ROLE OF NUTRITION TO PRVENT DENTAL CARIES

Today I will talk about nutrition and dental caries.....

Very few nutritionist talk about this, because there are very few studies being done by researchers and scientist. Which kind of sugar is effecting?? what is the frequency of sugar consumption?? Do fruits and vegetables also effect the teeth and gums??? 

So many queries in mind... lets solve them...  

Oral health is related to diet in many ways, for example, nutritional influences on craniofacial development, oral cancer, dental caries, dental erosion, developmental defects, oral mucosal diseases and oral infectious diseases. Diet affects the integrity of the teeth; quantity, pH, and composition of the saliva. Nutrition affects the teeth during development and malnutrition may exacerbate periodontal and oral infectious diseases. However, the most significant effect of nutrition on teeth is the local action of diet in the mouth on the development of dental caries and enamel erosion. Dental erosion is increasing and is associated with dietary acids, a major source of which is soft drinks. Despite improved trends in levels of dental caries in developed countries, dental caries remains prevalent and is increasing in some developing countries undergoing nutrition transition. There is convincing evidence, collectively from human intervention studies, epidemiological studies, animal studies and experimental studies, for an association between the amount and frequency of free sugars intake and dental caries. Although other fermentable carbohydrates may not be totally blameless, epidemiological studies show that consumption of starchy staple foods and fresh fruit are associated with low levels of dental caries.

Therefore on the basis of the scientific researches, the following recommendations are suggested by me as a nutritionist:

• High intakes of starchy staple foods, fruits and vegetables are associated with low levels of dental caries.
• Cooked staple starchy foods such as rice, potatoes and bread are of low cariogenicity in humans.The cariogenicity of uncooked starch is very low. Finely ground and heat-treated starch can induce dental caries but the amount of caries is less than that caused by sugars. 
• The addition of sugar increases the cariogenicity of cooked starchy foods. Foods containing cooked starch and substantial amounts of sucrose appear to be as cariogenic as similar quantities of sucrose.

• Animal studies have also been used to investigate the relationship between amount of sugars consumed and the development of dental caries. A research done by Mikx et al. found a significant correlation between the sugar concentration of the diet fed to rats and the incidence of dental caries. According to Hefti and Schmid found that dental caries severity increased with increasing sugars concentrations up a 40% sucrose diet. A number of epidemiological studies provide evidence for an association between amount of sugars consumed and dental caries. 
• Data from animal studies have indicated the importance of frequency of sugars intake in the development of dental caries. Dental caries experience increases with increasing frequency of intake of sugars even when the absolute intake of sugars eaten by all groups of rats was the same. The frequency of consumption of foods containing free sugars should be limited to a maximum of 4 times per day.
• Many of the earlier animal studies investigating the relationship between sugars and dental caries focused on sucrose, which was at that time the main dietary sugar that was added to the diet. However, modern diets of industrialised countries contain a mix of sugars and other carbohydrates including sucrose, glucose, lactose, fructose, glucose syrups, high fructose corn syrups and other synthetic oligosaccharides and highly processed starches that are fermentable in the mouth. Oral bacteria metabolise all mono and di-saccharides to produce acid and animal studies have shown no clear evidence that, with the exception of lactose, the cariogenicity of mono and disaccharide differs. However, early plaque pH studies have shown plaque bacteria produce less acid from lactose compared with other sugars.

• Combining dairy foods with sugary foods, raw foods with cooked and protein-rich foods with acidogenic foods are beneficial.
• Eating and drinking be followed by cariostatic foods such as xylitol chewing gum is recommended. Sugar-free chewing gum is “toothfriendly” as it helps increase saliva flow and clears food debris from the mouth.
• Restrict consumption of sweetened beverages during meal and snack time. 
• Hard cheese increases the flow of saliva. Cheese also contains calcium, phosphate and casein, a milk protein, which protects against demineralisation. Finishing a meal with a piece of cheese helps counteract acids produced from carbohydrate foods eaten at the same meal.
• Do not nibble food or sip drinks continuously. Allow time between eating occasions for saliva to neutralise acids and repair the teeth.
• Decrease frequency and contact with acidic foods and drinks
• Avoid brushing teeth immediately after consuming acidic foods, drinks, citrus fruits and juices. This allows time for remineralisation to occur.

