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DIET & DENTAL CARIES

CONTENTS

Introduction Classification and physical properties of food Dietary factors in caries promotion. Carbohydrates and DC Studies providing evidence for relationship between diet & DC Relationship of various food stuffs & DC
Factors influencing cariogenicity of food Sugar substitutes Labelling & Legislation & regulation Tooth friendly sweets Effect of sugar containing medicine Effect of advertising food & drinks on children Child nutrition service programmes Dietary recommendations. Conclusion & References

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Oh, I wish Id looked after me teeth, And spotted the perils beneath, All the toffees I chewed, And the sweet sticky food, Oh, I wish Id looked after me teeth -SOME OF ME POETRY BY PAM AYRES

Terminologies:

Food:

Diet:

Nutrition:

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Dental caries equation: Sugar + Bacteria from plaque = Caries

PATHOGENESIS OF DC
ENAMEL PELLICLE + BACTERIA

PLAQUE FORMATION
PLAQUE BACTERIA + FERMENTABLE CARBOHYDRATE ( FOOD) ACID PRODUCTION DEMINERALISATION OF INORGANIC AND DISSOLUTION OF ORGANIC STRUCTURES OF TOOTH DENTAL CARIES

CLASSIFICATION OF FOOD STUFFS Classifications :

Non Acidogenic
Swiss Health

Highly Acidogenic
Plaque pH measurements and Animal Studies

No Cariogenic potential Low Cariogenic potential High Cariogenic potential

PHYSICAL PROPERTIES OF FOODS

Mechanical properties
Hardness Cohesiveness Viscosity Adhesiveness

Others
Moisture Fat content

Geometric properties Particle size and shape

Macgregor (1958):

Classifications of Sugars

Total Sugars

Intrinsic Sugars

Extrinsic Sugars

Milk Sugars
No Harm to Teeth

Non Milk Extrinsic Sugars ( NMES)

Harm to Teeth

Classifications of Fermentable Carbohydrates

Food Factors:
Increased Susceptibility

Decreased Susceptibility Proteins

Fermentable Carbohydrates Sugars Sugar/Starch Combination Fats: Cheese, Nuts Foods with Sugar Alcohols Healthy Snacks

Role of Diet in Dental Caries:

Main

Concerns:

Type of Food

Frequency of Ingestion
When Ingested

Common Dietary Risk Factors:

Infants:

Toddlers:
Adolescents/Adults:

Seniors:

Sugars and dental caries. Touger-Decker R, van Loveren C. American J Clin Nutr 2003;78(suppl):881S-92S.

STUDIES

Human studies - Interventional studies Hopewood House Study Vipeholm study Turku Study Tristan da Cunha - Non-interventional studies Epidemiological studies Observational studies Cross sectional studies - special gp population - Experimental production of caries Other studies Seventh Day Adventist Children Wartime Dietary Restrictions National Surveys Animal studies Laboratory studies Dietary substrate studies

HOPEWOOD HOUSE STUDY (1947-62)

1942 Bowral, NSW, Australia. Natural diet

STUDY GROUP - 80 - 7-14 yrs - 10 year period Sullivan 1958, Harris 1963 DIET CHARACTER OF DIET RESULTS (AT END OF 10 YRS)
-13 yr-DMFT 1.6 vs 10.7 in general child - 53% free of caries vs 0.4% - general health - oral hygiene poor calculus uncommon gingivitis 75%

CONCLUSION:
institutionalized children- dental caries can be reduced by SPARTAN DIET, without the beneficial effects of fluoride and In presence of unfavorable oral hygiene.
Can be attributed to NATURE

OF DIET

VIPEHOLM STUDY 1945- 1954

In 1939, the Swedish govt. The Royal medical board

The VIPEHOLM HOSPITAL, Southern SWEDEN. Mentally defective opportunity for longitudinal study under wellcontrolled conditions

