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Diet and dental caries

Ahmed Abdulelah Al-jawady
University of Mosul

A dynamic relation exists between sugars and oral health. Diet

affects the integrity of the teeth; quantity, pH, and composition of
the saliva; and plaque pH. Sugars and other fermentable
carbohydrates, after being hydrolyzed by salivary amylase,
provide substrate for the actions of oral bacteria, which in turn
lower plaque and salivary pH. The resultant action is the
beginning of tooth demineralization.

Many factors in addition to sugars affect the caries process. including the form of food or fluid the duration of exposure  nutrient composition  sequence of eating  salivary flow  presence of buffers  and oral hygiene. .

“nutrition is an integral component of oral and nutrition are major multifactorial environmental factors in the etiology and pathogenesis of craniofacial diseases. . 2.According to the American Dietetic Association(2):  1.

The 2 primary bacteria involved in caries formation are mutans streptococci and lactobacilli. and dental plaque (Figure 1) (4) .Relation between diet and caries(Miller’s chemoparasitic theory)(3) Dental caries was first described in Miller’s chemoparasitic theory in 1890 (3). Caries is caused by the dissolution of the teeth by acid produced by the metabolism of dietary carbohydrates by oral bacteria. In the 1960s the caries theory was depicted as 3 circles representing the 3 prerequisites for dental caries: the tooth. the diet.


socioeconomic status. and an average pH of 5.5 pH units. level of education. the immune system.5( 4) is the generally accepted value. many modifying factors have been recognized. thus exerting its protective effect. the critical value for enamel dissolution is 5–6. time. The presence of fluoride reduces the critical pH by 0.Since then.5. . Sugars and dental caries The caries process can be described as loss of mineral (demineralization) when the pH of plaque drops below the critical pH value of 5. and the use of fluorides. lifestyle behaviors. Redisposition of mineral (remineralization) occurs when the pH of plaque rises. resulting in a more complex model that includes saliva.

In contrast. The resultant low pH favors the growth of the acidogenic and aciduric bacteria (mutans streptococci).Diet and nutrition may interfere with the balance of tooth demineralization and remineralization in several ways. a diet lower in added sugars and fermentable carbohydrates and high in calcium-rich cheese may favor remineralization. which are metabolized to acids by plaque bacteria (Figure 2). . The diet provides sugars and other fermentable carbohydrates.


and casein. which decrease demineralization and enhance remineralization (6) . thereby reducing acid production. and 3-intake of increased alkaline substances.The anticariogenic effect of cheese: Mechanisms proposed to explain the anticariogenic effects of cheeses are as follows: 1-increased salivary flow and the subsequent buffering effect. calcium. 2-inhibition of plaque bacteria and the effect of that inhibition on reducing the amount of bacteria. inorganic phosphate. which can neutralize plaque acids.

6. a complex sugar in barley and malt syrups. we usually mean granulated Table sugar. we need to be very clear the word “sugar” includes these things ending in “ose”: 1. However there are so many kinds of sugars these days. a refined simple sugar from corn. Glucose. Maltose. Lactose. Fructose. . 2. a simple sugar in fruits. 4. Dextrose. vegetables and grains.What do we mean by sugar? When we say “sugar”. sugar cane or beets. Sucrose (Table sugar) a simple sugar made from cane sugar or beets. 3. a complex sugar in milk. a simple sugar in fruits. 5. plants and honey.

.Recommended and current levels of sugar intake The recommended intake of non-milk extrinsic sugars is a maximum of 60g/day. which is about 10% of daily energy intake.

3-affects plaque :by inhibiting bacterial metabolism of sugar thus reducing acid production.remineralisation of enamel . . 2.The influence of fluoride on the sugars–caries relationship(7) 1-reduces and inhibits demineralization.

Factors that affecting the food cariogenicity (8) 1-types of carbohydrate 2-physical form of food retention and oral clearance time 3-factor in the diet that protect against dental caries 4-intake frequency 5-nature of diet .


and dairy products) and those that are added to foods during processing to alter the flavor. honey.g.. or texture of the food (9) . fruit. taste.2-physical form of food retention and oral clearance time Forms of sugars and starch in the diet Sugars are a form of fermentable carbohydrate. Sugars enter the diet in 2 forms: those found naturally in foods (e. Fermentable carbohydrates are carbohydrates (sugars and starch) that begin digestion in the oral cavity via salivary amylase.

Retentiveness of foods is not the same as retention Prolonged oral retention of cariogenic components of food may lead to extended periods of acid production and demineralization and to shortened periods of remineralization. A caramel or jellybean may be sticky. . but its retentive properties are fairly low and they are cleared from the oral cavity faster than are retentive foods such as cookies or chips .

2.adsorption onto oral surfaces.metabolism by microorganisms. .  3-degradation by plaque and salivary enzymes.  4-saliva flow. Most carbohydrates will be cleared by these simultaneous mechanisms.Oral clearance properties vary by individual person and depend On: 1. and  5-swallowing.

