Diet and Dental CariesPresented by :Dr Pawan Raj M.D.S II nd year

contents• Definations • Introduction• Diet and Dental Caries• Major factors in dental caries

process• Stephen’s curve• Factors affecting caries process• Dietry constituents and cariogenicity• Food guide pyramid • Sugar clocks• Epidemiological human studies

1.Interventional human studies

2.Non interventional human studies• Starch and Dental caries • Cariogenicity of Food • Can food be ranked acc to

cariogenic potential

• Role of fats ,proteins &vitamins in dental caries

• Artificial sweetners for reduction of dental caries

• Soft drinks and beverages in dental caries

• Trace elements and its mechanism

• References

Definations• Diet :

Total oral intake of a substance that provides nourishment and energy (Nizel,1989)

• Balanced Diet :It is one which contains varities of foods in such quantities & proportion that the need for amino acids,vitamins,fats,carbohydrates &other nutrients is adequetly met for maintaining health ,vitality & general well-being and also makes provision for a short duration

of leaness(Chauliac,1984)

• Child diet :Combination of food consumed and the nutrients contained there in, which have a profound ability to influence cognition, behavior and emotional development in addition to ultimate physical growth & development (DCNA 2003)

• Dental caries:

Dental caries is an irreversible microbial disease of the calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth , which often leads to cavitation

Introduction • Diet :plays imp role in which contribute to development

of caries

• Dietry sugar : Most imp etiology of Dental Caries

• Todays diet contains :

a) Fermentable carbohydrate

b) High pronounced starch containing food

c) Novel synthetic carbohydrate(oligofructose,sucrose,glucose

d) Non cariogenic sweetners

• Multifaced strategy for caries control:

a) Oral hygiene

b) Use of flouride

c) Diet control

Diet and Dental caries• Frequent consumption of carbohydrate associated

with prevalence of dental caries

• Overall imp factor Dental Caries & Food consumption are the events that occur in evidently diff time periods

• To determine the effect of diet :assessment of form & frequency of carbohydrate should be made earlier than clinical examination of caries

• 2nd problem :evaluating diet & caries in large intra individually and inter individually

Dietary sugars and caries SUCROSE-ARCH CRIMINAL (Newbrun 1969)• Effect on plaque• substrate for cariogenic microflora Sucrose polymers bulk of plaque

attachment of bacteria High free energy, high specificity of enzymes

SUGARS – THE ARCH CRIMINAL (zero 2004)

Diet

Sucrose + other carbohydrates

AdhesiveExtracelluar polymers

Intracellular storage

polysaccharides

Glycolytic metabolism

ExtracelllularStorage

polysaccharides

Dental caries Periodontal disease

Plaque accumulation

Lactic acid production Co2

fixation

ATP production

Biosynthesis of toxic

macromolecules

growth

• Diet and dental caries have several background factors:

a) Intake pattern

b) Total food intake

c) Salivary secretion rate

d) Plaque composition

e) Use of flouride

f) Socioeconomic variable

Estimation of consumption based on supply data do not take in account factors such as ;

• Age distribution• Socioeconomic • Ethnic • Cultural differences

Relation of starch to Dental Caries ----> controversial

• Lingstrom et al 2000:

When evaluating starch in animal human plaque ph response in situ caries model studies

Results: Processed food starches in mordern diet posses a significant cariogenic potential

• Lingstrom et al 2000studies on human provide unequivocal data on

actual cariogenicity

historical data->starch has low caries

effect

Moredern sources->starch contribute to

caries development

Major factors in the dental caries process

• Five Dental and oral environment factors :

1. Tooth chemistry

2. Amount of salivary flow

3. Types of Dental Plaque bacteria

4. Type of fermentable carbohydrate eaten

5. Frequency of daily food intake, especially the between meal snacks, are causative agents concerned with initiation and extension of dental caries

• Dental caries is caused by interaction between oral bacteria, their access to fermentable carbohydrates and vulnerable parts of the tooth.

• Classic graph which bears Stephan's name, shows the rapid drop in plaque pH after a glucose rinse

• The drop in pH is the result of fermentation of carbohydrates by some plaque bacteria.

