Transcript nutritional aspects of Dental Caries: causes, preventive

NUTRITIONAL ASPECTS OF
DENTAL CARIES: CAUSES,
PREVENTION, AND TREATMENT
CHAPTER 17
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Prevalence
 Nutrients have topical and systemic effects that
can be primary or secondary factors in the
development of dental caries
 National Call to Action to Promote Oral Health
stresses prevention
 Dental caries remain the most common chronic
childhood disease
 Certain racial, ethnic, and lower-income populations
suffer disproportionately higher rates of caries
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Prevalence
 Caries rates rise with age
 28% of children ages 2–5 years
 49% of children ages 6–11 years
 68% of adolescents 12–19 years
 75% of adults
From Bird DL, Robinson DS: Torres and Ehlrlich
Modern Dental Assisting, ed 9. St. Louis: Saunders,
2009.
 Prevalence of root caries also rises with age
 9.4% among persons ages 20–39 years
 17.8% among those ages 40–59 years
 31.6% among those ages >60 years
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries
Process
 Caries results from a combination of
factors occurring simultaneously
 Susceptible host or tooth surface
 Sufficient quantity of cariogenic
microorganisms in the mouth
 Presence of fermentable carbohydrates
 Particular composition or flow of saliva
From Darby ML, Walsh MM: Dental Hygiene:
Theory and Practice, ed 2. St. Louis: Saunders,
2003.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries Process
 Tooth structure
 Resistance against
demineralization begins
in pre-eruptive phase
with adequate intakes
of calcium;
phosphorus; vitamins
A, C, and D; fluoride;
and protein
 Deep pits and fissures
increase susceptibility
 Overlapping/crowding
 Host factors
 Food selection and
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dietary patterns
Oral hygiene habits
Genetics
Race or ethnic group
Age
SES (socioeconomic
status)
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries Process
 Saliva
 Availability of essential
nutrients (vit A, iron,protein)
during development of
salivary glands (begins in 4th
prenatal week)
 Protection provided by
adequate salivary flow to
wash away food, buffer
and neutralize acids,
remineralize teeth (calcium,
phosphate, fluoride ions) and
kill bacteria (IgA)
 Plaque biofilm
 Composition of plaque is
altered and strongly
influenced by diet
 By-products of sucrose
and glucose metabolism
produce acids; lowers pH
to 6.7-5.5 to create
environment for growth of
bacteria, such as S.
mutans and Lactobacillus
 pH may reach as low as 4
in some areas for 1 hour
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Major Factors in the Dental Caries
Process
 Cariogenic foods
 Salivary amylase breaks down oral monosaccharides
(glucose) and disaccharides (fructose, sucrose, maltose)
 Sucrose is used to produce glucans (polysaccharides) that
facilitate adherence of bacteria (S.mutans) to the pellicle
 Processed starches (instant oatmeal) are often more
fermentable than their nonprocessed counterparts due to
partial hydrolysis or diminution of particle size
 High concentration of fructose found in juices is potential
source of substrate
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries
Process
 Anticariogenic properties of food
 Sugar alcohols
 Fermented more slowly than mono- and disaccharides;
therefore, buffering effects of saliva neutralize destructive acids
produced by plaque biofilm
 Oral flora do not contain enzymes to ferment xylitol
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Microorganisms, such as S. mutans, are inhibited
Teeth are able to experience benefits of saliva without acidic insult,
resulting in remineralization of incipient decay
 Nonnutritive sweeteners
 Not metabolized by microorganisms; do not promote caries
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries
Process
 Protein and fat
 Considered cariostatic because do not lower
plaque pH, may offer buffering effects
 Phosphorus and calcium
 Provide a buffering effect in the saliva
 Dairy products
 Protein, casein (principal protein in milk), phosphorus,
calcium are ingredients of anticariogenic or even
cariostatic foods, such as cheese and milk
 Although lactose is cariogenic (but the least cariogenic of
all saccharides), these other elements in milk and milk
products decrease risk of dental caries
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries
Process
 Other foods with protective factors
 Constituent in chocolate, known as the
cocoa factor, has shown anticariogenic
properties in Vipeholm study
 Glycyrrhiza, the active ingredient in
licorice, also anticariogenic
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries
Process
 Dental hygiene considerations
 Encourage meticulous oral self-care, regular
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preventive dental visits
Promote sealants for deep pits and fissures
From Bird DL, Robinson DS:
Torres and Ehlrlich Modern
In high-risk patients encourage use of a
Dental Assisting, ed 9. St.
