A.Sudharsana et al /J. Pharm. Sci. & Res. Vol. 7(1), 2015, 49-50

Tooth Friendly Chocolate
A.Sudharsana
CRI,
Saveetha Dental CollegeDr.Srisakthi .M.D.S.
Senior lecturer, Dept. of Community Dentistry,
Saveetha Dental College

Abstract:
One of the main constituents of chocolate is cocoa. Extracts from this cocoabean husk is said to contain certain anti-cariogenic
substances. The cocoa bean huskhas been shown to possess two types of mode of action, one showing
antiglucosyltransferase(GTF) activity and the other antibacterial activity. They act against bacterial adhesion to the tooth
surface and thereby decreasing the microbial growth. These substances are identified and are tried to incorporate in various
forms for usage such as in tooth paste, mouth rinses and etc. The aim of this review is to highlight the recent trends about theevolution of cocoa bean extracts in dentistry and its usage indental field.
Key words: Theobromine, cocoa bean husk, anti-cariogenic, plaque control.

INTRODUCTION :Worldwide, 60–90% of school children and nearly 100% ofadults have dental cavities (1). Inspite of the increase inawareness about oral health care among people and recent
advances in dentistry, there is still a high prevalence ofcaries (2) The reason for this being the food habits which
has transformed from traditional food to junk food.
Chocolate being the king of junk foods, a common
misconception is that, chocolate is the main culprit for
causing dental caries. But the truth being, Among all
cariogenic substance, chocolate does not top the list. Apartfrom this there is a good aspect of chocolate (refined
chocolates are not considered), it contains cocoa powderwhich is derived from cocoa bean. This cocoa bean is said
to contain substances which are anticariogenic(3).
Fluorides, as a preventive measure for dental caries is in
use for more than many decades, but it has certain
drawbacks such as toxicity, fluorosis etc. Apart from this
there is controversy towards usage of fluorides by the anti
fluoride lobbies. Austria, Belgium, Denmark, Finland,France, Germany, Iceland, Italy, Luxembourg, Netherlands,
Norway, Sweden, and Switzerland are some of thecountries, where anti fluoride lobby is in its strong hands(4). Caries vaccine on the other hand is in itspreliminary
stages of development. Even if it reaches the common
market, the feasibilityand affordability by common man,especially from developing countries is questionable.
In this era of modern medicine, antibiotics are used foranything and everything. This has not only reduced theproblems, but has given rise to issues like antimicrobial
resistance and allergic reactions to drugs. A safe alternative
would be going back to the nature. Hence researchers are
keen to identify anti-cariogenic substances with reduced illeffects. Cocoa bean extracts have been incorporated inpreventing caries occurrence.
But these researches are still in the initial phase and are
expected to gain importance in the near future. This review
aims at giving a preliminary insight in to cocoa bean husk
and its uses in dentistry.
COCOA BEAN HUSKThe cocoa bean husk is a waste material in the chocolate
industry known to contain a large amount of polyphenols
and dietary fibers, such as cellulose, pectin, lenin. Cocoa

