Transcript Sugar- The only Culprit?… have another Coke…

Sugar- The only Culprit?… have
another Coke…
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FACTS…
Kids and teens are more susceptible to decay because enamel is not
mature or fully formed
12- 19 yr old boys who drink soft drinks consume an average of 81
gallons of sugar a year. Girls the same age drink and average of 61
gallons of sugar -- that means 750 cans per year EACH!
It takes two hours of moderate walking to burn off the calories in one
20 oz. soft drink
Soft drinks have no nutritional value. That’s why they are often
referred to as “liquid candy” “sugar water” or “wasted –empty
calories”
Teens get 13 percent of their calories from carbonated and noncarbonated soft drinks
Other Facts
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Soda does not really quench your thirst;
in fact the chemicals present in soda can
result in lack of moisture in the body
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Soda has caffeine & sugar so excessive
intake could lead to craving for more
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Children respond to caffeine in a much
more “exaggerated” way than adults and
can literally have an overdose reaction
How Acidic are the drinks you drink?
The pH of regular and diet pop ranges from 2.47-3.35
The PH in our mouth is normally about 6.2 to 7.0
(slightly more acidic than water)
At a PH of 5.2 to 5.5 or below the acid begins to
dissolve the hard enamel of our teeth
http://www.youtube.com/watch?v=SWKB_6lwcx4&f
eature=related
GERD
Acidic
Unsweet no lemon tea (contains fluoride)
Alkaline
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Acidity of Different Types of Drinks
Choc milk PH 7.1!!
Diet snapple w/ lemon more acidic than regular 2.5
“SIP ALL DAY….. GET DECAY”
& EROSION!
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Hard Facts
• Diet or "sugar-free" pop STILL contains acid- just not sugar & still
stimulates cravings
• Acid in soft drinks, whether they contain sugar or not, is the primary cause
of weakening tooth enamel (also dulls luster)
• Each acid attack lasts about 20 minutes (before neutralized)
• The acid attack starts over again with every sip
• Bacteria in your mouth cause cavities when tooth enamel is damaged
• If you have a receding gum line, acid does more damage below the gum
line than above it. This is particularly a concern for adults– because
cementum is weaker than enamel and the acid level does not have to be
as “potent” to cause decay
• Estimated 20% of children <2 years old drink soft drinks regularly
“SIP ALL DAY….. GET DECAY”
& FATTER
Fruit vs. sugary drinks - 60 Minutes - CBS News
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Soda Substitutes
What to do to reduce decay from soft
drinks
 Drink soft drinks on rare occasions
 Don't sip for extended periods of time –
drink all at once (don’t buy ones with resealable lids)
 Use a straw
 After drinking, swish your mouth out with
water (tums?) – not proven technique
 Avoid before bed
 Read labels!
 Use fluoride– if higher acid/sugar intake =
need higher fluoride intake/concentrations
 Drink with a meal instead of alone
 Eat with neutralizing foods
Role of Nutrition in Caries
Including Fermentable carbs
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BIOFILM
Food or drink
Fermentable carbs
EROSION
Simple enough?
Sugars-- caries potential= YES
Monosaccharide- glucose, dextrose (most foods)
fructose, corn syrup (candy, soft drinks, fruit drinks, nondairy creamers)
Disaccharide- sucrose (fruits/veg/table sugar), brown sugar, turbinado (raw), molasses
(breads/waffles), honey, lactose (milk, baked goods, whip top), maltose (beer)
Other carbs- polysaccharides (starch- potatoes, grains, breads, rice, bananas, legumes)
See Harris p. 317
Factors That Hinder or Enhance
Caries
Do they Hinder or Enhance?
 Protective minerals-healthy
enamel & ACP?
 Fluoride
 Calcium/phosphorus in saliva
 Good home care
 Xylitol
 Sealants
 Good nutrition (especially
firm texture foods)
 Frequency of eating
 Physical formconsistency/retention/rate
of clearance
 Sequence of foods
 Type of food
 Time eaten
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Always a “balance” & can change at different periods in life
Need susceptible host
& biofilm
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Key Terms to Know….
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Harris p. 302
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**Readily lower pH in mouth= predictive to caries
Good choices!
Harris p.303
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Cariogenic Foods & Biofilm pH
Frequency a HUGE factor in caries (not quantity)
20 minutes a part- see Wilkins p. 513
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Neutralizing the Acid
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Cheese
Nuts/PB
Meat, Chicken, and Fish
Raw Vegetables
Beans
Milk, eggs, plain yogurt
Water
Popcorn
Butter/margarine
*If consumed with or after sugary food/drinks, these products
may help to neutralize the acid produced or accelerate the
clearance from the mouth
Reading food labels
Hidden sugars?