Louis: Saunders, 2009.
chlorhexidine, fluoride, xylitol protocol
Encourage healthy eating habits with minimal
fermentable CHO intake between meals
Eating low-fat cheese as snack or at end of a meal
could provide anticariogenic effects
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries
Process
 Dietary factors must be modified to reduce the
risk of caries. Dietary recommendations need
to address the following dietary factors:
 Frequency of eating meals and snacks
 Oral retentiveness of foods (sticky, chewy, starchy)
 Sequence of food consumption
 Amount of fermentable carbohydrate consumed
 Sugar or acid concentration of the food or drink item
 Physical form of the carbohydrate
 Proximity of eating to bedtime
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries
Process
 Physical form
 Liquids include fruit juice, soda, sports
drinks, energy drinks, liquid medications
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An acidic medium that further demineralizes
the tooth
Diet soft drinks contain added citric and phosphoric acids
 Retentive CHOs include bakery items, crackers,
potato chips, pretzels
 Slowly dissolving CHOs include antacids, cough
drops, breath mints
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries
Process
 Frequency of intake
 Linear relationship between caries rate and number
of meals and/or snacks consumed
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Each time a food containing carbohydrates is eaten, the
salivary pH drops below the critical level for approximately
40 minutes
Enamel demineralization occurs
Acid exposure is additive throughout the day
Eventually demineralization progresses to the point at which
decay may be detected clinically
The calcium and phosphorus in saliva need time to
remineralize the tooth between meals/snacks
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries
Process
 Timing and sequence in a meal
 Amount of acid is reduced if a fermentable
carbohydrate food is eaten before or between other
noncariogenic foods
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Dairy products, such as cheese, reduce demineralization of
the tooth and help buffer acids produced by the bacteria
Sialagogues, like sugar-free chewing
gum, stimulate the saliva and
promote buffering of acids
produced by bacteria and aid
in oral clearance of the food
Coffee with sugar after a meal decreases pH which increases
cariogenicity
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Major Factors in the Dental Caries
Process
 Dental hygiene considerations
 Review diet history for patterns of fermentable
carbohydrate consumption, frequency, and form
 Consume fermentable carbohydrates within a meal or
eat a noncariogenic food at the end
 Noncariogenic snacks include raw fruits and
vegetables; low-fat cheese, milk, and yogurt; nuts;
popcorn; seeds; pizza and tacos
 Encourage limiting of soft drinks and sports/energy
drinks
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Dental Hygiene Plan
 Assessment
 Gather information about the quality of the patient’s meal
pattern and eating habits with a 24-hour diet recall or 3to 7-day food record
 Use MyPyramid as a guide to assess adequacy of food
intake with cooperation of the patient
 Have the patient highlight all the fermentable
carbohydrates and note form, frequency, and when eaten
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Estimate amount of time teeth are exposed to cariogenic foods
More than 2 hours of acid exposure generally considered high
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Dental Hygiene Plan
 Goals
 Help patient develop realistic goals
 Goals need to be flexible to meet the patient’s needs,
preferences, and lifestyle
 Education
 Education alone does not guarantee behavioral
change
 Assessment and goals are the basis for any
recommendations
 Dispel myths, redirect inappropriate habits, and
provide new ideas
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