The duration of the decrease in pH after intake of a cariogenic food is an important confounder in this relation . Higher frequency means more demineralization and less remineralization. although Bowen et al (10) concluded that it is not the frequency of ingestion per sec that is related to the development of caries but the time that sugars are available to microorganisms in the mouth caries is regarded as the outcome of the alternation of demineralization and remineralization.Frequency The frequency of consumption seems to be a significant contributor to the cariogenicity of the diet.

increasing the clearance of sugars and other fermentable carbohydrates from the teeth and the oral cavity and increasing buffer capacity. Tooth-friendly polyols include sorbitol. xylitol. In rat experiments. and isomalt. coffee. mannitol. However. erythritol. tea polyphenols reduced caries (11). which may reduce plaque formation (11). Sorbitolsweetened gums simulate saliva without causing a drop to the critical pH and have been shown to be equal to xylitol gum in terms of caries control (13). stimulation of saliva resulting in increased buffer activity and an increase in pH. xylitol—a 5-carbon sugar that oral microflora cannot metabolize—has additional anticariogenic effects attributable to antimicrobial action. tea.   2-Sugar alcohol–based products Sugar-free gums can stimulate saliva. In vitro experiments have shown that these polyphenolic compounds may interfere with glucosyltransferase activity of mutans streptococci. and enhanced remineralization (12). and many fruit juices may reduce the cariogenic potential of foods.anticariogenic sugars 1-Polyphenols Polyphenols such as tannins in cocoa. .

sports beverages and citrus products.g. soft drinks.15) .g. The intrinsic acids are from vomiting. and citrus-flavored candies and lozenges]or from the occupational environment (e.TOOTH EROSION  Tooth erosion is the progressive loss of dental hard tissue by acids in a process that does not involve bacteria or sugars. juices. gastroesophageal reflux.( 14. including citrus fruit. battery and galvanizing factories). Tooth erosion as a result of eating disorders (bulimia nervosa) and dietary practices involving frequent intake of acidic foods and beverages can weaken tooth integrity. The extrinsic acids are from the diet [e. and regurgitation..

Groups at particular risk of caries in relation to diet 1-Infants and toddlers with prolonged breast- feeding on demand Infants and toddlers provided with a feeding bottle at bedtime. with sugar containing liquid . or bottle suspended in the cot for use during the night.

or other chronic illness. Crohn’s disease. 4-Those with reduced salivary secretion. 3-Those with an increased carbohydrate intake due to a medical problem e. e. malnutrition or failure to thrive.g.. chronic renal failure. uncontrolled diabetes.. eating disorders. irradiation in the region of the salivary glands. .2-People with increased frequency of eating because of a medical problem. Sjogren’s syndrome. gastrointestinal disease.g.

on long term and/or multiple medications. 7-Drug abusers who have a craving for sugar and a prolonged clearance rate as a result of reduced salivary secretion 8-People of any age. 6-Workers subject to occupational hazards such as food sampling and those on a monotonous job such as a night shift.5-Athletes taking sugar-containing sport supplement drinks. . Are these sugar-based and/or do they cause a dry mouth? 9-Any sugary bedtime snacks or drinks.

and eat dairy product such as cheese after the consumption of fermentable carbohydrates.DIETARY RECOMMENDATIONS FOR REDUCING THE RISK OF ORAL INFECTIOUS DISEASE (16. chew sugarless gum (particularly those containing sugar alcohols. and vegetables and practice good oral hygiene—particularly the use of fluoridated toothpastes—to maximize oral and systemic health and reduce caries risk. including foods that can buffer the acidogenic effects. 4) chew sugarless gum between meals and snacks to increase salivary flow. 3) rinse mouth with water. drink sweetened and acidic beverages with meals. which stimulates remineralization). or other sugarcontaining beverage. include dairy products with fermentable carbohydrates and other sugars and consume these foods with.18) 1) eat a balanced diet rich in whole grains. between meals. fruit. sweetened and acidic beverages. 5) drink.17. . 2) eat a combination of foods to reduce the risk of caries and erosion. 7) avoid putting an infant or child to bed with a bottle of milk. instead of. other fermentable carbohydrates. juice. 6) moderate eating frequency to reduce repeated exposure to sugars. and acids. rather than sip. add raw fruit or vegetables to meals to increase salivary flow.

crumpets. shredded wheat) Fresh fruit (whole and not juices) Peanuts (not for children under 5 years) Sugar-free chewing gum Sugar-free confectionery Water Milk Sugar-free drinks Tea and coffee (unsweetened) .g. starchy staple foods Cheese Fibrous foods (e. toast. raw vegetables) Low sugar breakfast cereals (e. rice.g.FOODS AND DRINKS WITH LOW POTENTIAL FOR DENTAL CARIES Bread (sandwiches. Pasta. pitta bread).

THANKS Ahmed Abdulelah Al-jawady University of Mosul .