Diet and dental caries

DIET AND DENTAL CARIES
KOMAL GHIYA

INDEX
• INTRODUCTION
• DEFINITION
• RELATIONSHIP OF DIETARY FACTORS AND DENTAL CARIES
• ROLE OF DIFFERENT FOOD CONSTITUENTS IN CARIES:
 CARBOHYDRATES:SUGAR ALCOHOLS
 SUCROSE:ARCH CRIMINAL
 STARCH VS SUGAR
 LIPIDS
 PROTEINS
 MINERALS:PHOSPHORUS
 FLUORIDE
 OTHER MINERALS
• DIET COUNSELLING:TYPES
 GUIDELINES
 PROCEDURE
• IDEAL SNACK
• MY PLATE
• CONCLUSION

INTRODUCTION
• MILLERS CHEMICOPARASITIC THEORY:1889
• DENTAL DECAY IS A CHEMICOPARASITIC PROCESS CONSISTING OF 2
STAGES,THE DECALCIFICATION OF ENAMEL,WHICH RESULTS IN ITS TOTAL
DESTRUCTION AND THE DECALCIFICATION OF DENTIN,AS A PRELIMINARY
STAGE,FOLLOWED BY DISSOLUTION OF SOFTENED RESIDUE.THE ACID
WHICH AFFECTS THIS PRIMARY DECALCIFICATION IS DERIVED FROM
FERMENTATION OF STARCHES AND SUGAR DISLODGED IN THE RETAINING
CENTERS OF TEETH
• SIGNIFICANCE OF MILLER’S OBSERVATION IS THAT ASSIGNED TO AN
ESSENTIAL ROLE TO THREE FACTORS IN CARIOUS PROCESS:
• THE ORAL MICROORGANISMS IN ACID PRODUCTION AND PROTEOLYSIS
• CARBOHYDRATE SUBSTRATE
• THE ACID WHICH CAUSES DISSOLUTION OF TOOTH MINERALS
STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC
DENTISTRY,SCIENTIFIC FOUNDATIONS AND CLINICAL
PRACTICE,1982

ATWATER CALORIMETRY
• CARBOHYDRATES:4 Kcal/g
• PROTEINS 4Kcal/g
• FATS 9 Kcal/g
NIZEL R,PAPAS T,NUTRITION IN CLINICAL
DENTISTRY,THIRD EDITION

DEFINITION
• DIET:
• NIZEL(1989):TOTAL ORAL INTAKE OF A SUBSTANCE THAT PROVIDES NOURISHMENT AND
SUPPLY
• BALANCED DIET:IS THE ONE WHICH CONTAINS VARITIEIS OF FOODS IN SUCH QUANTITIES
AND PROPORTION THAT ARE NEEDED FOR ENERGY.
• WHO:NUTRITION IS THE INTAKE OF FOOD, CONSIDERED IN RELATION TO THE BODY’S
DIETARY NEEDS
• CHILD DIET:COMBINATION OF FOOD CONSUMED AND THE NUTRIENTS CONTAINED
THERE IN, WHICH HAVE A PROFOUND ABILITY TO INFLUENCE COGNITION, BEHAVIOR
AND EMOTIONAL DEVELOPMENT IN ADDITION TO ULTIMATE PHYSICAL GROWTH &
DEVELOPMENT (DCNA 2003)
• DENTAL CARIES:MICROBIAL DISEASE OF CALCIFIED TISSUES OF TOOTH,CHARACTERIZED BY
DEMINERALIZATION OF INORGANIC PORTIONS AND DESTRUCTION OF ITS ORGANIC
STRUCTURE

RELATIONSHIP OF DIETARY FACTORS
AND DENTAL CARIES
• BACTERIAL VIRULENCE
• HOST RESISTANCE
• SALIVA BUFFERING CAPACITY
• QUANTITY OF CARBOHYDRATES
• CHEMISTRY OF TOOTH SUBSTANCE
• STICKINESS
• FOOD ACIDITY
• FOOD TEXTURE
• ORAL RETENTION OF FOOD

CARBOHYDRATES
INITIATION OCCURS AT THE
LESION OF INTERFACE BETWEEN
ENAMEL OR CEMENTAL
SURFACES
ENZYMES OF DENTAL PLAQUE
BACTERIA ACT ON
FERMENTABLE
CARBOHYDRATES
BREAK THEM INTO ORGANIC
ACIDS
:LACTIC,PYRUVIC,PROPIONIC,FOR
MIC:WHICH CAN BEGIN TO
DEMINERALIZE