PURPOSE OF THE STUDY

STUDY 436 pt- 7 gps different wardsto maintain strict diet 4 meals a day 1 yeardiet relatively low in sugar- no sugars in b/n meals. New carious lesions extremely low (0.34/pt) Subsequently addition of sugar Plan & results GUSTAFFSON et al 1954 summarized by DAVIES 1955 GROUPS

60 males34.9 yr low CHOstarch, high fat diet- free from refined sugars for 2 yrs caries activity completely suppressed After 2 yrsordinary diet 110g sugar daily added at mealtimes small but statistically significant increase in DC

CONTROL GP

SUCROSE GP 300g sucrose solution raised to 370g No significant rise in DC BREAD GP Male & female gp 1st 2yrs 345g of sweet bread containing 50g of sugar once daily with afternoon coffee no demonstrable caries. 2nd 2yrs 4 portions of bread daily with all meals significant increase in DC males > females
CHOCOLATE GP 1st 2yrs 300g sucrose solution 2nd 2yrs reduced to 110gsupplemented with 65g of milk chocolate b/n meals 4 fold increase in DC

CARAMEL GP 1st 2yrs control 3rd yr 22 -2 portions- b/n meals 4th yr 22- 4 portions 5th yr caramel withdrawn isocaloric quantity of fat with meals Caries in 3rd yr & more so in 4th yr. Dropped to control levels in 5th yr

8-TOFFEE GP 3rd yr 8-toffee in 2 portions 4th & 5th yr in 4 portions rise in dc in 3rd, 4th, & 5th yr 24-TOFFEE GP 3rd & 4th yr 24 toffees b/n meals increase in DC (DMF 6) 5th yr withdrawn. Sharp drop in DC

Main conclusions of Vipeholm study

Form Retained on the tooth surfaces Consumed between meals Caries disappears or decreases on withdrawal of sugar rich foodstuffs Increase in duration of sugar clearance from saliva DC may continue to appear despite avoidance of refined sugar.

TURKU STUDY (1972-1974)

2 studies Scheinin & Makinen(1975) Aim: to compare cariogenicity of sucrose, fructose, and xylitol Basis : Xylitol is a sweet substance not metabolized by plaque organisms. 125 subjects (15-45yr) 3 gp. Sucrose, fructose, xylitol. DIET- 100 food items made with alternative sugars

1st study

RESULTS

2nd study

After 1st yr sucrose & fructose equal cariogenicity xylitol produced no caries after 2 years caries continued to increase in sucrose gpremained unchanged in fructose gp DMFS score zero for xylitol & white spots lesions remineralized 1979 Scheinin based on advanced cavities (DMFS) xylitol 1.47 sucrose 3.33 fructose 3.57 1 yr trail study xylitol chewing gum 102 subjects(22.2yrs) 2 gp sucrose gum(4.2 sticks/day) xylitol gum(4.9 sticks/day) DC rose in sucrose gum, & fell in xylitol gum Remineralization seen in xylitol gum

RESULTS

TRISTAN DA CUNHA STUDY

Introduction of modern diet including sugar & refined CHO to this remote island greatly increased caries prevalence Holloway et al. 1963 Fisher 1968

SPECIAL POPULATION GROUPS

Nursing bottle caries Cereal studies Hereditary fructose intolerance Industrial risk

Nursing bottle caries

Extensive destruction of deciduous teeth Added sugar or sugar dipped pacifier at bed time (Fass)

CEREAL STUDIES

Sugar coated highly cariogenic Eating sucrose during meal time as part of a diet does not increase dental caries Sreebny 1983: 12yr -children different Wheat: + Maize: -

Rice: No

HEREDITARY FRUCTOSE INTOLERANCE

Froesch 1959. AR disorder of fructose metabolism Episodes of pallor. . . . Newbrun 1980: 17 HFI---- 2yrs, total sucrose-5% & DMFS < 10% difference MS & LB count