The dental team should thoroughly understand the relationship of diet to caries and conscientiously apply that knowledge to educate the patients in general as well as counsel specific high-risk individuals. Further emphasis should be placed on the acquisition of sound scientific data for counseling caries patients concerning diet and dental caries.

The primary public health measures for reducing caries risk, from a nutrition perspective, are the consumption of a balanced diet and adherence to dietary guidelines and the dietary reference intakes.

References

• Mikx FHM, Hoevel JSvd, Plasschaert AJM, Konig KG. Effect of Actinomyces viscosus on the establishment and symbiosis of Streptococcus mutans and Streptococcus sanguis on SPF rats on different sucrose diets. Caries Research 1975; 9: 1–20. 
• Guggenheim B, Konig KG, Herzog E, Muhlemann HR. The cariogenicity of different dietary carbohydrates tested on rats in relative gnotobiosis with a streptococcus producing extracellular polysaccharide. Helvetica Odontologica Acta 1966; 10: 101–13.
• Konig KP, Schmid P, Schmid R. An apparatus for frequencycontrolled feeding of small rodents and its use in dental caries experiments. Archives of Oral Biology 1968; 13: 13–26.
• Holbrook WP, Arnadottir IB, Takazoe I, Birkhed D, Frostell G. Longitudinal study of caries, cariogenic bacteria and diet in children just before and after starting school. European Journal of Oral Sciences 1995; 103: 42–5.
• Holbrook WP, Kristinsson MJ, Gunnarsdottir S, Briem B. Caries prevalence, Streptococcus mutans and sugar intake among 4-year-old urban children in Iceland. Community Dentistry and Oral Epidemiology 1989; 17: 292–5.
• Rugg-Gunn AJ, Hackett AF, Appleton DR, Jenkins GN, Eastoe JE. Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent schoolchildren. Archives of Oral Biology 1984; 29: 983–92.  
• Burt BA, Eklund SA, Morgan KJ, Larkin FE, Guire KE, Brown LO, et al. The effects of sugars intake and frequency of ingestion on dental caries increment in a 3-year longitudinal study. Journal of Dental Research 1988; 67: 1422–9.
• Ludwig TG, Bibby BG. Acid production from different carbohydrate foods in plaque and saliva. Journal of Dental Research 1957; 36: 56–60.
• Hussein I, Pollard MA, Curzon MEJ. A comparison of the effects of some extrinsic and intrinsic sugars on dental plaque pH. International Journal of Paediatric Dentistry 1996; 6: 81–6.

http://www.who.int/nutrition/publications/public_health_nut7.pdf

http://ajcn.nutrition.org/content/78/4/881S.full

http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862005000900015

http://www.ncbi.nlm.nih.gov/pubmed/12699234

http://www.ncbi.nlm.nih.gov/pubmed/10553247

NUTRITION FOR PREGNANT WOMEN AND LACTATING MOTHER

Good evening everyone...

Glad to be back again.

After such a long time I m writing an article. It fees so good.

Today I m going to talk about nutritional requirement for pregnant women and Lactating mother. As I am facing the same phase, very exciting, different and always alarming. Taking care of yourself more than anybody else so that the fetus inside me should be safe and happy.

From conception to exclusive breast feeding (first 6 months) the baby completely depends on mother’s nutritional status.  If the mother is overweight, it will decrease the blood circulation to the uterus and restrict the quantity and quality of nutrients transferred to the placenta which further provide nutrients to the fetus. On the other hand, if the mother is underweight or not gaining optimal weight during pregnancy the nutrients that are transferred to the fetus will be of inadequate in context with quality as well as quantity. There is a considerable increase in the nutritional needs of the mother. On an average the pregnant women gains about 10 - 12 kg during pregnancy. A pregnant women need to consume about 350 extra calories per day, which translates to one additional meal. The growth and development of the fetus is determine

d by the food taken by the mother. All the nutrients provided to the baby are derived from her food. In the first seven days, baby nourishes with the nutrients from the just fertilized ovum, then the amniotic fluid and later on throughout the pregnancy the baby receives nutrients via the placenta. Even after birth the baby receives all the nutrients for the first 6 months exclusively from mother’s milk. This is followed by gradual introduction of complementary foods after 6 months along with the mother’s milk. Eating healthily during pregnancy will help the baby to develop and grow normally, and will keep the mother fit as well. A healthy diet during pregnancy should contain the right balance and combination of nutrients. If the mother is consuming a balanced diet comprising of various food groups, she gets the benefit of various nutrients that are necessary and increased during the pregnancy

