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