Dietary Advice in Dental Practice PDF

Dietary advice in dental practice The occurrence of dental caries is in uenced by - The composition of the teeth - The type and quantity of oral bacteria - Composition and ow rate of saliva - The presence of dietary sugars - The residence time of sugars in the mouth - The presence or absence of uori...

Dietary advice in dental practice The occurrence of dental caries is in uenced by - The composition of the teeth - The type and quantity of oral bacteria - Composition and ow rate of saliva - The presence of dietary sugars - The residence time of sugars in the mouth - The presence or absence of uoride. * sugars are the most important dietary factor in the aetiology of dental caries. * Fluoride has an e ect on caries reduction but not elimination of caries. * Fluoride increases the resistance to dental caries, but doesn’t get rid of the cause of dental caries — dietary sugars. * Limiting sugar intake is still important in the prevention of caries * Both the frequency and amount of sugars consumed are associated with dental caries and the evidence for one is not stronger than the other. Potentially cariogenic foods and drinks Sugar and chocolate confectionery Cakes and biscuits Buns, pastries, fruit pies Sponge puddings and other puddings Table sugar Sugared breakfast cereals Jams, preserves, honey Ice cream Fruit in syrup Fresh fruit juices Sugared soft drinks Sugared, milk-based beverages Sugar-containing alcoholic beverages CLASSIFICATION OF SUGARS FOR DENTAL HEALTH PURPOSES - Extrinsic sugars are more readily available for metabolism by oral bacteria than intrinsic sugars and are, therefore, potentially more cariogenic. - Due to the lower cariogenicity of lactose and the cariostatic nature of milk - Sugars naturally present in milk and milk products are classi ed as ‘milk sugars’ and are distinguished from other free sugars or ‘non-milk extrinsic sugars’ (NMES). - The sugars that are potentially damaging to dental health are the NMES and include all added sugars, sugars in fresh fruit juices, honey and syrups. The dietary reference value (DRV) for NMES is a maximum of 60 g/day, which equates to approximately 10% of daily energy intake. - The main source of sugars in the diets of boys and girls is sugared, non-low-calorie soft drinks, with confectionery being the second largest source. - Together, soft drinks (including fresh fruit juice which is high in NMEs) and confectionery contributed to more than 50% of NMES intake. - Both of these food categories may also be associated with obesity. fi fl fl fl ff 1 of 5 STARCHY STAPLE FOODS - Dietary starch is heterogeneous - It is naturally present in a number of di erent food types, sometimes cooked or consumed raw. - Raw starch is of low cariogenicity. With the exception of raw vegetables, however, most starch is cooked or re ned for consumption. - Cooked and highly re ned starch does have the potential to cause dental decay, particularly if it is retained in the mouth long enough for amylase digestion to occur. - Animal experiments have shown that combinations of cooked starch and sucrose (eg biscuits and cakes) cause more caries than sucrose alone. - Baked and processed sugar-containing starchy foods, such as cakes, biscuits and sugared breakfast cereals, may be of particular concern. - Current dietary guidelines encourage the consumption of starch-rich staple foods (such as bread, potatoes, unsweetened breakfast cereals and grains), and vegetables that naturally contain starch. - There is no epidemiological evidence to show that these staple starchy foods and vegetables are harmful to teeth. FRUIT AND FRUIT SUGARS - Current dietary guidelines recommend at least ve portions of fruit and vegetables per day. - Fruit does contain sugars (fructose, sucrose and glucose) - Plaque pH studies and incubation studies have shown that fruit is acidogenic. - Data from epidemiological studies largely show that fruit is non-cariogenic. - Fresh fruits as eaten by humans, also appear to be of low cariogenicity - NMES in the diet should be replaced with fresh fruit, vegetables and starchy foods. - Fresh unsweetened fruit juice also contains NMES because the juicing process releases the fructose, sucrose and glucose from the whole fruit. - The NMES content of unsweetened juice may amount to as much as a standard soft drink, - Dried fruit is likely to be more cariogenic than fresh fruit: - Drying degrades the cellular structure of the fruit releasing some intrinsic sugars into NMES. - Tendency to adhere to the teeth = prolonged oral retention time. - As consumption of dried fruit is low, however, there are no epidemiological data linking its consumption to dental caries. MILK SUGARS - Cow’s milk is non-cariogenic, as the sugar present is lactose - Lactose is the least cariogenic of all mono- and disaccharides. - Milk contains factors that protect against demineralization of enamel - (calcium phosphate & casein) - Evidence from animal experiments strongly suggests that milk may be anti-cariogenic. - Cheese and yoghurt without added sugars may, be considered safe