NUTRIENT RECOMMENDED DURING PREGNANCY

Adequate intake of a nutritious diet is reflected in optimal weight gain during pregnancy (10 to 12 kg) by the expectant woman. Their diet should be well balanced and include adequate amount of foods from all food groups, i.e. body building foods (Protein), protective foods (Vitamins and Minerals) and energy giving food (Carbohydrates). If mother takes a well balanced diet, she will have a normal course of pregnancy.

Pregnant women should choose foods rich in fiber (fibre 25 g/1000 kcal) like whole grain cereals, pulses and vegetables, to avoid constipation.

Excess intake of beverages containing caffeine like coffee and tea adversely affect foetal growth and, hence, should be avoided. In addition to satisfying these dietary requisites, a pregnant woman should undergo periodic health check-up for weight gain, blood pressure, anaemia and receive tetanus toxoid immunization.

Daily oral iron and folic acid supplementation is recommended as part of the antenatal care to reduce the risk of low birth weight, maternal anaemia and iron deficiency. Iron is needed for haemoglobin synthesis, mental function and body defence. Deficiency of iron leads to anaemia. Plant foods like legumes and dried fruits contain iron. Folic acid, taken throughout the pregnancy, reduces the risk of congenital malformations and increases the birth weight. Green leafy vegetables, legumes, nuts and liver are good sources of folic acid. 500 mg folic acid supplementation is advised preconceptionally and throughout Pregnancy for women with history of congenital anomalies (neural tube defects, Cleft palate). 

Calcium is essential, both during pregnancy and lactation, for proper formation of bonesØ and teeth of the offspring and for secretion of breast-milk rich in calcium and also to prevent osteoporosis in the mother.  Iodine intake ensures proper mental health of the growing foetus and infant.

The pregnant women require enough physical exercise with adequate rest for 2-3 hrs during the day. Pregnant and lactating women should not indiscriminately take any drugs without medical advice as some of them could be harmful to the foetus/baby. Smoking and tobacco chewing and consumption of alcohol must be avoided. Wrong food beliefs and taboos should be discouraged.

NUTRIENT RECOMMENDED DURING LACTATION

A balanced diet suitable for a nursing mother shall contain the same kind of food as those recommended during pregnancy, but slightly increased quantities. Twin factors of physical activity and active production of breast milk make additional demands for energy yielding foods, proteins and other nutrients. A mother's capacity to produce milk of sufficient quantity and quality to support infant growth is resilient and remarkably resistant to nutritional deprivation, however, milk production normally affects maternal body composition and nutritional status, and lactating women have increased nutrient demands.

The women who are breastfeeding her infant requires not only large quantities of body building (Proteins) foods and protective foods (Vitamins and Minerals) but also additional energy yielding foods to facilitates the synthesis and secretion of breast milk.

Intake of fluids should be increased as fluids are essential for adequate milk production. Therefore, consumption of fluids in any form like juices, butter milk, milk and milk based beverages and even plain milk should be encouraged. A mother should preferably take some fluids before breastfeeding her infant

The choice of food is wide during lactation. No food is restricted except highly spiced and strongly flavoured food, as they impart flavour to the milk which may be repulsive to the baby.

They are also given special preparation having ajwain, methi seeds, saunth, til seeds etc, which supply protein, iron, calcium and B-vitamins. These foods are called as galactogogues, i.e foods that help produce more milk.

Small and frequent meals (5-6meals in a day) are recommended. Greenleafy vegetables and fruits of all varieties should be consumed.

Since some of the medicines can be absorbed into the mother’s blood stream and may be secreted in the milk, the use of medicines during lactation should be strictly under medical supervision.

Good nutrition during lactation will not only ensure optimum milk supply for the baby and a healthy and happy infant but also help the mother maintain a good nutritional status.