease
of
Lacobacilli
colony
forming
units
per
1
mL
of
saliva
from
the
pretest
to
the
post
test.
The
results
of
the
MANOVA
comparing
mean
Lactobacilli
change
scores
in
the
lollipop
group
to
the
control
group
were
not
statistically
significant,
F(1,30)
=3.09,
p
=
0.09.
The
control
group
had
a
mean
increase
of
.20
DMFT/dmft
score.
The
study
group
showed
a
mean
increase
of
.06
DMFT/dmft
score.
The
results
of
the
MANOVA
comparing
mean
DMFT
change
scores
in
the
lollipop
group
to
the
control
group
were
not
statistically
significant,
F(1,30)
=
1.43,
p
=
0.24.
Table 1
Distribution of Participants assigned to Star or Heart Group
Participant Group
Frequency (Percent)
15 (46.9%)
17 (53.1%)
Table 2
Participant Demographics
Frequency (Percent)
Demographic
Treatment Group
Control Group
Ethnicity
Caucasian
1 (3.1%)
4 (12.5%)
Hispanic
9 (28.1 %)
6 (18.8 %)
African American
7 (21.9%)
4 (12.5%)
Asian
0 (0%)
1 (3.1%)
Gender
Male
12 (37.5%)
10 (31.3%)
Female
5 (15.6%)
5 (15.6%)
<$15,000
5 (15.6%)
4 (12.5%)
$15,000-$24,999
6 (18.8 %)
5 (15.6%)
$25,000-$49,999
4 (12.5 %)
3 (9.4%)
>50,000
1 (3.1%)
0 (0%)
1 (3.1%)
3 (9.4%)
Annual income
Table 3
Did you know that frequent use of asthma medication could lead to a higher rate of tooth
decay?
Parents answer
Frequency (Percent)
Yes
10 (32%)
No
22 (68%)
Table 4
MANOVA Comparing Mean Change Scores of the Lollipop vs. Control Group
Measure
Control
p value
Experimental
Streptococcus Mutans
71.27
-2.76
3.09
p = .09
Lactobacilli
-36.13
-81.65
0.21
p = .65
0.20
0.06
1.42
p = .24
DMFT
Discussion:
The
experimental
group
(herbal
lollipop)
showed
a
mean
decrease
in
bacteria
for
both
Streptococcus
Mutans
and
Lactobacilli
supporting
the
notion
the
lollipops
work.
The
DMFT
of
the
experimental
group
had
less
of
an
increase
than
the
control
group.
Results
were
not
statistically
significant
because
of
a
power
issue
and
a
variance
issue
(SD),
and
likely
would
have
been
significant
with
more
subjects.
Many
challenges
were
faced
with
completing
this
study.
The
study
began
trying
to
find
participants
with
a
narrow
qualifying
window.
The
participants
needed
to
use
a
Beta2-adrenergic
agonist
inhaler
at
least
1
time
a
week.
It
was
found
that
most
kids
with
a
medical
diagnosis
of
asthma
are
controlled
with
a
corticosteroid
and
the
use
of
their
beta2-adreneric
inhaler
was
needed
for
emergency
purposes
only,
which
occurred
less
than
one
time
a
week.
Some
participants
used
their
beta2-adrenergic
inhaler
more
during
the
winter
and
less
during
the
summer
seasons,
where
some
used
it
more
during
the
allergy
season.
After
finding
very
few
subjects
who
used
their
inhaler
more
than
one
time
a
week
the
criteria
changed
to
having
a
medical
diagnosis
of
asthma
and
using
a
beta2-adrenergic
agonist
PRN.
A
high
no-show
rate
occurred
when
trying
to
get
the
qualified
subjects
to
arrive
for
the
first
visit.
This
is
partially
due
to
the
patient
population;
the
population
has
a
high
no-show
rate
for
all
dental
appointments.
The
subjects
were
told
prior
to
their
first
appointment
that
they
would
receive
a
spin
brush
if
the
study
was
completed.
Throughout
the
course
of
the
study
there
was
too
many
opportunities
for
the
patient
to
drop
out.
Some
of
the
incomplete
participants
did
not
finish
the
first
batch
of
lollipops
with
reasons
of
did
not
like
the
taste
or
gave
me
a
stomach
ache
or
just
forget
to
suck
on
them.
Some
of
the
incomplete
participants
did
not
return
to
pick
up
the
second
batch
of
lollipops
three
(3)
months
into
the
study.
A
few
participants
did
not
finish
the
second
batch
of
lollipops
and
some
did
not
return
for
the
final
evaluation/visit.
Most
children
liked
the
taste
of
the
lollipops
in
the
control
group
and
the
experimental
group.
There
were
not
any
side
effects
with
most
children,
except
a
few
stated
it
gave
them
a
stomachache.
The
study
would
be
stronger
if
the
lollipops
were
given
in
a
more
controlled
situation.
