File Name: diet and nutrition in oral health palmer .zip
Carole A. This book may also be used as a text, by reading the chapters and answering the questions posed in case research to check understanding.
Dental professionals have had for some time a clear understanding of the biologic activity associated with dental caries . Certain oral bacteria are known to readily produce organic acids from metabolism of fermentable dietary carbohydrates in the oral cavity. Bacteria synthesize insoluble plaque matrix polymers or extracellular dextran that serves to perpetuate bacterial colonization on the surface of the tooth. The resulting acidic environment or low pH in dental plaque is an ideal environment for these bacteria.
Thus, the organic acids contribute to the demineralization of the tooth surface proportionally to the bacterial colonization and activity . Eating patterns can enhance or promote the caries process or interfere with and depress this activity. The purpose of this article is to examine those dietary factors involved in dental caries promotion and those that are involved in caries prevention.
Malnutrition, in the E-mail address: mobleyc uthscsa. All rights reserved. It is the local or topical effect of the diet on the tooth surface that is of greatest interest in examining caries, a pathologic disease process resulting from bacterial and dietary interactions .
Over time, fermentable car- bohydrate metabolism supports the colonization of the bacteria on the tooth surface and orchestrates changes in an acidic-basic milieu . The proportions and numbers of acid-base—producing bacteria can alter the impact of what is the demineralization-remineraliza- tion equilibrium of the tooth surface . At a critical pH of approximately 5. When the pH exceeds 5. As shown in Fig. These variables are not discussed in detail in this article. Furthermore, saliva encourages tooth remineraliza- tion by serving as a source of calcium, phosphate, and proline-rich proteins active in recrystalization of the tooth surface .
Aging, health status, and iatrogenic changes can alter saliva production and composition and, thus, caries-risk status .
Xerostomia, or dry mouth, is associated with increases in the number of cariogenic bacteria and increased caries .
Factors in demineralization and remineralization that are dynamic in the caries process. In summary, the balance between demineralization and remineralization is dependent on not just one factor but on multiple factors . Both the right substrate and the right bacteria must be present to produce high levels of acid required for caries initiation and progression. Dental caries is a major cause of tooth loss in the United States.
Specific foods Sugars [18,19] and other fermentable carbohydrates listed in Table 1 are fundamental to dental caries generation, whereas other food components have varying ancillary effects.
Lactitol, isomalt, maltitol Hydrogenated starch hydrolysates High-intensity sweeteners Nutritive Aspartame No Chemical compounds that are used as food additives in desserts, beverages, and confections that are — times sweeter than sucrose.
Sugars consumed alone are readily fermented by oral bacteria to acids and can cause a rapid drop in dental plaque pH. Simply put, if fermentable carbohydrates were never present in the oral cavity, then there would likely be no caries.
Bacteria are unable to replicate and generate acid without adequate substrate; however, investigators have shown that the amount of acid produced does not correlate linearly with the fermentable carbohydrate content of foods . A complexity of the multiple variables in this process prevents concise interpretations that include all the factors. Associations between total sugar consumption and dental caries in both developed and developing countries are inconsistent .
In the United States, total sucrose consumption decreased between and , but total added-sugar consumption increased because of dramatic increases in supplies of corn sweeteners or high-fructose corn sweeteners . Soft drinks or sodas are the major source of added sugars in the American diet .
The classic Vipeholm Dental Caries Study , conducted between and , reported that in- creased sugar consumption resulted in increased caries incidence. Conclusions were that the combined quantity and frequency of sugar consumption contributed to caries risk and that consistency of the sugar- containing foods was important . Starches cannot directly serve as substrate for oral bacterial fermentation [40,41]. Grains and vegetables such as potatoes, wheat, and beans contain starch granules that are damaged when subjected to heat and mechanical forces, leading to the formation of gelatinized starch.
The bioavailability and cariogenicity of food starches in the mouth vary with the basic genetic character and different cooking and food- processing methods frying, boiling, and so forth . Starchy foods such as untreated whole grains and raw vegetables have lower caries-promoting potential  than heat-processed foods such as white breads, crackers, chips, and dry cereal snacks.
Nutritive sources of energy sweeteners such as table sugar, honey, molasses, high-fructose corn syrup, dextrose, and sugar alcohols alcohol forms of monosaccharides are extrinsic and added to foods and beverages .
Acidogenicity and potential cariogenicity of sucrose, glucose, fructose, and maltose are similar; however, lactose is less cariogenic . There is lack of evidence to suggest these intrinsic sugars support the caries process. Since the mids, little has been done to explore the cariogencity of foods. Edgar et al  found considerable difference in the acidogenicity of 54 snack foods. Bibby and Mundroff  tested foods and reported that those snacks with high sugar concentrations did not destroy as much tooth enamel in a test situation as did low-concentration sugary foods in combination with starch breads, cookies.
Processed high- starch snacks produce as much acid in dental plaque as sucrose alone, but at a slower rate [48,49]. In conducting measurements of food retention, others investigators [32,43] indicated that high-sugar foods caramels, chocolate bars clear the mouth more rapidly than high-starch foods crackers, potato chips, cookies.
When sucrose is added to a cooked starch food, the starch brings sucrose into closer contact with the tooth surface for a longer period than if the food were only a sucrose food . These and other experimental studies with various snack foods have led to conclusions that cariogenicity is dependent on food composition, texture, solubility, retentiveness, and rate of salivary clearance rather than on sugar content alone [32,51]. Caution should be exercised, however, in presenting these data.
