CLASSIFICATION OF SUGARS FOR DENTAL HEALTH PURPOSES
INTRINSIC SUGARS: sugars integrated into the cellular structure of food (e.g., in fruits) are called intrinsic sugars. EXTRINSIC SUGARS: sugars present in a free form (e.g., table sugar) or added to food(e.g., sweets biscuits) are called extrinsic sugars. They are more readily available for metabolism by the oral bacteria and therefore potentially more cariogenic.
Milk contains lactose but is not generally regarded as cariogenic. Cheese and yoghurts, without added sugars, may also be considered safe for teeth. Thus the most damaging sugars for dental health are non-milk extrinsic sugars (NMES)
Recommended and current levels of sugar intake The recomended intake of non-milk extrinsic sugars is a maximum of 60g/day, which is about 10% of daily energy intake.
Starch, fruits and fruits sugars Raw starch (e.g., raw vegetables) is of low cariogenicity. However, cooked and highly refined starch (e.g., crisps) can cause decay. And a combinations of cooked starch and sucrose (e.g., cakes, biscuits, sugared breakfast cereals) can be highly cariogenic.
Fruit contains sugars (fructose, sucrose and glucose) but fresh fruits appear to be low cariogenicity. However, the same cannot be said for fruit juices. The juicing process releases the sugars from the whole fruit, and these drinks are potentially cariogenic.
Dried fruit is also cariogenic. These products are sticky, tending to adhere to teeth and the drying process release some of the intrinsic sugars.
Groups at particular risk of caries in relation to diet
Infants and toddlers with prolonged breast-feeding on demand Infants and toddlers provided with a feeding bottle at bedtime, or bottle suspended in the cot for use during the night, with sugar containing liquid.
People with increased frequency of eating because of a medical problem, e.g., gastrointestinal disease, eating disorders, uncontrolled diabetes. Those with an increased carbohydrate intake due to a medical problem e.g., Crohn’s disease, chronic renal failure, or other chronic illness, malnutrition or failure to thrive.
Those with reduced salivary secretion. Sjogren’s syndrome, irradiation in the region of the salivary glands. Athletes taking sugar-containing sport supplement drinks.
Workers subject to occupational hazards such as food sampling and those on a monotonous job such as a night shift. Drug abusers who have a craving for sugar and a prolonged clearance rate as a result of reduced salivary secretion People of any age, on long term and/or multiple medications. Are these sugar-based and/or do they cause a dry mouth?
There are two principal techniques for determining food intake. One is to record the dietary intake during the preceding 24 hours, the so called 24- hour recall. The other method is to obtain a 3-4 day written diet record.
How to analyze the diet record The main meals, to see whether they are sufficiently substantial-this is important to prevent the patient craving food between meals The between-meal snacks. Are they cariogenic? Any medication, particularly if it is based on sucrose syrup or it is likely to cause dry mouth or thirst.
The number and type of between-meal drinks. Are these cariogenic? The consistency of any between-meal snacks. Are they sticky and therefore take a long time to clear from the mouth?
The use of sucrose-containing chewing gum or any sweet that takes a long time to dissolve in the mouth Any sugary bedtime snacks or drinks.
It would not be unreasonable to suggestthat after a sugar attack the plaque is likely to remain acid for 1 hour , thus 8 attacks would equal 8 hours of acid plaque.