for teeth. - Milk products with added sugars cannot, be considered as protective against decay fi ff fi fi 2 of 5 ‘HIDDEN SUGARS’ AND FOOD LABELLING - Many foods carry nutrition labels that show the total sugars content of the product in g/100 g. - Total sugars includes all mono and disaccharides but excludes oligosaccharides oligosaccharides - Fructo-oligosaccharides (found in some ‘sugar-free’ chewable vitamins and yoghurts) - Maltodextrins (tasteless used to increase the energy content of food without increasing the sweetness and are also used as anti-caking agents in dried packet foods) - Glucose syrup. - Studies indicate that these types of oligosaccharides are potentially cariogenic. The only sweeteners that are safe for teeth are: - Sugar alcohols (eg sorbitol and mannitol) - Lycasin (hydrogenated glucose syrup) - Isomalt - Intense’ sweeteners, such as aspartame and acesulphame K - Sugar alcohol, xylitol, may have a have a speci c anticariogenic e ect. However, the laxative e ect of the sugar alcohol sweeteners will limit their use in the diet. - The 1989 COMA report1concluded that ‘non-sugar bulk and intense sweeteners are non-cariogenic or virtually so’ and that ‘substitution of sugars with alternative sweeteners could substantially reduce caries development DIETARY RECOMMENDATIONS FOR PREVENTION & MANAGEMENT OF DENTAL CARIES The best advice for reducing caries risk is - to reduce the frequency of consumption of sugars- containing food and drinks - to limit their consumption to mealtimes only. - to avoid sugars-containing food and drinks close to bedtime (within one hour) - salivary ow is low and its bu ering capacity is reduced at night. - Grazing: A common eating pattern, to eat little and often. - It is important to recommend food and drinks that carry a lower caries risk or may help to prevent caries (Table 3) - Patients should be encouraged to eat foods, such as cheese and chew sugar-free gum after meals to neutralize the acidogenic e ects of dietary sugars - Studies shown that chewing sugar-free gum prevent and protects against dental caries. - As little as 5 g of hard cheese has been shown to be e ective against dental caries in children - Parents of infants should be made aware of the dangers of bottle caries ff ff fi ff ff fl ff 3 of 5 - Mothers should be advised not to add any food or drink to a baby’s bottle other than formula milk, expressed breast milk, cow’s milk or water. - As soon as possible, Infants should be encouraged to use a cup or beaker rather than a bottle and all bottle feeding should cease by one year old - Cow’s milk is lower in sugar than formula milk & is higher in the protective factors, calcium and phosphorus. However, no cow’s milk should be given before the age of six months due - to the risk of allergy and - the high solute load. - From six months onward, cow’s milk may be integrated into the diet but the main source of milk should remain breast milk or formula, both of which are higher in iron. - From one year, full fat cow’s milk may be given, from two years semi-skimmed milk and from five years fully skimmed milk, if desired. DENTAL EROSION Dental erosion is the loss of dental hard tissue by a process that does not involve bacteria. There are a number of causes of erosion of tooth tissue including - Acids in foods (citric, malic, phosphoric, tartaric, acetic and [carbonic acids -> least erosive]) - Intrinsic acids (from vomiting or re ux) - Environmental acids. The consumption of carbonated water has not been implicated in dental erosion. * Erosion often co-exists with other forms of tooth wear, such as attrition and abrasion where enamel softened by acid has been worn away by over-zealous tooth-brushing or grinding of teeth. * There is also evidence that juices are 3–10 times as erosive as whole fresh fruits. If acidic drinks are sipped over a long period of time, this may increase their erosive potential, as the longer the teeth are bathed in acid the longer period of time for erosion to occur. fl 4 of 5 DIETARY RECOMMENDATIONS FOR THE PREVENTION & MANAGEMENT OF DENTAL EROSION - As a preventive measure, all patients should be informed of the types of food and drinks that may cause dental erosion (Table 4). - In cases of erosion, a dietary history should be carried out to determine which particular foods are relevant to the individual patient and advice tailored to the patient should be given to reduce their consumption. - Patients may also be advised to consume foods and drinks with low/no erosive potential (Table 5) and to take foods that neutralize dietary acids, such as cheese and milk, following acidic foods and drinks. - Cheese protects the teeth by - By stimulating salivary ow - By increasing plaque calcium concentration, achieved with a small amount of cheese (~5g) - All patients should be advised to keep acidic drinks to mealtimes if possible, to avoid them close to bedtime and to drink them down in one go rather than sip them over a long period. - Acidic drinks should also be low in sugars to minimize dental caries. - The best drinks are, milk and water. Z fl 5 of 5