This information used in isolation would imply choosing corn chips over dried fruit; however, in reality, dried fruit is more nutrient dense and can be included in the diet as part of a complete meal, with minimal impact on caries risk. Because frequency of intake, food combinations, nutrient adequacy, and individual needs are as relevant as the potential cariogenicity of a food, nutrition messages for dental patients require context for meaning and accuracy.
Frequency of dietary intake Despite the overwhelming evidence showing the correlation between sugar consumption and dental caries, increased frequency of eating is considered to be the primary dietary factor associated with the caries process.
Most people eat four to six times daily. Thickened dental plaque, food debris, anatomic tooth abnormalities, and frequent consumption of cooked starches, simple sugars, or processed sugar- starch combinations will sustain an oral environment that promotes demineralization in preference to remineralization. With increased eat- ing frequency, there is expected increased total fermentable carbohydrate intake. Thus, the two are highly associated.
Dietary factors in caries prevention Just as there are food components and whole foods that promote the caries process, there are others that are protective and act to enhance the remineralization process.
Investigators have conducted human and animal studies demonstrating the effectiveness of milk in reducing the cariogenic potential of sugary foods [60—62]. Calcium and phosphorous bound to casein protein in milk are believed to be responsible for a protective effect on tooth enamel [58,63,64]. Likewise, cheese is considered to be an excellent anticariogenic food [65— 67]. Like milk, cheese contains casein phosphopeptides that appear to reduce demineralization and enhance remineralization.
A cube of cheese eaten after sugary meals or snacks reduces the demineralization process. Xylitol, which is derived from birch trees, corn cobs, oats, strawberries, and bananas, has received the greatest attention by dental professionals .
Xylitol users in the studies experienced the highest caries reductions. Although polyols have biologic properties that effect microbial growth and metabolism, it is thought that the chewing process itself has the greatest role in caries prevention, relative to saliva production .
Xylitol chewing gums and mints following a meal or snack are generally effective in reducing caries. Nonnutritive intense sweeteners used as sugar substitutes are non- carigenic.
Approved products on the market include saccharin, aspartame, acesulfame K, sucralose, and cyclamate . Newer products and for- mulated foods including these products as ingredients will continue to be submitted for government approval. The United States Food and Drug Administration authorized the use of the terms does not promote, useful in not promoting, or expressly for not promoting dental caries on food labels for those containing one or more sugar alcohols .
Plant foods Plant foods such as grains and vegetables have natural protective factors that act as anticariogenic agents. Studies in animal models indicate these in vitro effects can translate into caries prevention and that regular tea drinking may reduce the incidence and severity of caries .
Other food components have been evaluated for their protective characteristics. Oleic and lenolic fatty acids in cocoa bean husk have shown bactericidal activity against Streptococcus mutans in laboratory studies [76,77]. Licorice candies made of glycyrrhizinic acid have been shown to increase plaque-buffering capacity and inhibit bacterial metabolism but can cause enamel staining . Dietary recommendations Despite the risk associated with some of the protective foods, the opportunity to fashion dietary messages that put good nutrition into practice exist.
Terms like cariogenic or caries promotion used in descriptions of both foods and diets associated with dental caries conjure avoidance. Assessment of food choices will help the dental professional develop strategies for suggesting the combining of caries-promoting and cariostatic foods .
For example, sugary foods can be part of a meal and, when combined with proteins and limited amounts of fats, may be less caries promoting. Fermentable carbohydrates eaten alone stimulate a rapid drop in plaque pH; however, if a nonsugary item that stimulates saliva is eaten immediately before, during, or after this challenge, then the pH will rise .
Inclusion of milk or nonfat yogurt with a meal or snack will encourage a cariostatic effect. Foods eaten in sequence within an eating occasion can affect the magnitude of plaque pH. Study outcomes report that those who snack frequently and have a high proportion of total energy intake from a variety of fermentable carbohydrates and a low intake of protein foods have more caries . Other investigators report that those who eat diets higher in vegetables and milk products have less caries [85,86].
Diets that promote variety and moderation are going to contribute to both dental and general health. Dietary screening and education in the dental practice Dental professionals should routinely screen patients to assess the role of diet in caries risk and management . Dentists are not trained to conduct a complete nutritional assessment that includes anthropometrics and bio- chemical data but they can use dietary screening, assessment, and analysis to provide nutrition and dietary education and referral to registered dietitians for more in-depth nutrition counseling .
Diet and Nutrition in Oral Health is designed to enable readers to answer patient questions and integrate nutrition into clinical practice just as comfortably as they would fluoride and other preventive modalities. Filled with models, guidelines, and practical suggestions, the book can be used as a how-to manual for diet screening and guidance. Readers can also use the book and appendix as a reference on specific nutrition topics, life-cycle groups, or health-related conditions. Convert currency. Add to Basket. Book Description Pearson,
Diet and Nutrition in Oral Health subscription 3rd edition. A healthy diet is one that includes all the essential nutrients in appropriate amounts to promote health and prevent disease. A healthy diet is based on the concepts of variety, balance, and moderation. Subscriber Account active since Like what you see here? Subscribe to our daily newsletter to get more of it.
View larger. Dentistry today is changing to meet the needs of a changing population. Life expectancies continue to increase, and the nature and demographics or oral diseases are changing. Associated oral conditions such as coronal caries, root caries, periodontal disease, endentulism, cancer, AIDS, and all oral infections, all have nutritional implications. The American Dental Association and the American Dental Hygienists' Association recommend that dental professionals "maintain current knowledge of nutrition recommendations as they relate to general and oral health and disease", and "effectively educate and counsel their patients about proper nutrition and oral health".
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