War of nutrition

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Diet plays a crucial role in optimising oral health. A dynamic relationship exists between nutrition and overall oral health, and it is recognised that one of the primary measures for reducing caries risk is adherence to healthy dietary practices. While the frequent intake of acidic foods and beverages is well established as having a detrimental effect on teeth, many dentists are unsure of how to advise parents on dietary guidelines for their children. This article aims to give an overview of current dietary advice, from a dental perspective.

Fermentable CARBS

The cariogenic potential of sugar and other fermentable carbohydrates is evident. That the incidence of caries still ranks worldwide as one of the most common diseases in society demonstrates that established oral hygiene practices, and fluoride use, do not completely protect teeth from dietary risk factors.

Sugar consumption is reported to be higher in Middle Eastern countries than in many other developing areas. A study conducted by Sayegh et al. (2002) in Jordan shows that sugary snacks are consumed by a majority of children. Confectionary was reported to be regularly consumed by 76% of the 4 to 5 year-old children surveyed, and biscuits and cakes by 71%. More than 50% were reported to drink canned fruit juice and carbonated drinks regularly between meals. Consequently, the prevalence and severity of caries in 4 to 5 year-old children was high; 67% of the children had some caries experience and 33% had DMFT greater than 4.

Dental caries is caused by the dissolution of the teeth by acid, produced by the metabolism of dietary carbohydrates by oral bacteria. The process can be explained as a loss of mineral, as the neutral pH value of saliva is affected. From an average value of 7, once the pH of saliva drops below 5.7, the dental enamel begins to lose calcium and other minerals, leading to dissolution. Many common food products containing fermentable carbohydrates can, after consumption, drop a plaque pH below 4.

The development of caries requires the presence of sugars and other fermentable carbohydrates, which are metabolised to acids by plaque bacteria. Sucrose is one of the most, but not the only, cariogenic substance in the diet. Glucose, fructose, lactose and starch are examples of other fermentable carbohydrates.

The relation between frequent sugar consumption and caries is notable in early childhood caries (ECC). This condition is characterised by significant decay of a child's teeth, particularly the upper and lower incisors. Poor feeding practices without appropriate preventive measures can lead to a distinctive pattern of caries in infants and toddlers, known as baby bottle tooth decay (BBTD). Frequent bottle feeding at night, nocturnal breast-feeding on demand, and extended and repetitive use of a no-spill training cup are associated with ECC. Caries is often triggered by prolonged exposure to liquids or snacks containing sugar, or by the tradition of dipping pacifiers in honey, sugar or syrup.

The correlation between sugar consumption and caries is also a sociocultural phenomenon. In newly industrialised countries, such as certain Middle Eastern countries, the incidence of caries has increased as residents switch from a dependence on traditional, staple foods, to a dependence on refined carbohydrates, without an accompanying change to regular oral hygiene habits.

Food acids and erosion

Tooth erosion is the progressive loss of dental hard tissue by acids, in a process that does not include plaque bacteria. Tooth erosion is not an infectious disease, but the resulting defects can impair the integrity of the tooth. Dental erosion is less common than caries primarily because saliva flow protects the teeth by neutralising acids. When dental erosion does occur, it is usually the result of either a diminished saliva flow rate or frequent consumption of soft drinks, fruit juices, sports drinks and flavoured waters.

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Dental Nutrition for Children
Posted by Valerie Houghton, Abu Dhabi, UAE on Wednesday 21 November 2007 at 23:00 UAE time


Children, aged 2-11 yrs. have very specific nutritional needs with the primary goal of promoting growth and development and the prevention of chronic disease. Yes, even at this age, children are at risk for developing metabolic disease. Eating and physical activity patterns established in childhood can have long–term health effects and proper dental nutrition dispended by dental professionals should include heart healthy recommendations such as no more than 10% saturated fat calories per day, no more than 30% total fat calories per day and not less than 20%. Fibre recommendations should be quantitative with the recommended amount equal to or greater than the child’s age plus 5 grams per day. This can be easily obtained if children consume the recommended amounts from breads and grains. For the 2-3 year old, 3 servings, 4-8 year olds 4 servings and 9-13 year olds 6 servings. Examples of a serving are; 1 slice of bread, 30 grams of cold cereal, ½ cup of cooked pasta or rice. Fruit and vegetable recommendations are 5 servings per day while limiting fruit juice to about 4-6oz each day. From ages 1–8, children need 2 cups of milk or its equivalent each day and from ages 9–18, 3 cups per day. Meat recommendations for children 2-8 years old are 1 serving per day and children 9-13 years old should have 1-2 servings of meat or alternatives a day. A serving of meat is one ounce, or approximately 25-30 grams. Lastly, children, especially young ones, do need a healthy meal or snack about every 3 to 4 hours to keep them energized. Healthy offering could include choices such as vegetables and fruit, whole grain bread, low sugar cereals, whole grain crackers, milk, yogurt, cheese, milk puddings, hard boiled eggs, or cooked lean deli meats such as turkey, chicken, beef or ham.

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