• The gradual return of the pH is the result of buffers present in plaque and saliva.

• Provided the pH does not drop below 5.3 the enamel remains intact, but below this critical level, crystals of apatite dissolve (demineralise).

Stephen’s curve

• Fortunately both plaque and saliva are saturated with calcium and phosphate ions, so that if the pH returns fairly rapidly above the 5.3 level, ions will go back into the enamel and recrystallise (remineralise).

• Acid environments favour demineralisation and occur when there is a plaque biofilm, a supply of sugar for them and little saliva. Neutral or alkali environments favour emineralisation and occur when there is good oral hygiene, no sugar and plenty of saliva.

• The presence of fluoride ions in the tooth or in the plaque also help remineralisation to take place.

Factors affecting caries process

• Caries results from a dietary disorder, the damage to the tooth is not done directly by the excess of sugar but a combination of factors which result from the excess.

• These include the effect of sugar on bacterial activity, time and the tooth environment

Dietary Constituents and Cariogenicity

Constituents :Polysaccharides & Sugars

Starch

sucrose

Fructose

Glucose 4

sugars

• Main polysaccharide—starch (not highly cariogenic)(cariogenic in some circumstances

• Japan & italy known to consume high amount of starch –caries rate relatively low

• Studies—excessive & frequent use of highly fermentable mono & disaccharides correalted with high caries rates

• Glucose,fructose,lactose and mannose-cariogenic bt minor constituents in human food

• Sucrose –commenest dietary sugar

Physical properties of food and cariogenicity

• Some important physical properties that determine food texture are:

1. Mechanical properties Hardness

Cohesiveness

Viscosity

Adhesiveness

2. Geometric properties Particle size

Shape

3. Others Moisture

Fat content

Texture of food• Caldwell,1970 –Texture of food & subjective descriptions of

food items by the use of terms as soft-hard,crumbly-brittle,tender-tough,sticky-gooey,gritty-coarse,dry-moist arise from physical properties

• Mcgregor,1958-physical properties of food have significance by affecting food retention,food clearence,solubility & oral hygiene

Fibrous fruits & vegetables• High fibrous,cellulose content of plant food exerts a mechanical

cleansing action on teeth &eating raw fruits & vegetables has long been recommended an aid to oral hygiene & caries preventive measure

• Slack and martin,1958-study on effect of apples & dental health gave indications of caries reduction

other fibrous vegetables a celery also exerts mechanical cleansing effects & not strongly acidic as apples.

Physical texture and chemical composition• Effect salivary flow rates• Flowing saliva more alkaline than resting saliva & more

supersaturated with calcium & phosphate –thus more caries inhibitory

• Those properties that improve cleansing action &

reduce the retention of food within oral cavity

& increases saliva flow encouraged everyday

Natural v/s processed foods

• Natural,unrefined foods contain protective factors against dental caries.

• Studies showed-saliva incubated with refined foods caused a greater dissolution of tooth enamel than when incubated with unrefined foods.

• Mixtures that included bran,wheat germ & unrefined treacle & cane juice contained protective factors

Jenkins ,1966• Protective substance in cereals-”PHYTATE”

a polyphosphate• PHYTATE=when applied to tooth enamel

reduces solubility & has caries inhibiting

effect

Acidity of Foods• Acidic diet usually affect in transient manner ,ph in plaque and saliva.

• Natural foods such as lemons,apples,fruit juices and carbonated beverages sufficiently acidic demineraliztion of enamel

• Above items in normal dietary usage no influence on dental caries process

• Excessive usage of foods and beverages causes etching of enamel and cavitation

• Reports of excessive frequency of consumption of carbonated beverages,having a low ph ,continuous chewing & habitual sucking of lemons causes dental erosion

Food guide pyramid

• Pictorial representation of UNITED STATES DEPT OF AGRICULTURE’S DAILY FOOD GUIDE

• Commonly used tool for planning healthful diet

• User friendly and offers people flexibility in planning a daily diet

• Varitions of the food guide pyramid exist over various populations such as elderly,vegetarian & peoplelderly ,vegetarian & people of diff ethnicities

Sugar clocks (S S Fuller & M Harding)

Frequent eating – Acid formation

No acid formation

• Important factor in the prevention of dental caries is limiting the number of times in a day that sugar enters the mouth.