STEPHEN’S CURVE
WHEN SUGARS ARE GIVEN,AT PH 5.0-5.5
DEMINERALIZATION OF ENAMEL STARTS AND
BELOW THIS RANGE OF PH HYDROXYAPAPTITE
CRYSTALS START DISSOLVING
PH:5.5 IS THE CRITICAL PH

ACIDOGENIC
APPLES,DRIED BANANAS BEANS BAKED BREAD,WHITE
APPLES,FRESH BREAD,WHOLE
WHEAT
CARAMEL CARROTS,COOKED
APPLE DRINK APRICOT CEREALS,NON
PRESWEETENED
CEREALS
SWEETENED
CHOCOLATE,MILK COLA,BEVERAGES COOKIES,VANILLA
SUGAR
CORN FLAKES
CORNSTARCHES CRACKERS,SODA CREAM CHEESE DOUGHNUTS PLAIN
GELATIN,FLAVORED
DESSERT
GRAPES MILK MILKCHOCOLATE
ORANGES PASTAS PEANUT BUTTER POTATO AMYLASE
PEAS,CANNED POTATO AMYLASE POTATO,BOILED RICE,INSTANT
COOKED
SPONGE CAKE TOMATO,FRESH WHEAT FLAKES
NIZEL
R,PAPAS
T,NUTRITI
ON IN
CLINICAL
DENTISTR
Y,THIRD
EDITION

NONACIDOGENIC
• CREATE A PLAUE PH OF 6 OR HIGHER
• ARE RELATIVELY HIGH IN PROTEIN
• HAVE A MODERATE CONTENT TO FACILITATE ORAL CLEARANCE
• CONTAIN A MINIMAL CONCENTRATION OF FERMENTABLE CARBOHYDRATE
• EXERT A STRONG BUFFERING ACTION
• HAVE A MINERAL CONTENT INCLUDING CALCIUM AND PHOSPHATE
• CHEESE SUCH AS BLUE CHEESE,CHEDDAR,GOUDA,MONTAREY
JACK,MOZZARELLA,SWISS

MILK AND MILK PRODUCTS
Rugg-Gunn, 1993 milk contains about 4.8g lactose per 100g
milk. This amount could be sufficient to
classify milk as cariogenic, but there is
evidence that lactose is the least cariogenic
the common dietary sugars
Prabhakar et al. (2010) plain bovine milk was relatively cariogenic
(Southgate, 2000). YOGURT:The lactose content reduces
substantially during fermentation although
some galactose remains: other constituents
are unchanged
Tanaka et al. (2010) yogurt consumption:with a lower prevalence
of caries
Ravishankar, T.L.(2012) Cheese and yogurt without any added sugar
(sucrose) are non-cariogenic

• SUGAR ALCOHOLS
• LITTLE OR NO EFFECT ON PLAQUE PH AND DENTAL CARIES
• SORBITOL CONTAINING CHEWING GUMS-REASONABLE DOUBT
• RECOMMEND ALTERNATIVE CONFECTIONS CONTAINING SUGAR ALCOHOLS
• DISSUADE PATIENT FROM USE OF MINTS AND CHEWING GUMS

STUDIES
VIPEHOLM STUDY(1954)
• Mental institution at the Vipeholm
hospital near Lund, Sweden
• Purpose- to determine the effects of
frequency and quantity of sugar intake on
the formation of caries.
• Conclusion : physical form of
carbohydrate stickiness, oral clearance
time, frequency of intake much more
important in cariogenicity than the total
amount .
HOPEWOOD STUDY
1960
80 children, ages 5and 13years
Sugar and refined carbohydrates
excluded.
Carbohydrates-raw form.
Def and DMFT 10% of general population
Caries can be reduced to a minimal level
by
dietary means alone in spite of
unfavorable
hygiene and f levels.
TURKU SUGAR STUDY(1972)
Aim: To test the effects of chronic consumption of
sucrose, fructose, and xylitol on dental and
general health. (1972-1974)
Basis : Xylitol is a sweet substance not
metabolized by plaque organisms.
Caries reduction -after 2 years of xylitiol
consumption: acceptable metabolite
Fructose was as cariogenic as sucrose for first 12
months .
Chewing of a xylitol gum produced an
anticariogenic effect- in between meals.