Low prevalence- starchy food

INDUSTRIAL RISKS

Bakeries air polluted with sugar dust exceed 200 mg/m3: workers consume relative large amounts of sugar Sugar cane cutters Kunzel & Borroto et al 1973: illustrate the fact the raw sugar can be as deleterious to dental health as refined sugar

NON-INTERVENTIONAL STUDIES

Subjects are free to choose whatever diet they please,

Based on dietary recall, questionnaires

No control over amount/ frequency of sugar intake EPIDEMIOLOGICAL STUDIES CROSS- SECTIONAL STUDIES OBSERVATIONAL STUDIES

EPIDEMIOLOGICAL STUDIES
Modern diet Vs primitive diet Dental caries incidence in native population Australian Aboriginees, Bantu tribes of South Africa, the New Zealand Maoris, the Eskimos

OBSERVATIONAL STUDIES

North thumberland Duration age subjects 2yr 11.5 456

Michigan 3yr 11-15 499 4.3t/d 3-10 day 142g/d 0.97DMFS /Y

Burt et al 1988
Michigan

Rugg-Gunn et al 1984
North thumberland, England Axelsson and El Tabakk 2000- 685, 12yr old (period of 2yrs) with poor oral hygiene, sugar diet

Frequency 6.8 t/d of eating Diet diary 15 day diary Total sugars Caries incidence 118g/d 1.21 DMFS/Y

Crosssectional studies
Brian Burt & Satishchandra pai review article J Dent Edu oct 2001

St of relationships bet. Sugar exposure & caries development -36 papers were reveiwed. 23 were selected for final review 2 - strong relation 16 - moderate 8 - weak to none

EXPERIMENTAL PRODUCTION OF CARIES IN HUMANS

White spots on short term basis in volunteer dental students Denmark (von der Fehr et al.1970) Britain (Edgar et al.1978) Procedure: 9 daily rinses with 10ml of 50% sucrose & discontinuance of active oral hygeine procedures lasted for 3 weeks White spot lesions High cariogenic challenge dense plaque Oral hygiene reinstituted 0.2% NaF mouthrinse

Caries research 2004, 38, 277- 285

SEVENTH DAY ADVENTIST CHILDREN

Seventh Day Adventist dietary counsels advise Adventist children tends to be lower than that in non- Adventist children in same geographic location and socioeconomic stratum.

WARTIME DIETARY RESTRICTIONS

During world war II- European countries & Japan Norway & Switzerland: potatoes, fish, cod liver oil, vegetables, unrefined flour & decrease in fat, meat, sugar & its products Toverud 1957 in Scandinavian countries. DC rates in 7 & 8 yr old decreased about 1-3 yrs after reduced sugar intake DC increased after 1-2 yrs after rise of sucrose in postwar diets Takeuchi 1961- Japan, Marthaler 1967- Switzerland.

ANIMAL STUDIES
Kite et al 1950- local effect of diet -Increase the knowledge of relationship b/w carbohydrates and dental caries

CONCLUSIONS Rats fed by stomach tube no caries

Sol v/s solid

Coarse v/s fine sugars Litters born to animals fed with cariogenic diet Streptococci do not colonize / produce caries absence of Carbohydrate in diet Frequent sucrose intake (60-100 min/day) Phosphate & Fluoride additions

Sugar alcohols like xylitol, sorbitol, mannitol

STEPHENS CURVE (1940)

7 6.5 6 5.5 5 4.5 4 0 10 20 30 40 50 60 pH

Stephan Curve
pH changes in plaque following application of different carbohydrate solutions

EFFECT OF FREQUENCY OF FOOD ON DENTAL CARIES

KONIG ET AL (1968)

SUCROSE & DENTAL CARIES

Pathways of sucrose metabolism

SUCROSE CARIOGENICITY

Minah et al 1981, Staat et al 1975 Sucrose promotes- MS, LB- pH fall Pecharki et al, Riberio et al 05

Biofilm formed in presence of sucrose- < pH values, MS, LB- cariogenicity

Starch & dental caries

Major

Cooking . . . .