• simply illustrated by using the sugar clock.

• The effectiveness of this as a technique for teaching 9-11-year-old children the importance of limiting frequency of sugar intakes was tested in a controlled study.

• Four weeks and 4 months after sugar clocks

were used with a study group of children, they showed a significant increase over baseline in the number of correct answers given to a questionnaire. 

• A control group showed no significant increase.

• It was concluded that the sugar clock is an effective method of teaching the importance of limiting frequency of sugar intake to this age group

British Dental Journal 170, 414 - 416 (1991) 

Epidemiological Human Studies

• Shift towards habits & diets associated with urban living led to increase in dental caries

Primitive way

Urban

living

• Food consumed by mordern society compared with earlier periods charaterized as

a. Manufactured and more

processed food

b. High take of refined flour

c. Softer food consistency

• Starch consumed during earlier periods differ from highly gelatinized processed starch today constitute majority of mordern diet.

• Rugg-gunn,1986studies point out low caries prevalence during starch

• Schamschula ,1978 ed caries has been

observed in relation to certain starches such as diet consisting frequent consumption of sago starch in grps of people in new guinea

Reduced refined carbohydrate Caries prevalence fall

• toverud,1951 marked changes in intake of refined carbohydrate in europe and japan

Reduction in sugar and sugary products

Reduction in caries

In short Hopewood study

• Lonngitudnal study (australian children)

• Diet given: lactovegetarian with minimum sugar and refined flour

• Showed low caries prevalence as compared to control group

• Caries ed when children left home

• Newbrun et al,1980

a. 17 human subjects ,the sugar intake was 2.5g for H & 48.2g for control grp.

b. Corresponding DMFT index 2.1 & 14.3

c. Both grps ate high levels of starch(160g/day in H grp & 140g/day in cntrl grp)

• Result consumption of starch did not appear to be conductive to caries development

INTERVENTIONAL STUDIES• VIPEHOLM STUDY• HOPEHOOD HOUSE STUDY• TURKU SUGAR STUDY

EXPERIMENTAL CARIES STUDY

NON INTERVENTIONAL STUDIES• EPIDEMIOLOGICAL STUDIES• CROSS- SECTIONAL STUDIES• OBSERVATIONAL STUDIES

Interventional studies1) Vipeholm study, Lund (Sweden) 1945- 1954

• 1930,Hojer and Maunsbach, Gustafson 1954• Purpose- to determine the effects of frequency

and quantity of sugar intake on the formation of caries.

• Institutionalized patients (436- 32yrs) were divided into 6 experimental and 1control group

• Poor oral hygiene, twice normal sugar

Seven groups

• Control group - low sugar diet only at meals• Sucrose group - high- sugar diet (300g) mostly in drinks

with meals• Bread group - sweetened bread at meals (sugar- ½ or

equal to normal)• Caramel group- 22 sticky candies

2 portions at meals (carbohydrate study I)

4 portions between meals (carbohydrate study II)• 8- toffee group• 24-toffee group- throughout day, twice normal total intake

of sugar• Chocolate group- milk chocolate- 4 portions bet

meals( CSII)

Studies were divided into 3 phases

1. clinical experimental studies of the relation bet diet and caries

2. Supplementary studies3. Special studies (Hojer and

Maunsbach 1954)

Preparatory period (1945- 1946)

pts were selected, recording methods

I Clinical experimental studies

1) Vitamin study (1945-1946) Vit A,C,D, 1mg Fl tab Basic diet- sugar (1/2) + starch = low caries

2) Carbohydrate study To examine how caries activity was influenced by the

ingestion of carbohydrates under controlled conditions

• Study 1 (1947- 49) SUGAR - solution/ sticky form at (new bread) /bet

meals( toffees)

• Study 2 (1949- 51) Types of sweets were similar

Preparatory and vitamin period- low sugar= 0.34 carious lesions/pt/yr

Carbohydrate I- twice the normal amt of sugar, only at meals

Carbohydrate II- normal amt of sugar only at meals/ at and bet meals

Results

• Little effect- sweet drinks with meals

bread sugar in non sticky

• Moderate increase in caries- chocolate (4times) bet meals

• Dramatic increase- 22 caramels

8 / 24 toffees bet or after meals

Effect of frequency and CHO intake (Davies 1955)

