Dental Caries PDF

DIET AND DENTAL CARIES  Introduction ▪ It is a localized destruction of tooth surface by the acids produced from catabolism of dietary sugars (esp. CHOs) by the oral bacteria. ▪ It affects all ages especially children, where more than 530 million are affected annually ▪ Enamel, gets...

DIET AND DENTAL CARIES  Introduction ▪ It is a localized destruction of tooth surface by the acids produced from catabolism of dietary sugars (esp. CHOs) by the oral bacteria. ▪ It affects all ages especially children, where more than 530 million are affected annually ▪ Enamel, gets destroyed completely in the process of dental caries. Dental Caries  Dental Caries ▪Dental caries was first described in Miller’s chemoparasitic theory in 1890. ▪The 2 primary bacteria involved in dental caries are : Streptococcus mutans Lactobacillus acidophilus  Dental Caries Three major prerequisites for dental caries are: ▪ Teeth ▪ Diet ▪ Dental plaque (Bacteria) Other risk factors  Dental Caries ▪ Diet interferes with the balance of tooth demineralization and remineralization in several ways ▪ Demineralization occurs when the dental plaque pH drops below 5.5 which favors the growth of S. mutans ▪ Remineralization is favored by low sugar and high calcium rich protein diet e.g. cheese, use of fluoride, etc Dental Caries Dental Caries  Dietary factors that affect dental caries 1 -Types of carbohydrate 2 -Physical form of sugars and oral clearance time 3 -Factors in the diet that protect against dental caries 4 -Intake frequency  Types of Carbohydrates 1. Sucrose (Table sugar) from sugar cane or beets. 2.Fructose, a simple sugar in fruits and honey. 3.Maltose, a complex sugar in barley and malt syrups. 4.Lactose, a complex sugar in milk. 5.Dextrose, a refined sugar from corn, sugar cane or beets. 6.Glucose, a simple sugar in fruits, vegetables and grains. 7. Polysaccharide (e.g. starch) Types of Carbohydrates The sugars with the most cariogenicity are sucrose and glucose (red). Other carbohydrates (maltose, lactose, fructose, and starch) are less cariogenic. The sugar alcohols, such as sorbitol and mannitol, are the least cariogenic (yellow) Xylitol has been shown to be anticariogenic (green). Physical form of sugars and Retention time ▪ Dietary sugars could be: those naturally found in foods (e.g. fruit, honey, and dairy products) those that are added to foods during processing to alter the flavor, taste, or texture of the food ▪Prolonged oral retention of sugars may lead to Extended period of demineralization and shortened periods of remineralization  Oral clearance properties 1- Metabolism of food by oral bacteria 2- Adsorption of food on the oral surfaces 3-Degradation of food by plaque and salivary enzymes 4-Saliva flow rate 5-Swallowing. ▪Most carbohydrates will be cleared by these mechanisms, although the rate varies between individuals.  Frequency of food intake ▪ Frequency of sugar consumption is a significant contributor to the cariogenicity ▪ Higher frequency means more demineralization and less remineralization. ▪ Duration of the decrease in pH after sugar intake is an important confounder in this process  Anticariogenic substances ▪ Cheese Proposed mechanisms are as follows: 1-Increased salivary flow and consequent buffering effect, which neutralizes plaque acids 2-Inhibition of plaque bacteria and the effect of that inhibition on reducing acid production ▪ Fluoride 1- inhibits demineralization & improves remineralization of enamel. 3- Inhibits bacterial metabolism of sugar thereby reducing acid production. ▪ Polyphenols (e.g. tannins in cocoa, coffee, tea, and many fruit juices). In vitro & in vivo experiments show that tea polyphenols interfere with glucosyl transferase activity of S. mutans which may reduce caries formation. ▪Sugar alcohol–based products Tooth-friendly sugar-alcohols including sorbitol, xylitol, mannitol, erythritol, and isomalt. Xylitol—a 5-carbon sugar that oral microflora cannot metabolize—has many anticariogenic effects: ✓ Antimicrobial action ✓Stimulation of salivation & increasing buffering effect ✓Increase in pH of plaque promotes remineralization  Sorbitol ✓ Simulate salivation without reducing the critical pH ✓ Similar effect to xylitol in terms of caries control ▪ Generally Sugar-free gums like sorbitol or xylitol gums, stimulates salivation, and increases clearance of other fermentable sugars from the oral cavity.  Vitamins Vitamin D and K were shown to be useful in the maintenance of oral hygiene. ✓VITAMIN D- Required for normal development of teeth and therefore helps in reducing the risk of dental caries in children. VITAMIN K- Helps in reducing the breakdown of carbohydrates, so that bacteria in the oral cavity are not able to use it.  Groups at risk of dental Caries 1-Infants and toddlers 2-People with increased frequency of eating 3-Those with increased carbohydrate intake 4-Those with reduced salivary secretion. 5-Athletes 6-Those on long term and/or multiple medications. 7- Those taking sugary snacks or drinks at bedtime  Recommendations for prevention of Dental Caries ▪ Eating a balanced diet rich in whole grains, fruit, and vegetables ▪ Practicing good oral hygiene—particularly the use of fluoridated toothpastes ▪ Eating a combination of foods. e.g. Dairy products such as cheese in between meals Adding raw fruits or vegetables to meals to increase salivary flow Recommendations for prevention of Dental Caries ▪ Chewing sugar-free gums to stimulate remineralization and increase salivary flow ▪ Avoiding putting an infant or child to bed with a bottle of milk, juice, or other sugar-containing beverages.