Role of Refined Starch Soluble starch and refined starch- salivary amylase

pH drop

HUMAN OBSERVATIONAL STUDIES

Hope wood HFI 1982- Sreebny 1984 RUGG-GUNN War time observational studies
No correlation b/w intake of starch and caries increment

Human interventional studies

TURKU study 1975 Starch amount remained unaltered ANIMAL STUDIES

Frostell & Baer (1971)- 1/2 sucrose Green & Hartles (1967)- Starch + sucrose more cariogenic

PLAQUE pH studies: Investigate acidogenicity rather than cariogenicity

Frostell (1972), Edgar et al ( 1975), Rugg-gunn et al (1978)Cooked starch/ starchy foods are less acidogenic than sugar or high sugar foods Frostell (1972)- Uncooked starch was virtually non acidogenic

ENAMEL SLAB STUDIES: -Effect of starchy foods on the demineralizaton of enamel slabs worn in the mouth of volunteers- Starch- 25% of de-mineralization than that of sucrose - Brudevold et al 1985- Sucrose had a considerably greater demineralization effect than starch

CONCLUSIONS:

Cooked staple starchy foods- rice potato & bread- less Raw / uncooked starch- less Refined starches- cariogenic- less sucrose Starch + sugars- more

FAT AND DENTAL CARIES

Enamel surface may be protected from demineralization by the formation of fatty films Prevent fermentable sugar substrate from being transported into the plaque Fatty acids = interfere with growth and metabolism of cariogenic bacteria.

Oleic & lenolic acid protective against decalc. Williams et al 1982 fatty acid as antimicrobial action, but whether this occurs in the mouth has not been adequately studied Eskimos 78%- 80% diet is animal source ( Volker & Finn 1973) Dietary fat arrest caries in children

FRUITS AND DC

FRUITS INTAKE IS ENCOURAGED & RECOMMENDED non-milk extrinsic sugars replaced by fresh fruit , veg & starchy foods

UK NATIONAL FOOD GUIDE Balance of good health 1/3rd is fruits and vegetables FRUITS & VEG. PREFERED THAN FRUIT JUICES

non-starchy polysaccharide
Good salivary stimulator

TRACE ELEMENTS AND DC

Navia 1970 classification -Strongly cariostatic : Fl , P. -Mildly cariostatic : Mo, V, Sr, Ca, B, Li , Au. -Promoting elements : Se, Mg , Cd , Pt , Pb , Si. -Caries inert : Ba, Al, M, Fe , Ti. -Doubtful : Co , Mn , Sn , Zn , Br, I.

Ingestion of Se actually dental caries in man & experimental animals if taken during the period of tooth formation.

FLUORIDES AND DC

MARTHALER (1990): In spite of dramatic reductions in dental caries primarily due to the wide spread use of fluoride, sugars continue to be the main threat to dental health

MURRAY ET AL 1991:
ARTIFICIAL WATER FLUORIDATION 113 STUDIES, 23 COUNTRIES

Calcium & Phosphorous & DC

Constant et al (1954): dietary calcium & acidic and basic mineral mixtures- reducing the level of calcium- increase in dental caries Cariostatic action by inorganic phosphates Phosphates increase cariostatic depending on TYPE OF ANION:cyclic, trimeta, tripoly, hexameta, ortho & pyro resp. TYPE OF CATION H, Na, K, Ca & Mg resp. Harris 1970: Organic (phytates & glycerophosphates) decrease DC MOA: local effects rather than a systemic influence: 1) PO4 ions reduce rate of dissolution of HA of the enamel 2) supersatured soln. of PO4 ions to redeposit CaPO4 particularly in the area of enamel that have been partially demineralized 3) Phosphates to buffer organic acids formed by fermentation of plaque microflora 4) PO4 ions to desorb proteins from enamel surface, thereby modifies acquired pellicle ( Pruitt et al 1970)

PLANT FOOD & DENTAL CARIES

Protective agents in plant food: Organic & inorganic phosphates Ca sucrose phosphate Phytate- anti cariogenic Na tri meta phosphate - most effective

MILK AND DENTAL CARIES

Main source of sugars in the diet infant Lactose Less acidogenic.