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10% Desired weight
MY FITNESS PAL APP
Other Sweeteners
Polyols
• Sorbitol
• Mannitol
• Xylitol
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What’s all this about?
XYLITOL
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XYLITOL
 Interferes with MS metabolism
 Stimulates saliva =reduces decay
 Helps with clearance & xerostomia
*recommend gum with xylitol– should be
one of 1st ingredients -- check the labels!
Other Sweeteners
Intense “True” artificial sweeteners
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What about PKU?
Saccharin
Aspartame
Cyclamate
Sucralose
Others…..
STEVIA
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Safety concerns?
http://www.youtube.com/watch?v=3M2krP3SXNU
http://www.youtube.com/watch?v=A-hUyw2lcio
Dr OZ
Avoiding the “roller coaster ride”
effects moods!
Purpose & Objectives for the Dental
Dietary Assessment & Counseling
Allows the patient an opportunity to see own eating & snacking habits
(take ownership)
Identify whether patient is meeting daily requirements (myplate)
(do 1st) Find ways to incorporate missing foods
(offer specific suggestions- not just “you need more veggies”)
2nd Identify frequency, consistency of diet, cariogenic potential of diet
Provide individual recommendations
3rd offer general suggestions based on Dietary recommendations
**referral if needed
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We are in NO way an expert!
?????!!!!
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Forms Used for Assessment
• Carbohydrate Intake –Short form noted as
“Dietary planning”
• 3 Day Diet (w/instructions and nutritional
assessment sheet)- “Nutritional
Counseling”
For different reasons– don’t do both on one person!
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Considerations
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# of servings in each group- is it adequate?
# of Cariogenic foods - have pt circle first in
Consistency of diet
Frequency (Snacking?)
Retention time of foods chosen
Multiple nutrient dense foods?
Sequence of foods eaten & times (skipping meals?)
Get some help!
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Goal Diet (Adults)
 Total Carbohydrates 45-65% (<7% sugars)
 Protein 10-35%
 Fat 20-30% (saturated <10 if possible)
Processed foods
From Guidelines 2010
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Just a Few Basic Dietary Recommendations
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Limit eating events to 3 a day. Reduce
snacking (unless required, such as with
diabetes)
If patient snacks, recommend fresh fruit,
vegetables, popcorn, and dairy (give list
of better food choices for caries)
Cariogenic foods, such as retentive
starches and sugary foods and liquids
should be consumed during meals if
possible
Liquids clear cavity faster than more
retentive items
When oral hygiene does not follow a
meal or snack, end the eating event with
a dairy product (cheese or milk) or
another food that helps clearance or
neutralizes acid (xylitol gum?)
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Other Possible Suggestions
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Encourage a variety of foods
Stress the importance of eating vegetables, fruits, and whole grains
Explain how to read labels and that most sugars end in “ose;” emphasize <
sugars/fermentable carbs
Explain the relationship between sugar/carbs/erosion & tooth decay
Give examples of “hidden sugars” & counsel regarding “sipping” drinks
Give examples of ways to add foods that they show deficiencies in
Stress using sodium and salt in moderation- “no salt added” does not mean that
the product is low in sodium– read labels
Emphasize less processed foods versus whole/natural sources
Emphasize that alcohol intake should be in moderation; alcohol is high in calorie
and contains few nutrients
Encourage an active lifestyle and to consult resources or a dietician for more
specific recommendations- especially if systemic disease exists
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Other Possible Suggestions
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Discourage eating snacks before bed, unless followed by thorough OH
Drink water (best choice) but if not unsweet tea?
Discourage skipping meals
Recommend a multi-vitamin daily
Look at additional sources of fluoride or Peridex for caries control
Provide with resources (websites, color handouts, etc…..)
Remember, small changes can make a big impact in the long run
Use Dietary Guidelines for general suggestions
Don’t take it for granted that “they know already”
LISTEN to your patients desires
Consider Biotene or other xerostomia aids if needed, rather than sucking
on candy
Other Resources
http://www.USDA.gov
http://www.health.gov/healthypeople
http://diabetes.org
http://www.ific.org
http://www.floss.com
http://ada.org/consumer/diet.html
http://www.eatright.com/aoral.html
http://www.ahrq.gov/clinic/uspstf/uspsdiet.htm
www.nat.uiuc.edu
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