bean husk is separated from the pre-roasted beans oftheobroma cocoa. The cocoa bean husk has been shown topossess two types of cariostatic substances, one showing
anti-glucosyltransferase (GTF) activity and the otherantibacterial activity(3).
Theobromine is one of the major constituent in the cocoa
bean. Theobromine (theobromide), which was previously
known as xantheose, is a bitter alkaloid of the cocoa plant.
It is found in chocolate, as well as in a number of otherfoods, including the leaves of the tea plant, and the kola (orcola) nut. It is in the methylxanthine class of chemicalcompounds which also includes the similar compounds
theophylline and caffeine. Cocoa beans naturally containapproximately 1–4% theobromine. Cocoa powder can varyin the amount of theobromine, from 1.2%-2.4% (5).
There are usually higher concentrations of theobromine indark than in milk chocolate.
OTHER PRODUCTS FROM COCOA HUSKCocoa husk is commonly used as animal feed, in pelletized
form. Cocoa bean husk contain potash and this is used in
the manufacturing of soft soaps (6) and also as fertilizers
for soil.
ANTICARIOGENIC EFFECT OF COCOA BEAN HUSKStreptococcus mutans has been implicated as a primarycausative agent of dental caries in humans. The microorganisms produce 3 types of glucosyltransferase (GTFB,GTFC, and GTFD), and synthesize an adherent and waterinsoluble glucan from sucrose by their cooperative action,
which causes the organisms to adhere firmly to the tooth
surface (3). The adherent glucan also contributes to theformation of dental plaque, in which the accumulation ofacids leads to localized decalcification of the enamelsurface (7).
Cocoa bean husk extract is said to contain, higher
molecular- weight polyphenolic compounds which is said
to have strong anti-glycosyltranseferase property. Apartfrom this it contains unsaturated free fatty acids, such asoleic and linoleic acids, which exhibit antibacterial activity
against S. mutans. The cariostatic property of the cocoa
bean husk is due these biological active constituents (3).
There was a study done to identify the anticariogenic effectof theobromine by examining its ability to cause

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A.Sudharsana et al /J. Pharm. Sci. & Res. Vol. 7(1), 2015, 49-50

remineralization of enamel lesion and it was concluded,
thattheobromine in an apatite-forming medium can enhance
the remineralizationpotential of the tooth (8).
THEOBROMINE TOOTH PASTE
An invitro study by Sadeghpour has found thattheobromine is better than fluoride(2). It is thought that theamount of theobromine in a one ounce darkchocolate bar
has a better effect on tooth hardness than a 1.1%
prescription sodiumfluoride treatment, (9). They showedthat at a concentration 142times less than that of fluoride,
the theobromine active had twice the protective effectonteeth. As said before, fluoride has so many
disadvantages, including its irritation of the gastro intestinal
mucosa, conversely theobromine was found to be readily
absorbedby the gut, metabolized and cleared cleanly byhumans(9).
Similarly there was another study conducted by thescientists of Tulane University regardingtheobromine,
which showed theobromine’s effect on the crystalline
structure of teeth has an additional benefit, when used in
the same concentration of sodium fluoride that is generally
used in the tooth paste, it was seen thattheobromine wasbetterin its action (10).
APART FROM ANTI CARIOGENICITY
Cocoa bean husk extract rinse is highly effective in
reducing mutans streptococci counts and plaqueaccumulation when used as mouth rinse by children. It canfeasibly be incorporated in chocolates, chewing gums,
mouth rinses, and beverages to prevent dental caries (11).
Though no side effects were observed, the commoncomplaint expressed by the children was regarding thebitter taste of the rinse. Addition ofnoncariogenic sugar
substitutes should make it more acceptable, especially forchildren.
There are few studies comparing chlorhexidinemouthrinseversus cocoa bean huskextract mouth rinse as antimicrobial
agent (12). The results show thatthere was significant
reduction in streptococcus mutans counts in saliva at all
follow-upintervals for both mouthrinse groups. However,there was no significant difference inreduction of
streptococcus mutans counts in saliva, between
chlorhexidinemouthrinse group and cocoa bean husk
extract mouthrinse group.
Hence cocoa bean husk extract mouth rinse can be used as
mouth rinse as an alternate tochlorhexidine mouth rinse as
they both have same antimicrobial effect and evades theside effects of later.

EFFECT ON PERIODONTITIS
Oxidative stress affects the progression of periodontitis.
Cocoa is a rich source of flavonoids with antioxidant
properties, which could suppress gingival oxidative stressin periodontal lesions. Consuming a cocoa enriched dietsuppressed gingival oxidative stress and periodontal
inflammation in an animal study.
CONCLUSION
The research on theobromine and its anti cariogenic effectis in its nacent stages. The strength of evidence of its
effectiveness against the gold standard, such as fluoride isvery low because of the lack of randomized controlled
trials both in vitro and in vivo. If infuture this proves to bebeneficial and cost effective, then it could open a new era
ofapproach to prevention.
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