Other protective factors against caries Mineral, Ca., Ph., Casein, lipids and protein components

Children and adolescents with low incidence of dental caries drank more milk.
Eur J Epidemiol 13:659-664, 1997 Com Dent Oral Epidemiol 24:307-311, 1996

Breast feeding:
The AAP and AAPD strongly endorse breastfeeding
Although breastmilk alone is not cariogenic, it may be when combined with other carbohydrate sources.

For frequent nighttime feedings with anything but water after tooth eruption, May cause ECC

CHEESE AND DENTAL CARIES

-

Excellent anticariogenic food Calcium lactate, physically protects, increase salivation Ingestion of cheddar cheese caused increased pH of plaque Rugg-Gunn et al 1975

Elderly people who eat cheese several times per week had a lower incidence of root caries.
Am J Clin Nutr 61:417S-422S, 1995

Remineralization of enamel was observed when cheese and milk were used as between meal snacks. Dairy products, except sweetened yogurt, generally reduced the amount of dentin demineralization.
J Contemp Dent Prac 1:1-12, 2000

Summary of protective factors present in food

Fat content Protein content Cocoa Organic and inorganic phosphate Vitamin B6 & arginine rich peptides Honey Green, Oolong and black tea Peanuts Cows milk Cheese plant food Fresh fruits Fluoride, Calcium content

FACTORS INFLUENCING CARIOGENICITY OF FOOD

Edgar 1983
FOOD FACTORS

CULTURAL AND ECONOMIC FACTORS

Amount and type of carbohydrate Food pH and buffering power Eating pattern Food consistency and retention in mouth Factors influencing oral flora Factors modifying enamel solubility Sialogogue property Other substrates for bacterial metabolism Presence of protective factors Availability and distribution Selection and marketing

METHODS TO MEASURE THE CARIOGENIC POTENTIAL

In vitro caries models In vivo caries models Adhesiveness of foods Plaque pH measurements Animal caries model Plaque acidity model

note

All human caries studies on specific food items suffer from the same inherent weaknesses -Great diversity of human diet countless food sources -Difficulty in interpreting the finding -Typical individual consumes approx. 100 lb of sucrose/yr from variety of foods. Several variables in food components, as well as those in oral Biology make it unlikely that any single type of food or food component can be named as exclusive determinant of caries activity

Who Wants a $1,000,000 $mile?

SUGAR SUBSTITUTES:

Have low potential for caries production (FDA,1996)

Some can maintain cariogenic bacteria however acid production does not occur with typical use Examples: sorbitol, mannitol, aspartame, sucralose
cariostatic (Xylitol) Control body wt, DM, oral health. Imp req : not detrimental to health & well being - nutritionally appropriate - safe substances ( non toxic, non oncogenic)

CLASSIFICATION OF SWEETENERS
CHO sweeteners (bulk sweeteners): sucrose, oligosaccharides- palatinose, starch sugars- glucose, starch syrup, maltose, invert sugar, fructose sugar alcohols- erythritol, sorbitol, mannitol, xylitol, lactitol, palatinit. NON- CHO sweeteners (high- intensity sweeteners) chemically- sachharin, aspartame, sucralose plants- stevioside, thaumatins, monellin

Chemical Formula:

Sugar alcohol- 2/3 calories-is not as sweet (60%). White, odorless, sweet-tasting powder. Sources: Cherries, Plums, Pears, Apples, Seaweeds, and Algae Industrially from glucose by high pressure hydrogenation Or by electrolytic reduction Cannot be stored for long time ,HYGROSCOPIC PROPERTY reduced by adding Gum Arabic