I
would
recommend
a
school
nurse
give
the
participants
the
lollipops
at
the
same
time
everyday
to
assure
that
the
participants
are
using
their
lollipops.
Upon
completion
of
the
study
it
was
simply
the
parent/legal
guardians
word
that
they
finished
all
the
lollipops.
A
few
families
had
multiple
children
participating
in
the
study
with
one
child
being
in
the
control
group
and
the
other
the
study
group.
It
was
our
hope
that
the
lollipops
did
not
get
switched
between
the
two
children.
Bacteria
levels
increased
in
many
participants
in
both
control
group
and
study
group.
A
benenficial
test
would
be
to
take
a
pre
and
post
plaque
index.
It
is
important
to
realize
that
these
lollipops
are
adjunctive
therapy
and
brushing
and
flossing
are
still
the
most
important
oral
hygiene
therapy.
A
plaque
index
was
not
completed
but
it
is
my
hypothesis
that
increases
in
Streptococcus
Mutans
and
Lactobacilli
were
due
to
increased
amounts
of
plaque
in
patients
who
were
either
not
brushing
effectively
or
not
brushing
at
all.
A
few
participants
had
an
increase
in
bacteria,
but
also
had
new
caries.
With
active
caries
in
the
oral
cavity
it
would
be
suspected
that
there
would
be
an
increase
in
bacteria.
Conclusion:
This
study
may
not
be
statistically
significant,
but
still
showed
evidence
that
the
herbal
lollipops
decrease
bacterial
levels
in
the
oral
cavity.
A
decrease
in
bacteria,
aids
in
decreasing
the
caries
process,
which
most
children
using
a
beta2-adrenergic
agonist
would
benefit
from.
It
is
a
hope
that
this
study
can
be
used
to
build
off
for
future
studies.
Herbal
lollipops
appear
to
be
good
adjunctive
oral
hygiene
therapy
and
hopefully
in
the
future
more
studies
can
be
completed.
References:
(1) office
of
the
Surgeon
General
(internet).
US
Dept
of
Health
and
Human
Services;
(updated
2007
Jan
9;
cited
2009
April
11).
Available
from:
http://www.surgeongeneral.gov/news/speeches/oralhealth042903.htm.
(2) Wange
LY,
Zhong
Y,
Wheeler
L.
Direct
and
indirect
costs
of
asthma
in
school-
age
children.
Prev
Chronic
Dis
(online)
2005
Jan
(cited
2009
April
11).
Available
from
:URL:
http://www.cdc.gov/pcd/issues/2005/jan/04_0053.htm.
(3)
Kargul
B.,
Tanboga
I.,
Ergeneli
S.,
Karakoc
F.,
Dagli
E.
Inhaler
medicament
effect
on
saliva
and
plaque
pH
in
asthmatic
children.
J
Clin
Pediatr
Dent
1998;
22:
137-40.
(4) Ryberg
M.,
Moller
C.,
Ericson
T.
Effect
of
Beta
2-adrenoceptor
agonists
on
saliva
proteins
and
dental
caries
in
asthmatic
children.
J
Dent
Res
1987;
66:
1404-6
(5) Ryberg
M.,
Moller
C.,
Ericson
T.
Saliva
composition
and
caries
development
is
asthmatic
patients
treated
with
Beta
2-adrenoceptor
agonists;
A
4-year
follow
up
study.
Scand
J
Dent
Res
1991;
95;
159-64
(6) Reddy
D.
K.,
Hedge.
M.,
Munshi
A.
K.
Dental
caries
status
of
children
with
bronchial
asthma.
J
Clin
Pediatr
Dent
2003;
27:
293-6
(7) McDerra
E.
J.,
Pollard
M.A.,
Curzon
M.E.J.
The
dental
status
of
asthmatic
British
school
children.
Journal
of
Pediatric
Dentistry
1998;
20
(4):
281-7
(8)
Milano
M.
Increased
risk
for
dental
caries
in
asthmatic
children.
Texas
Dent
J
1999;
116:
35-42
(9) Shulman
J.D.,
Taylor
S.E.,
Nunn
M.E.
The
Association
between
Asthma
and
Dental
Caries
in
Children
and
Adolescents:
A
Population-case
Case-Control
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Caries
Research
2001:
35
(4):
240-246
(10)
He. J., Chen L., Heber D., Shi W., Lu Q. Antibacterial compounds from
(12)
Hu C., He J., Eckert R., Wu X., Li L., Tian Y., Lux R., Shuffer J., Gelman F.,
Mentes
J.,
Spackman
S.,
Bauer
J.,
Anderson
M.,
Shi
W.
Development
and
evaluation
of
a
safe
and
effective
sugar-free
herbal
lollipop
that
kills
cavity-
causing
bacteria.
Submittted
to
Public
Health
Nutrition.
Pending
publication.
(13)