0

1

2

3

A B C D E

CONTROL GROUP

NEW CARIOUS SURFACES /PERSON/YEAR

The effect of frequency and form of carbohydrate intake on dental caries activity

Influence of carbohydrate type and frequency on Dental Caries

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Sugar with meals sugar with and bet meals

Coronal caries

Cementum caries

II Supplementary and special studies

Supplementary study Quensal et al 1954 – reliability of the method in determination of

caries, caries activity was statistically significant in all groups (sticky)

Special studies 1) Biochemical studies (Lundquist 1952, Swenander lanke 1957)

sugar content of blood and urine, pH viscosity, buffer capacity, cap conc in saliva and oral sugar clearance.

2) Microbiological studies (Grubb and Krasse 1953, 1954)

Differences in lactobacilli and carbohydrate

caries promoting diet=>caries, high LB count

Other studiesa) Consumption of sweets and caries activity in school children an

Hungarian farm workers-showed increase in caries with increase in high sucrose diet

b) Studies on the inhibition of acid production by substance produced by chocolate bean – showed significant decrease in caries and streptococcous mutans

3) Genetic study (Book and Grahnen 1953)

Parents and siblings of caries free recruits - low caries prevalence, no diff bet oral hygiene and dietary habits.

IMPLICATIONS “All the sweets you like but only once a

week” sugar substitutes Malmo study 1976- consumption of

sugar (sticky) form bet meals= >caries incidence + high LB count

Vipeholm study - Citation classic

Conclusion

• Increase avg sugar consumption(30-330g/day) showed very little increase in caries(0.27-0.43 cs/yr) provided additional sugar was consumed at meals in solution

• In patients with poor oral hygiene - caries• Varies from person to person• Subsides- withdrawal of sugar containing foods• Great risk –Sugar (retained on tooth surf)• Greatest risk- bet meals, form• Increase in duration of Sugar clearance from the saliva

Limitations

• No possibility of matching the age• Initial caries• Mentally handicapped- instructions• Dietary regimes of various groups

Hopewood study in Bowral, N.S.W, Australia

• 1942, 80 children, 7-14 yrs (10yr period)

• Vegetarian diet- carbohydrates (whole meal bread, whole meal porridge, biscuits, wheat germ, fruits ,vegetables, dairy products)

• 1948- 49 – meat• Vitamin concentrates, nuts and honey• Unfavorable oral hygiene, insignificant fl, meals

controlled = Toothsome diet

• Results- 13yr old (DMF) -1.6(53%) HH

-10.7(0.4%) general

Heredity fructose intolerance • 1st described in 1956

• Autosomal recessive disorder of fructose metabolism associated with reduced activity of fructose 1 phosphate aldolase by 2.5%liver ,renal cortex & small bowel

• Following fructose intake,patient experiences nausea vomiting,excessive sweating,malaise ,coma & convulsions

• Patients tend to avoid all sweets and most of the fruits

• Patient able to take glucose ,galactose,lactose & starch containing foods

• Patient usually have teeth with extraordinary good condition

• Caries if present limited to pits & fissures & usually not in smooth surfaces

• Indicative of –starchy foods do not produce decay sugary foods do

Turku sugar study, Finland (Scheinen and Makinen 1975)

• AIM - To compare the cariogenecity of sucrose, fructose and xylitol. (1972-1974)

• BASIS- Xylitol is a sweet substance not metabolised by plaque organisms.

• 125 subjects (115), 27.6yrs (15-45yr)

3 groups – sucrose (S), fructose (F) and xylitol (X)

• Examination- clinically, radiographically • Precavitational and cavitational lesions• primary and secondary caries

Results

1) Early white spot lesions- • Sucrose group- DMFS- 3.6• After 1 yr- sucrose and fructose= equal

xylitol= no caries• 2nd year- sucrose- increase

fructose- unchanged

Xylitol- zero• Xylitol- non cariogenic / anticariogenic

2) Cavitation- low DMFS –xylitol than sucrose and

fructose.