FDA & WHOS Commission report- limited 150mg/kg/day USES Sorbitol is used in low calorie candies, and in many foods as both a sweetener and as a humectants (moisture retaining ingredient). Sorbitol is used as an emollient (skin softener) in soaps. DISADVANTAGES: Gastric upset in large doses. Acts as a laxative, due to osmotic transfer of water into the bowel

DENTAL CONSIDERATION:
1) FERMENTATION BY ORAL MICROORGANISM All strains of streptococci mutans ferment- final PH < 5 ferment at a slower rate. This permits salivary buffer to neutralize acid end products as they are formed 2) CARIOGENICITY Causes less caries and reduction in plaque accumulation 3) BACTERIAL ADAPTATION:
acid formn occur, but non-cariogenic slow acid prodn by MS

( Birkhed et al 1984, Rugg-Gunn & Hogg 1991, Imfeld

1994)

(xylo-pentane-1,2,3 & 4,5- pentol, C5H12O5)

Pentose alcohol Structure and sweetness similar to sucrose Its a metabolic intermediate in Glucoronate pathway in humans Sources: fruits, vegetables, (raspberries, strawberries, plums, lettuce, cauliflower, mushrooms, chestnuts) Commercially from Birch trees, cotton seed hulls, And coconut shells Xylitol, 1g xylitol Calories: 2.6 Protein: 0.0g Carbohydrate: less than 1.0g Total Fat: 0.0g Fiber: 0.0g

Uses:
Food: Chewing gums, candy, ice lolly, chocolate, gum drops,& wafers Pharmaceuticals tab diabetics ,throat lozenges dentifrices, cough syrup.. Disadvantages: Diarrhea due to osmotic effect Toxic doses causes Urinary bladder calculi, Epithelial hyperplasia, neoplasm of the bladder

xylitol

Converted via
glycollate to

Oxalate

Which appears in urine the form of

Accumulation in

Calcium oxalate crystals

Thus acts as tumor promoter than true carcinogen (at high Conc.)

1) Due to ORGANOLEPTICS Properties stimulates salivation, Thereby >s plaque pH & also lowers plaque scores 2) Promotes remineralisation of incipient lesions so they are non-cariogenic in nature 3) Lowers bacterial colony count

Non-cariogenic- Turku sugar studies 1975 & Kandelman & Gagnon 1990
xylitol accumulates intracellularly in S. mutans. This inhibits the bacterias growth. In addition, the bacteria appears less adherent to tooth surfaces. Trahan L- INT Dent J 45:77-92, 1995. Certain studies indicate that xylitol gum in combination with other dental therapies is associated with the arrest of carious lesions. Lynch H, Milgrom P- J Calif Dent Assoc. 2003 Mar;31(3):205-9. Chlorhexidine rinses for 2 wks followed by Dailyxylitol gum- reduction SM Hildebrandt GH, Sparks BS- JADA 2000 Non- cariogenic or anti-cariogenic
Lout et al 1988, Bowen et al 1990, Das et al 1991

Aspartame is a dipeptide, Composed of two amino acids, phenylalanine and aspartic acid

Aspartame is digested like all other amino acids,

Uses of Aspartame 200 times as sweet as sugar Uses in foods: Direct sugar substitute Diet soft drinks Dry beverage mixes Chewing gum Puddings Yogurt Fruit juice beverages ...and more! DIS ADV: Aspartame cannot be used in baking because it breaks down and loses its taste when exposed to high heats.

Aspartame Controversy Phenylketonuria (PKU) Genetic disease where people cannot consume aspartame because their body abnormally metabolizes phenylalanine, one of the amino acids found in aspartame.

Products containing aspartame carry the label "Phenylketonurics: contains phenylalanine"

Food Ingredients, Whats Hot?

