The document discusses sugars and their impact on dental health. It classifies sugars as either intrinsic or extrinsic, with extrinsic sugars like table sugar being more cariogenic since they are more readily available to oral bacteria. Non-milk extrinsic sugars are considered the most damaging. The recommended daily intake of these sugars is no more than 60g. While fresh fruit is low in cariogenicity, fruit juices and dried fruits are more cariogenic due to released sugars. Certain groups are at higher risk of dental caries based on their diets, such as those who consume sugar before bedtime or have medical conditions affecting sugar intake or saliva production. Diet analysis focuses on cariogenic snacks, drinks, and medications

1. Diet and Caries
Dr. Kauser Sadia Fakhruddin

2. CLASSIFICATION OF SUGARS FOR
DENTAL HEALTH PURPOSES

3.  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.

4.  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)

5. 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.

6. 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.

7.  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.

8.  Dried fruit is also cariogenic. These products
are sticky, tending to adhere to teeth and
the drying process release some of the
intrinsic sugars.

9. Groups at particular risk of caries in
relation to diet

10.  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.

11.  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.

12.  Those with reduced
salivary secretion.
Sjogren’s
syndrome,
irradiation in the
region of the
salivary glands.
 Athletes taking
sugar-containing
sport supplement
drinks.

13.  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?

14. Diet Analysis

16.  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.

17. 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.

18.  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?

19.  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.

20. It would not be unreasonable to suggest
that after a sugar attack the plaque is
likely to remain acid for 1 hour , thus
8 attacks would equal 8 hours of acid
plaque.