Development of primary and secondary caries (24 mon)

Primary secondary

S- 7.2 10.5

F- 3.8 6.1

X- 0.0 0.9

Conclusion

• Substitution of xylitol for sucrose in normal Finnish diet resulted in low caries incidence.

• Reduced the number of most microorganism

• second 1yr trial –to test the effects of xylitol gum• 102 subjects- 22.2yrs• 2 groups (chewing gum)

1) sucrose (4.2 sticks/day)

2) xylitol (4.9 sticks/day)

Saliva- remineralistion

Xylitol- anticariogenic effect

IV. Experimental Caries Study

Von der fehr 1970-buccogingival enamel caries • 23 days,50% sucrose solution (9 timesdaily)• After 30 days- oral hygiene and fl rinses.• Critical factor- duration and frequency

Loe et al 1972- 3 weeks, chemical plaque control twice daily (CHX) but no Fl, no caries

Conclusion Sugar is modifying risk factor Dental plaque is a etiological factor Clean teeth- no caries

Non interventional human studies

• Subjects are free to choose whatever diet they please, correlation bet caries increment and dietary factor is low.

• Based on dietary recall

• No control over amount/ frequency of sugar intake

I. Epidemiological studies

Sugar consumption in selected countries in1977

0 10 20 30 40 50

Consumption (kg/y) / person

Australia

Finland

Iceland

Japan

Canada

China

Cuba

USSR

Sweden

Switzerland

USA

England

Sugar consumption in Sweden 1960-1990

0

20

40

80

100

120

1960 1970 1980 1990

60

• During world war II in Europe and Japan – wartime food restrictions

15kg- 0.2kg nutrition Marthaler 1967 – (1941-1946)- less decay

• Sreenby 1982 – international data 6yr (23 nations), 12yr (43 nations) <50gms- <3 DMFT

II. Cross sectional studies• Goose1967, Goose and Gittus 1968, James et al 1957,

Winter et al 1966, 1971 labial incisor caries and sugared pacifiers

• Granath et al 1976,1978- level of sugar-controoled, Fl was given

Oral hygiene (6yr, 4yr)-result –low caries prevalence

• Hausen et al 1981 – 2000 finish school children, least caries prevalence- sugar exposure

• Marthaler 1990- sugar main threat• Wendt et al 1995,1996- 700 infants,1-3yr Bottle fed/breast fed>12mon Less fl toothpaste Oral hygiene and diet-result :high caries prevalence

III. Observational studies• Axelsson and El Tabakk 2000- 685, 12yr old

(period of 2yrs) with poor oral hygiene, sugar diet.

• Rugg- Gunn et al (1984) North thumberland, England and Burt et al 1988 in Michigan

Assessed frequency and grouping of foods

North thumberland

Michigan

Duration 2yr 3yr

age 11.5 11-15

subjects 456 499 Frequency of eating Diet diary

6.8 t/d

15 day diary

4.3t/d

3-10 day Total sugars 118g/d 142g/d

Caries incidence 1.21 DMFS/Y 0.97 DMFS/Y

Starch and dental caries• Swenander lanke 1957

• Dietary starch - mixture of starch products with apparently widely varying potentials to serve as substrates for bacterial acidogenesis in plaque and hence induce cariogenesis.

a) Intraoral bioavailability of starch• Polymers of glucose• Starch molecules- starch granules

(grains and vegetables)• Gelatinization (8-100 c)

• Starch

dextrin and glucose (mormann and muhleman1981)

• Modifiers – starch protein, starch lipid interactions

Salivary

Bacterial amylaseMaltose + maltriose

b) Applications to cariology

1)Starch consumption, frequency and retention

• Stickiness of starches in human mouth (Bibby etal 1957,Gustafson 1953,Caldwell 1975)

• Kashket et al 1991 – increased starch food particles related to increased caries

• Lingstorm et al 1997 – high cariogenic potential

2) Studies of starch caries issues with humans

• Classic vipeholm study• Hopewood house experiments• Turku sugar studies• HFI individual study

