Diet and Dental Caries

Pre and Post Fluoride era:(the systemic effect)

·         Industrialized vs. underdeveloped countriesàmore caries in industrialized because of more refined carbohydrates..but after fluorideàcaries decreased.

·         Ca, P, and vitamin D levels increase, during teeth priority (development).

·         Fluoride ingestion during teeth development.

·         Protein deficiency can retard teeth and salivary gland development, which can diminish the immunity thus increasing caries susceptibility.

Note: Fluorosis teeth are hypocalcifed but hyperfluoridated bcz the the fluride present during development of teeth disrupting the normal ca and p content of hydroxyl apetite.

Local effects of diet on caries:

·         Dietary CHO are metabolized by plaque bacteria (strepto. Cocci) to produce acids. (high bacteriogenic , cariogenic)

·         Diet high in CHO will selectively favor acidogenic bacteria.

·         Fluid diet à ↓ salivary flow  & the buffering capacity à ↑caries

Special populations:

1-Infants:

Bottle caries (early childhood caries)ECC

Max incisors + max 1ry 1^st molar are mostly affected.

Cause: the stagnation of fluid while the baby sleep (this fluid are Lactose in milk, sugared milk, milk sweetened with honey, rice in milk for thickness, juices, sugary beverages and sugar dipped pacifiers).

2-Elderly:

·         Often neglected oral hygiene by themselves or their care giver.

·         Gingival recession increases the rates of root caries and cervical caries (higher critical PH)

·         Dehydration and dry moth due to multiple medication which increases the risk of dental decay.

·         Physical problems---cant brush the teethgood enought

·         The critical PH is the point at which the loss of mineral begin

critical PH for Enamel 5.5 while for cementum is higher 6.3 and dentin lower.

Cariogenicity of Food:

·         Sucrose is the criminal of dental caries being the primary cause of tooth caries

·         The focus on sucrose cariogenicity lead to the wrong belief that other so called natural sweeteners as fructose and high fructose corn syrup are noncariogenic.

·         Studies done on primates and other animals showed that mixture of natural sugar as glucose and fructose are cariogenic as sucrose as.

·         These studies have questioned the benefits of substituting fructose for sucrose.

·         It is not commonly known that many fruits contain a lot of sugars. E.g.: pineappleأناناس  13% sugar so has more sugar than Pepsi !

·         So, natural occurring sugars like fructose and glucose should be considered cariogenic.

·         Honey, sugar cane, fig and dried fruits are highly cariogenic.

Methods for Testing Cariogenicity of Food:

1.     Clinical trials.

2.    Intra-oral testing.

3.    Animal caries model.

4.    Measurement of acid production in plaque (intraoral plaque pH measurement) àmost acceptable.

5.    In vitro testing of acid production and enamel demineralization.

Intra oral plaque PH measurement received the greatest acceptance

·         In Switzerland, products that have been tested in vivo and were found not to lower plaque pH below 5.5 after 30 min were considered noncariogenic and given a label.

·         Noncariogenic labels are only permitted if the data is derived from clinical studies of caries indices. E.g.: xylitol is noncariogenic.

·         The pattern (frequency) and sequence of food intake are very important variables in influencing plaque pH. E.g.: cereal eaten between orange juice and toast with jam).

·         Intraoral pH tests can only be done on small people.

  Factors affecting cariogenicity:

1.     Type of carbohydrate (fermentability).

2.    Frequency and sequence.

3.    Retentiveness and solubility .

4.    Protective factors against caries.

5.   Time of day.

·         A highly cariogenic food item is:

-          High in fermentable carbs.

-          Dissolves slowly.

-          Retained for a long time.

-          Has no protective effects.

-          Eg…. sweets

·         Low cariogenic food:

-          Low in fermentable carbs.

-          Soluble.

-          Not retentive.

-          Has a protective effect.

-          E.g.: cheese, nuts.

Carbohydrates :Sources of CHO include the good (that contain fiber), the bad (sweet and candy) and the ugly.

Why do manufactures choose sucrose to be added in food?

1-    Enhances flavor.

2-   Adds texture.

3-   Preserves humidity (humectants).

4-   Adds bulk.

5-   Inexpensive.

Cariogenic properties of sucrose:

1-    Easily fermented by plaque bacterod of measuia.

2-   Easily diffuses into dental plaque.

3-   Acts as a substrate in the formation of extracellular glucan which forms the structure of plaque and causes more bacterial colonization.

Glycemic index:

·         Definition: A method of measuring blood sugar levels with respect to CHO consumption.

·         It only measures how much and how fast the blood sugar level increases.

(If some one Wants to raise his blood sugar quickly (athletes)>>>they would consume food with high GI>>>THIS WILL FILL THEM QUICKLY &GIVE FAST BURST ENERGY BUT THEN IT WILL LEFT THEMANGRY AND LETHERY)

Protective food: food that has protective characteristic against the dental caries.

1-    Fluoride:

-          The anticariogenic effect of fluoride has been documented and well established.

-          Fluoridated water and beverages has “ halo effect”.

-          Its major effect is topical.

-          E.g.: in some green tea up to 10ppm.

2-   Cheese:

-          Noncariogenic and may protect against caries.

-          In vitroàbeneficial effects.

-          Animals fed rich fermentable CHO showed reduced caries level after intake of cheese.

-          A study showed that: intake of chedder and swiss cheese between cariogenic meals decreased root caries.

-          Dental plaque decreased by different types of cheese.

-          Method of action(MOA):

Ø  Buffer effect.

Ø  Stimulates salivary flow if hard type.

-          Buffering effect of chesian phosphopeptides (calcium and phosphate) on acid formation in dental plaqueà remeniralization.

-          Plaque samples

-          Cheese contains various fatty acidsàcalcium and phosphate are retained by micelles and act as reservoir and serve as effective slow release.

3-   Phosphates:

-          Decreases caries level.

-          Mechanism is unknown.

-          Sources: unrefined grains such as oat hull contain phytate which is an organic phosphate.

-          When dicalcium phosphate dehydrate is added to chewing gumà decrease caries.

-          Calcium sucrose phosphate added to candyà decrease caries.

4-   Pyridoxine, fat, tannic acid, xanthenes, cacao, chocolate.

Fibrous detersive food itmes may prevent carried indirectly by increasing salivary flow.

            Penuts, fruit, vegetables also increase salivary flow.

Diet Modification:

1)    Recommend brushing at least twice after meals.

2)   Recommend drinking fluoridated water.

3)   Limit candies and confectionsحلويات  to meal times.

4)   Limit between meal sugar snacks.

5)   Explain and teach the patient about hidden sugars (salty CHO, ketchup, dates,pine apple,coffeemate,tougort.ادويت الكحى )

6)   Recommend noncariogenic confections according to the patient’s condition.

7)   Use detersive food (sugarless gum) which will increase salivary flow.

8)   Eat protective food items after sugar snacks “pillow effect”.

·         For pregnant women:

-          Carries control by:

1)    Topical fluoride (gel, Varnish, rinse).

2)   Chlorhexidine.

3)   Chewing xylitol gum.

4)   Restorative and preventive treatment of carious lesions.

5)   Decrease chances of caries transmission to the child (no kissing).

·         For infants and babies:

-          Carries control by:

1)    Do not dip pacifier into sweety food.

2)   Do not give sweetened beverages at night time.

3)   Do not give milk at bed time(or follow it by drinking water to wash it away).

·         For sweet snacking children:

-          Carries control by:

1)    General diet modification ”as mentioned previously”

2)   Supervised tooth brushing.

3)   Topical fluoride application.     

Aspurtam & sacarine not proven to be cancerous.