Cariology Lecture 10

What does plaque pH measure?

It measures the acidogenicity of foods—the ability of plaque bacteria to produce acid after eating.

What does a low plaque pH indicate?

Higher acid production and higher cariogenic potential.

What is the critical pH for enamel demineralization?

Between 5.0 and 5.5.

What do plaque pH studies teach us?

Fermentable carbohydrates lower plaque pH; longer time below pH 5.5 means higher caries risk.

What did incubation studies find about sugar and plaque bacteria?

All fermentable sugars can be metabolized by plaque microorganisms.

What was the purpose of Palmer's "Diet and ECC" study?

To examine how diet composition and meal patterns relate to Early Childhood Caries (ECC).

What foods were most protective in Palmer's study?

Cheese, nuts, and xylitol-containing foods.

What foods had low cariogenic potential?

Protein- and fat-only foods like meats and eggs.

What foods had moderate cariogenic potential?

Starches, fruits, vegetables, and milk.

What foods were high in cariogenic potential?

Sweetened beverages, bread, chips, cookies, baked starches with sugar.

What did Palmer's results show about food form and frequency?

Sticky or frequent sugar exposures greatly increased ECC risk.

What are the main carbohydrate types in foods?

Monosaccharides (glucose, fructose), disaccharides (sucrose, lactose, maltose), polysaccharides (starches), and oligosaccharides (maltodextrin, HFCS).

How does processing affect starch cariogenicity?

Cooking, baking, or modifying starch increases fermentability and cariogenic potential.

What did the 2024 Jangda study find about starch and caries?

Higher starch intake was associated with higher DMFT scores in adults.

Which foods within grain groups carry the highest caries risk?

Pastries, desserts, cookies, and sugary cereals.

Which food groups are lowest in caries risk?

Vegetables, unsweetened dairy, and protein-rich foods with fat.

What food components reduce caries risk?

Fat and calcium help buffer acid and protect enamel.

What did the systematic review on ultra-processed foods (UPF) conclude?

Higher UPF intake increases caries risk by 71%.

Why do ultra-processed foods increase risk?

They are rich in added sugars, refined starches, and are often sticky or retentive.

What factors affect clearance time of food from the mouth?

Oral motor skills, food texture, stickiness, salivary rate, and whether the food is solid or liquid.

How does clearance time affect caries risk?

Longer clearance time increases the duration of acid attack and risk of demineralization.

What are self-cleansing foods?

Fibrous, chewy foods (like carrots, apples, cheese) that stimulate saliva and clean teeth surfaces.

How does chewing affect salivary protection?

Chewing increases salivary flow, improving buffering and remineralization.

What are buffering agents in diet?

Chewy, fat-rich, or protein foods (like peanuts and cheese) that neutralize acids.

How does the sequence of foods in a meal affect caries risk?

Eating cariogenic foods first and protective foods last (like cheese) reduces acid exposure.

Why is eating a sugary snack followed by milk or water beneficial?

It helps neutralize acid and clear sugars from the mouth.

What did the Naval et al. (2013) study test?

Whether plaque pH differs after sugary snacks followed by different beverages.

What was the result when sugary cereal was followed by water or milk?

Smaller pH drop and faster recovery compared to juice or sucrose rinse.

What did this study show about beverage choice?

Milk and water after sugary foods reduce acidogenicity compared to juice or sugary drinks.

What is the difference between structured and unstructured meal patterns?

Structured meals have defined eating times; unstructured involves frequent snacking.

Which meal pattern increases caries risk?

Unstructured eating (frequent snacks) increases risk due to constant acid exposure.

What are non-nutritive sweeteners?

Artificial or natural high-intensity sweeteners providing sweetness without fermentable carbohydrate.

Name examples of polyols.

Sorbitol, xylitol, and erythritol.

Name examples of high-intensity sweeteners.

Aspartame, saccharin, acesulfame-K, sucralose, stevia, monk fruit.

What did Park et al. (1995) find about sweeteners and plaque pH?

Sugar alcohols and high-intensity sweeteners are not acidogenic or cariogenic.

How does xylitol compare to sorbitol?

Xylitol is more effective at reducing plaque and caries risk than sorbitol.

Are high-intensity sweeteners acidogenic?

No—they are not fermentable and do not lower plaque pH.

What is erythritol?

A sugar alcohol with 0.2 kcal/g, non-cariogenic, and possibly caries-protective due to reduced plaque formation.

What is monk fruit sweetener?

A non-nutritive sweetener using mogrosides for sweetness, 0 kcal, and non-cariogenic.

What is stevia?

A non-nutritive sweetener made from steviol glycosides, 0 kcal, and non-cariogenic.

What are non-milk extrinsic sugars (NMES)?

Sugars outside of plant cells or added to foods (added sugars, juices), often more cariogenic.

Why are NMES considered more cariogenic?

They are readily available to bacteria and increase acid production.

What information on food labels helps assess cariogenicity?

Ingredient list, total sugars, added sugars, starch content, and serving frequency.

In what order are ingredients listed on a food label?

In descending order by weight.

How can patients use labels to reduce caries risk?

Choose foods lower in added sugars and with fewer fermentable carbohydrates.

Do regular sodas cause cavities?

Yes—due to high sugar content (9-11 tsp per can) and low pH, which promote demineralization.

What factors were linked to rampant caries in soda users?

High soda intake, low water intake, smoking, and poor oral hygiene.

What three components are needed for dental decay?

Tooth, bacteria, and carbohydrates.

How does dental erosion differ from decay?

Erosion is loss from acid exposure (non-bacterial); decay involves bacterial fermentation.

What factors modify erosion and decay risk?

Carbohydrates, acidity, caffeine, and eating habits.

Compare regular vs. diet soda composition.

Regular soda: high sugar, acidic, cariogenic and erosive. Diet soda: low/no sugar, acidic, erosive but non-cariogenic.

What are typical calories and sugar content in regular soda?

150-170 calories and 9-11 teaspoons of sugar per 12 oz can.

What are typical sweeteners in diet soda?

Aspartame, sucralose, and acesulfame-K.

How does pH contribute to erosion?

Lower pH increases enamel dissolution even without bacteria.

What was observed in enamel erosion studies comparing Coke vs. Diet Coke?

Both caused erosion, but regular Coke caused significantly more loss than Diet Coke.

What are the oral health implications of regular soda?

High caries and erosion risk due to sugar-acid synergy and frequent consumption.

What are the oral health implications of diet soda?

No caries risk but erosion risk remains due to acidity.

What are systemic health implications of regular soda?

Excess calories contribute to obesity and nutrient deficiencies.

What are systemic health implications of diet soda?

May displace nutrient-dense beverages and still contribute to poor nutrition if overused.

What are recommendations for soda consumption?

Limit regular soda to one 12 oz can per day, preferably with meals.

What are recommendations for diet soda?

Consume quickly (avoid sipping) to minimize acid exposure.

What beverages are recommended between meals?

Water or other sugar-free options.

How many servings of milk or dairy should be consumed daily?

2-4 servings for calcium and buffering benefits.

Is it always appropriate to limit soda?

Generally yes, but some exceptions exist (e.g., public health issues like unsafe water).

What public health consideration was mentioned regarding soda and water?

Flint, Michigan water crisis—access to safe water impacts beverage choices and caries prevention.