Draw backs1) Frequency of consumption

2) plaque pH lowering potential

3) bioavailability

Hopewood house study

• Lacto vegetarian diet• 3 meals with milk upon rising and milk/fruit

after dinner• Low caries

Vs and HHS – not caries inducive

Turku sugar study• 3 groups- sucrose, fructose, xylitol• Xylitol- little / no caries

Newbrun et al 1980• HFI (hereditary fructose tolerance)= little caries • Little sucrose(2.5g/d), total carbohydrate (160g/d)

Rugg gun et al 1987 – (2yr) • High starch/ low sugar diet- no reduction caries

Sreenby 1983, 1996- 12yr children• Various starches + little sucrose=low

Schamschula et al 1978- • Starch diet+ sugar + frequency= caries

Studies of starch caries issue with animals

• classic animal model (van Houte 1980,1994)

MS free rats fed with high sucrose diet

sucrose replaced by starch – fissure caries

• Bowen et al 1980- starch sucrose diet• Processed starches• Amylopectin and amylose• Result - increased caries prevalence

• Firestone et al 1984- cooked wheat starches

• pH remained low for longer periods

Starch and dental caries???

Non cariogenic or cariogenic• Non cariogenic • Starch products can be , but frequently are not, as effective as

sucrose in inducing enamel caries

1) lower bioavailability of starches

2) diminished delivery of glucose and maltose to plaque bacteria.

• Enhanced retentiveness of starchy foods

“It is premature to consider starches in modern diet as safe for teeth”

Cariogenecity of foods (ADA 1985)

• Cariogenic potential- a foods ability to foster caries in humans under conditions conducive to caries formation. (Stamm et al 1986)

• Diet counselling• methods to assess

Animal models, plaque acidity models, demineralization and in vitro models.

• Influenced by- sugar content, protective factors, consumption pattern and frequency

(Bowen et al 1980)= CPI

Edgar 1985- • food factors- Amt and type of CHO,

food pH, buffer, consistency , retention in mouth, eating pattern, factors modifying enamel solubility.

• Cultural and economic factors- availability and distribution

Can foods be ranked according to their cariogenic potential?? • Foods – 2 categories ( Switzerland )

acidogenic / non- acidogenic

1. Cheddar cheese

2. non fat dry milk solution

3. 10% sucrose solution, fruit beverage

4. caramel. cracker, potato chip. SLS

5. Milk chocolate, sugar cookie, corn and wheat flake.

Minimum pH obtained with reference foods (schachtele and Jensen)

3

4

5

6

7

Caries promoting potential

categories examples CPP details

1) Simple sugars Disaccharides

Sucrosemaltose

Dextrin, corn syrup, fruit sugar, powdered sugar,

honey

yes Carbonated and bottle drinks, vegetables and

processed foods with added sugars

2) lactose Milk sugar low Galactose?

Fermentable CHO- polysaccharides- starch

Cooked potatoes, rice, legumes, grains,

cornstarch and bananas

yes Gelatinized

Non fermentable – 1) fiber

Cellulose, pectin, gums no Grains, fruits, vegetables

2) Sugar alcohols Sorbitol, mannitol, xylitolLactitol,maltitol, HSH

30-90% sweet

High intensity sweetners1)nuritive

aspartame no Food additives in desserts>200-700 times

2) Non nutritive SaccharinAcesulfamesucralose

no

Snack foods – Acidogenic potential Edgar 1981

Group1 Beverages

Fruit etc

Baked goods sweets

LeastAcidogenic

1) Milk peanuts Sugarless gum

2) Chocolate milk apple Bread , butter CaramelsSugared gum

Chocolate

3) Carbonated beverages

banana Cream filled cakes ,sandwich

cookies

Orange jellies

4) Apple/orange juice

DatesRaisins

Sweetened cereal

Bread jamSweet biscuits

5) Apple pie Clear mints

6) Fruit gumsFruit lollipops

Cariogenecity of foods

• Based on acidogenic potential Raw vegetables<nuts<milk<corn chips<fresh fruit<ice

cream<French fries<dried fruit.

