CARIES & EROSION PROTECTION - GIVING DIET ADVICE

what is dental caries

demineralisation of the tooth surface caused by bacteria - bacteria produce acid which leads to enamel demineralisation

how can the risk of dental caries be reduced

identification of risk factors and targeted actions

define diet

diet: refers to the customary allowances of food and drink taken by any person from day to day - varies within families and cultures

what is the effect of diet on the mouth

diet may exert a local effect in the mouth by reacting with the enamel surface and as a substrate for cariogenic microorganisms (acidogenic/ aciduric)

which sugar is the most cariogenic

sucrose is the most cariogenic sugar - disaccharide made up of glucose and fructose

which sugars are not a threat to the dentition

• lactose - in milk

• intrinsic sugars - in fruits and vegetables

» not a threat to dental decay

which sugars are a threat to the dentition

• added sugars

• non-milk extrinsic sugars

• free sugars (FS)

» major threat to dental decay

what happens to the pH of dental plaque after ingestion of free sugars (FS)

• soon after the ingestion of FS the pH of dental plaque drops below the critical pH (5.5)

• this is the pH at which enamel demineralises

Stephan Curve (1940)

why does the pH of dental plaque drop after FS ingestion

bacteria metabolises the FS taken in ≈ 10 minutes after ingestion therefore pH drops

what does this graph show

Stephan Curve

• the more frequently food is ingested the more frequent and longer the pH of plaque remains below the critical pH of 5.5

• this results in repeated demineralisation

• the gradual rise in pH overtime is due to the cleansing of oral cavity or a drink

how can the Stephan Curve be applied to clinical advice

caries can be reduced by:

• fewer intakes of food

• select foods that lead to a smaller drop in pH

in what two ways can sugars be eliminated in the mouth

• chewing

• rinsing effect of saliva

what is the clearance time of sugar dependent on (5)

• salivary flow rate - older patients tend to have drier mouths

• age

• adhesive nature of food e.g. fudge, caramel

  • causes longer period of metabolisation by bacteria » longer period of demineralisation of enamel

• concentration of sugar in food

• time of day - mouth becomes drier around bed time therefore sugary intakes around nighttime will cause longer periods of metabolisation by sugar

which foods reduce the cariogenic potential of carbohydrates (4)

• phosphates - found in cereal

• cheese - has a neutralising effect but high in fat

• fluoride - added to foods/ toothpastes

• xylitol - artificial sweetener in chewing gum is antibacterial

what should diet advice encourage

general physical wellbeing

what should meals be based on

diet advice should be based on:

• starchy foods

• 5 a day

• fish

» cut down on saturated fats, salt and sugar

pointers when giving diet advice

• advice should be personalised/ tailored

• resources should be targeted at those who are at greatest risk of caries

• be constructive, understanding and non-judgemental

• encourage healthier foods by suggesting alternatives - instead of just telling patients what they should not be having

• appreciate cultural norms

specific diet advice to give

• reduce frequency and amount of sugar

• restrict sugars to mealtimes

• avoid snacking

• avoid processed foods if possible e.g. cakes, fizzy drinks, dried fruits

• encourage sugar free gum consumption

• encourage tooth brushing x2 daily for 2 minutes

• do not brush immediately after eating/ drinking/ vomiting

• brush last thing at night and at one other time

what can parents be advised to do to monitor their child’s diet

record a diet diary

what should be recorded in a diet diary

• 3 day diary - 2 weekdays and 1 weekend

• time of day

• amount of food

• types of food

what is dental erosion

dental erosion: the irreversible loss of dental hard tissue due to a chemical process of acid dissolution

• does not involve dental bacterial plaque like dental caries

• not directly associated with mechanical/ traumatic factors or caries

• can be extrinsic or intrinsic

dental caries VS dental erosion

• the acid produced in dental caries is bacterial related

• in dental erosion, the acid is associated with the ingestion of acidic food and drinks

• dental caries and dental erosion are often found together within one patient

what does this image show

• dental erosion

• due to the ingestion of fizzy drinks through a straw

• thin enamel around incisal tips

state extrinsic sources of acid

• foods - citrus fruits, pickled foods, ketchup, vinegar, some crisps

• drinks - carbonated drinks, alcopops, fruit juice, wine, herbal teas, smoothies

• lifestyle - mood enhancing drugs

• environmental - swimmers, wine tasters, battery acid workers

state intrinsic sources of acid

• medical - gastric acid reflux, vomiting, rumination

• psychological - anorexia, bulimia nervosa

what ingredients in soft drinks are erosive

• phosphoric acid

• citric acid

» plunges pH of mouth to < 5.5 - critical pH

image of dental erosion with dentine exposure

LL6

what is an important thing to do prior to dental treatment

tackle aetiological factors of the condition

what food has quite a lot of sugar in it

baked beans

why is sugar more likely to stick to teeth for longer during nighttime

our mouths are drier during nighttime due to the circadian rhythm