Cariogenic potential of oral thickening agents in dysphagic patients

Dysphagia management in older adults often involves the use of oral thickening agents to modify the consistency of foods and liquids and thereby, reduce the risk of aspiration. Currently, there is limited evidence on the cariogenic potential of these agents and the consequences for oral health in elders. This pilot, comparative in-vivo study evaluated the cariogenicity of four commercially available thickening agents in water: Ensure Multi-thick, Thick & Easy, Thicken Up Clear, and Thicken Up Gel Express. The products were tested in three older adult volunteers (n = 8 tests; two replicates per product across four products) using intraoral plaque pH telemetry. Absolute cariogenicity (AC) was assessed via acidogenic potential (area under the pH-curve below 5.7), and relative cariogenicity (RC) was calculated relative to a 10 % glucose control rinse. One-way ANO-VA was used to compare mean AC and RC across products. All four products demonstrated measurable cariogenicity (AUC < 5.7). Mean AC ranged from 13.70 (Thick & Easy) to 21.62 (Thicken Up Gel Express). Thicken Up Clear and Thicken Up Gel Express showed narrow standard deviations (SD = 0.09 and 0.49, respectively); Ensure Multi-thick showed high variability (SD = 21.02). RC values were highest for Thicken Up Gel Express (0.81 ± 0.15), then Thicken Up Clear (0.68 ± 0.08), and lower for Ensure Multi-thick (0.42 ± 0.42) and Thick & Easy (0.43 ± 0.36). The ANOVA revealed no statistically significant differences among products (P > 0.05). Within the limitations of this pilot study, all tested thickening agents showed moderate relative cariogenicity that may be clinically relevant in older adults with existing caries risk factors. These preliminary findings suggest that product selection and preventive oral care strategies are important when thickening agents are used for dysphagia management. Further analyses with larger samples and in vivo clinical outcomes are needed to confirm and extend these results.