• Retention High sugar foods- caramel, chocolate bars

Sucrose+ cooked starch

Cariogenecity- food composition, texture, solubility, retentiveness, and rate of salivary clearance than sucrose alone

Role of vitamins in dental caries

Vitamin B1- thiamine

Caries promoting effect

Vitamin B6 (pyridoxine)

• Cole et al 1980 – reduce caries in rats• High doses - drug (pregnant women and children)

• Local effect?• Affect growth rates, metabolism and microbial

composition of dental plaque (by stimulating/ inhibiting microbial species)

Role of fats in dental caries

Post eruptive consumption- reduce caries

Mechanism ??• Protects the enamel surface by fatty film• Reduces the contact bet CHO and bacteria• Antimicrobial action? (Williams et al 1982)• Replace carbohydrates (Michigan 1994)• Rapid clearance of carbohydrates from oral cavity.

Role of proteins in dental caries

• Shaw 1970 and Navia 1979- protein deficiency during dental development in rats -

caries susceptibility• Experimental and control rat pups on cariogenic diet

Mechanism? Posteruptively – direct action on plaque met Short exposure time in mouth Replace CHO weak proteolytic activity in mouth

xylitol• Metabolism by microorganisms- lacks enzyme to

utilize xylitol• Frequency – 3 times a day• Timing- long term

Caries prevention• Turku 1975- 90% reduced• Gallium 1981- 70%- candies• Isokangas 1987- gum• Makinen et al 1995 (Belize study) – pellet and

sticky gums

sorbitol

• Fermented by microorganisms (Slow- SM)• Substrate for microorganisms• Diffuses out acid• Slack et al 1964- 48% reduction• Birkhed and bar 1991- acidogenecity reduced• Glass et al 1983,szoke et al 2001- gum• Von loveran 2004- between /after meal

sweeteners

• Non caloric• Not fermented by oral microorganisms

Saccharin- (Grenby et al 1991) • active cariostatic property• Inhibit bacterial growth

Aspartame (NutraSweet)- reduce caries

SOFT DRINKS AND CARIES

Potentially cariogenic• 10% sucrose• Carbonic and phosphoric acids- pH 2.4-2.5

(transitory)• Oral sugar clearance is rapid

Apple and orange juice- heavily buffered

Protective food components• Fluoride• Phosphates- capo4 toothpaste, ACP-CPP• Fatty acids- replace carbohydrates (Michigan 1994)• Arginine rich peptides and pyridoxine (basic)• Calcium lactate• Dietary acids and flavors (foods and beverages)• Tea and starch• Aged cheddar cheese- antiacidogenic effect• Chocolate ad extracts, glycyrrhizin/ liquorice• Sugar substitutes

Trace elements • Trace elements in diet can be cariostatic or caries

promoting • Grpd in to a. Cariostatic –Fl,Pb. Midly cariostatic –Mo,V,Cu,Sr,B,Li,Au,Fec. Doubtful cariostatic-Be,Co,Mn,Sn,Zn,Br,I,Yd. Caries inert –Ba,Al,Ni,Pd,Tie. Caries promoting –Se,Mg,Cd,Pt,Pb,Si

• Trace elements divided in to 2 categories1.Those that have well defined human requirements,namely –iron,zinc,iodine,copper,flourine

2.Those that are integral constituents or activators of enzymes namely manganese ,molybdenum,selenium,chromium ,cobalt

Possible mechanism of trace elements

• Altering the resistance of the tooth itself or modifying the local environment at plaque-tooth enamel interface

• Acts like flouride ,other elements can modify the physical and chemical composition of the teeth thus affecting the soluability of the enamel to acid attacks

References • Understanding dental caries-Niki foruk

• Dental caries-The disease and its clinical management-Ole Fejerskov & Edwina Kidd

• Nutrition in clinical dentistry 3rd edition-Athena Papas(nizel)

• Textbook of Pedodontics 2nd edition –Shobha Tandon

• Laura M.Romito.Nutrition and oral health .The Dental clinics of North America2003 vol 47(2)

• S S Fuller & M Harding The use of the sugar clock in dental health education British Dental Journal 170, 414 - 416 (1991) 

• Applied Oral Physiology - The Ecology of the Mouth chap 4

Thank you