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Prevention of Dental Caries
I- Dietary control
II- Increasing tooth resistance
III- Plaque control
Diet can affect the teeth in two ways:
Pre-eruptive effect:
i.e. before eruption, while the tooth is still forming.
1- Before birth through placental circulation from mother to fetus, this provides
calcium and vitamin D for proper development of teeth.
2- After birth through general nutrition where the essential nutrients are carried by
the blood stream from the digestive tract.
Post-eruptive effect:
i.e. after tooth has erupted into the mouth, the diet has a local effect by controlling
the lodgment of freely fermentable carbohydrates which accumulate around the
teeth.
Preventive dietary measures:
1- Reduction of the frequency of carbohydrate intake:
a. Oral clearance of carbohydrates: some forms of carbohydrates take a longer time
to be cleared from the mouth e.g: sticky candies and biscuits. Caries activity
increases with increase in clearance time. This is because carbohydrates stay for a
longer time in contact with teeth surfaces.
b. Time of consumption of carbohydrates: caries activity increases when
carbohydrates are consumed between meals.
c. Amount and frequency of consuming carbohydrates: caries activity increases
with increasing the amount and frequency of consuming carbohydrates.
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Dietary recommendations:
Carbohydrates should not be completely restricted from the diet, but dietary
recommendations can be given. These are:
- No more than half the daily caloric intake be from carbohydrates.
- Select more soluble forms of carbohydrates which clear quickly from the
mouth e.g. leafy green or yellow vegetables are good carbohydrates sources
with low retention. Avoid sticky candies and biscuits.
- Consume carbohydrates at meals and avoid between meal snacks. Substitute
sticky sweets with raw fruit or vegetables or nuts for in between meal snacks.
- Cheese is recommended as a caries preventive food because it causes:
a- Strong stimulation of salivary flow.
b- Raises calcium concentration in plaque.
c- Raises oral pH to 7.5 within 3 minutes following ingestion which favors
remineralization.
2- Sucrose substitutes:
a- Replacing sucrose, glucose and fructose with artificial sweetening agents such as:
aspartam, mannitol and saccharin reduce the cariogenicity of food.
b- Sorbitol sweetened chewing gum and candies are much less cariogenic than those
containing sucrose
c- Xylitol is used nowadays in confectionary and toothpaste because:
- It is less cariogenic than sucrose and sorbitol.
- It inhibits certain strains of streptococci.
3- Addition of caries inhibiting agents:
a- Fluorides:
Addition of fluoride to foods e.g. salt, milk, bread and flour. However, individual
consumption of those foods varies considerably.
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b- Inorganic and organic phosphates:
Act primarily by forming a protective layer on the enamel surface.
c- Dextranase:
Reduces the adherence of bacteria to tooth surface.
Diet History Analysis:
Aim:
Determination of individual eating habits when vague reports from patients make it
impossible to determine whether an adequate diet is being obtained.
Importance:
- Helps the dentist to define to the patient his dental and dietary problem and to
discuss solutions.
- Enables the dentist to give good dietary recommendations to change his
patient's dietary habits.
- Helps as a guide to improve the general nutritional level of patient.
- Makes the parents actively involved in the problem by recording the diet
history of their child.
Technique:
1- Ask the parents to record on a diet sheet the exact food intake of their child
for a period of 3 –7 days (at meals and between meals).
2- Analyze the report for calories, carbohydrates, proteins, fats and important
minerals and vitamins.
3- Compare the results with the recommended dietary allowances and the
desirable distribution of food among the four basic food groups.
4- Determine the total amount and type of carbohydrates consumed and the time
of consumption (at meals or between meals).
5- Accordingly, give dietary recommendations to improve the patient’s dietary
habits.
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