Key Trends for 2008:
Going Natural Functional & Condition Specific Foods Greener Than Thou Novel Functional Applications Forward to the Past Interactive Products Less is More

Hot ingredients:
Sweeteners: Stevia, Isomaltulose

Satiety/Weight Management: PinnoThin, CLA Gut Health: Chocolate and probiotics, Resistant Starch Salt reduction solutions:Lactosalt Optitaste Fat: Solutions for trans, NovaLipid Skin: Skin nourishing ingredients Health: InsuVital, GABA New Dietary fibres: Equacia Protein:Potato protein Adressing Acrylamide: Acrylaway, Puracal ACT Emulsifier: Grindsted Crystallizer Starch Solution: Etenia

HIGH-INTENSITY SWEETENERS

-leaf of stevia Paraguay & South America

-

STEVIA SWEETENER (STEVIOSIDE, REBAUDIOSIDE)

3 types--- regular Stevioside 7:3 to 8:2 Reva A Rebaudioside A 1:3 sugar metastasis Reva A > regular, 150-300 times, zero calories Das et al 1992, Kinghorn et al 1998Non-cariogenic

Isomaltulose
Gadot Biochemical Ind (Israel) introduced NRGlose, a tooth friendly, slow-digesting sweetener with a low glycemic index. Isomaltulose compared to sucrose: digested more slowly-> low glycemic response- same calorific value as sugar Applications: - diabetics and pre-diabetics - sport nutrition

Natural in honey & cane juice/ from sucrose using transferase Same energy & no diarrhoea--- excellent sweetener for sweets & drinks for infants, children, diabetic pt. Little or No acid. By MS (Maki et al 1983, Sasaki et al 1985 Candy & dairy products are marketed today

-intensely sweet proteins (thaumatin) arils of the fruit -2000 times Ikeda et al 1982 anti-cariogenic

THAUMATIN

MONELLIN
-sweet proteins African serendipity berries -70,000 times -taste unusual length of time Jacobsson-Hunt et al 1979 non-cariogenic

SUCRALOSE (trichlorogalactosucrose)
-from sucrose three OH replaced by Cl -no calories 600 times -non-cariogenic. Jenner 1989, Bowen et al 1990

ANTI- CARIOGENIC EFFECTS OF SUGAR SUBSTITUTES:

-

Inhibition of insoluble glucan synthesis from sucrose by MS Decrease in MS count in whole saliva & plaque Increase in buffering capacity & pH of plaque Interference with enamel demineralisation & an increase in enamel remineralization

PROMOTION OF SUGAR SUBSTITUTES:

-

Chewing gums High risk individual Labelling Education & marketing It is imp not only to look for non -cariogenic aspects but also nutritional ,economic , toxicological and technical point of view

DIET PATTERN AND DC

following factors must be considered -choice of items of food or drink -combination of items taken together -sequence in which selected are consumed -time taken to eat or drink each item -time lapses b/n consumption of each item

Rugg-Gunn et al 1975,1981, Geddes 1977- 3 studies

concluded that

Fermentable CHO. Acid prodn. pH falls Last item taken in an episode of eating. Greatest influence on subsequent pH If meals non- fermentsequencing & timing of eating periods. Influence pH Item is good sialogogue- saliva

Do YOU Know What You Are Eating? Read the Labels!

Key features of NLEA (1993) (Nutrition Labeling and Education Act)

New title--Nutrition Facts Required on almost all foods Standardized serving sizes-usual amt. consumed Not necessarily the serving size on food guide pyramid Standardized, easy-to-read format Nutrient reference values (% Daily Value) Uniform definitions and claims Informative ingredient list

EX:

Nutrition Facts
Serving Size 1 cup (253g) Servings Per Container 4 Amount Per Serving Calories 260 Calories from Fat 72
% Daily Value

Total Carbohydrates

Fibre

Total fat 8g Saturated Fat 3g Cholesterol 130mg Sodium 1010mg Total Carbohydrate 22g Dietary Fiber 9g Sugars 4g Protein 3g
Vitamin A Calcium 35% 6% Vitamin C Iron

13% 17% 44% 42% 7% 36%

2% 30%

Sugars--includes all monosaccharides and disaccharides, but no difference between refined and naturally occurring sugars (4 gm=1 tsp)

Nutrient content descriptors Characterized the content of a nutrient in the food

Good source--10-19% of daily value/serving High > 20% of daily value/serving Healthy Low in fat, sat. fat, <480 mg sodium, < 60 mg cholesterol, + 10% daily value for vitamin A, C, or iron, calcium, protein, or fiber Fresh Raw foods & never frozen, or heated foods with no preservatives

LEGISLATION AND REGULATION

In 1991, legislation was passed, FOODS FOR SPECIFIED HEALTH USES (FOSHU), that approves labels that make Health claims. As a result, many products have appeared & the market is Continuing to develop rapidly & uniquely. Directions for use & warnings:

Facts messages For consumers

All foods can fit into a healthy diet Variety Balance Moderation A high CHO food can be eaten, and not increase risks BUT frequency, quantity and other foods consumed influence risk

TOOTHFRIENDLY SWEETS - SWITZERLAND 1983

EFFECT OF SUGAR CONTAINING MEDICINE

ROBERTS AND ROBERTS (1979)

Dr David J. Kenny: children with congenital disorders & chronic illness rampant caries

SUGARLESS PRODUCTS
Dept. for health NSF for children, young People & maternity services- Sept 2004: Long term sugar containing med. partially Carcinogenic sugar free remedies should be used whenever possible Shaw L, Glen wright D.H- 1989: reduced salivary Flow during sleep limits the natural cleansing action of saliva, & so the sugar containing med. Is in contact with teeth for long period

Impact of advertisements & endorsements of food stuffs on children

EFFECT OF ADVERTISING FOOD AND DRINKS On CHILDREN

"The world has changed. Young people are living in distinct digital media environments, with far more impact on attitudes and development than TV,"

"The Food Industry Marketing to Children -1996 "The purpose of the report is an emergency wake-up call to clueless regulators," focusing on how marketers target kids online Children's Online Privacy Protection Act, which essentially requires marketers to obtain permission from parents before collecting any personal information from their children ages 12 and under. The current focus of the policy debate is centered on T.V.

Child Nutrition Services Programs

National School Lunch National School Breakfast Special Milk

Summer Food Service

Child and Adult Care Food

DIETARY RECOMMENDATIONS

Restrict the number of eating times to three main meals. Avoid carbohydrate ( sugars ) snacks in between meals. Take low carbohydrate and high protein snacks and fibrous fruits in between meals, if required. Eliminate eating sticky sweets like chocolates, toffees, candles, cake, and pastries, if not completely then as much as possible Increase eating of high protein food like meat, fish, milk, egg, pulses and beans. Restrict CHO eating so that they only provide between 3050% of total calories requirement of the body. Eat firm detersive food like raw vegetables and fruits which will reduce dental plaque formation and increase salivary flow.

To eat is a necessity, but to eat intelligentlly is an art - La Rouchefoncauld

The wise man should consider that health is the greatest of human blessings, let food be your medicine

- Hippocrates

CONCLUSION ..

REFERENCES

Nikiforuk, Understanding Dental Caries. 1st Edition. Newbrun, Cariology Rugg- Gunn ,Diet Nutrition and Dental Caries. 1st Edition. Nizel : Nutrition in Preventive Dentistry. 2nd Edition, Pallock : Nutrition in Health and Disease. 1st Edition. Soben peter -Essentials of preventive and community dentistry, 2nd edition, The dental hygienists guide to nutritional care, 2nd edition, Stagman & Davis DCNA:1999:43:4:615-633. DCNA:2003;47;2. Google search www.dentistpro.org

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