SUCROSE:ARCH
CRIMINAL:NEWBRUN,1969
• STREPTOCOCCUS MUTANS:SMOOTH SURFACE CARIES
• SUCROSE HELP IN GLUCAN FORMATION
• GLUCANS HELP IN SURVIVAL OF STREPTOCOCCUS MUTANS
• THUS CAUSE PLAQUE ACCUMULATION AND SMOOTH SURFACE CARIES
Leme AFP, Koo H, Bellato CM, Bedi G, Cury JA. The Role
of Sucrose in Cariogenic Dental Biofilm Formation—New
Insight. Journal of dental research. 2006;85(10):878-887.

STARCH VS SUGAR
RELATIVELY INSOLUBLE
DOES NOT READILY
DIFFUSE THROUGH
PLAQUE
DOES NOT READILY
FERMENT
NOT IMMEDIATELY
AVAILABLE AS AN
ENERGY SOURCE FOR
ORAL MICROORGANISM
RELATIVELY SOLUBLE
READILY DIFFUSE
THROUGH PLAQUE
READILY FERMENTS
IMMEDIATELY
AVAILABLE AS AN
ENERGY SOURCE FOR
ORAL MICROORGANISM
SUGAR:
STARCH:POLYSACCHARIDE

• Rugg-gunn,1986/NEWBRUN 1976,BOWEN,1982,SREEBNY,1978
point out low caries prevalence during starch
• Lingstrom et al 2000:
When evaluating starch in animal human plaque ph response in
caries model studies
Results: Processed food starches in mordern diet posses a
cariogenic potential

XYLITOL
• Naturally occurring pentose alcohol that can be derived from various types of
cellulose products ,such as wood, straw, cane pulp,or seed hulls
• Sweetness similar to that of sucrose
• Produces cooling sensation in the mouth
• When taken in excess it can produce diarrhea
• One gram xylitol yields 4 calories
REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

CLASSIFICATION OF SUGAR
SUBSTITUTES BASED ON SUGAR
SUBSTITUTE BEING CALORIC OR NON-
CALORIC:
• a) Caloric / Nutritive sweetener b) Non caloric / Non nutritive sweetener i) Poly
alcohols / sugar alcohols i) Cyclamate Xylitol Sorbitol ii) Hydrogenated starch
hydrolysate Lycasin Palatinit ii) Saccharin iii) Coupling sugar Sorbose
Palatinose iii) Aspartame iv) Sucralose v) Neotame Based on their origin: A)Natural
(derived from plant origin) B)Artificial 1. Monellin 1. Aspartame 2. Licorice 2.
Saccharin 3. Dihydrochalcone 3. Cyclamate 4. Miraculin 4. Sucralose

• Xylitol is neither fermented nor utilized by streptococcus mutants
• When xylitol is used as a sugar substitute in animal and human studies ,there
appeared to be some initial promise that this polyol might have useful anticaries
properties
• However toxicity studies in mice ,it was found that those were fed 20% xylitol in the
diet developed malignant neoplasms of urinary bladder

SORBITOL
• SUGAR ALCOHOL MADE COMMERCIALLY GLUCOSE BY HYDROGENATION.
• ABOUT 60% AS SWEET AS SUCROSE AND IS USED SWEETENING AGENT IN
DIABETIC FOODS AND SO CALLED SUGARLESS GUMS AND CANDIES.
• SORBITOL IS ABSORBED FROM GUT AND HAS SLOW ABSORPTION RATE,SO
DOESN’T RAISE BLOOD SUGAR LEVEL
• 1 GRAM-4 CALORIES

MANNITOL AND DUCITOL
• OBTAINED FROM HYDROGENATION OF MANNOSE AND GALACTOSE
• BREAKDOWN TO ORGANIC ACIDS IN THE MOUTH AT MUCH SLOWER RATE
• SALIVARY BUFFERS HAVE BETTER OPPORTUNITY OF NEUTRALIZING IT

FLAVINOID SWEETENERS
• MONELLIN:
• PROTEIN
• FOUND FROM FRUIT
• 3000 TIMES SWEETER THAN SUCROSE
• SACCHARIN
350 TIMES THAN SUGAR
1985 FDA :CARCINOGENIC
INCONCLUSIVE EVIDENCE

• ASPARTAME
• 4Kcal/gram
• 180 TIMES SWEETER
• 20 TIMES MORE EXPENSIVE
• ADJUSTED SAFE BY FDA

XYLITOL
• Naturally occurring pentose alcohol that can be derived from various types of
cellulose products ,such as wood, straw, cane pulp,or seed hulls
• Sweetness similar to that of sucrose
• Produces cooling sensation in the mouth
• When taken in excess it can produce diarrhea
• One gram xylitol yields 4 calories
• Xylitol is neither fermented nor utilized by streptococcus mutants
REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL
DENTISTRY,,1989

STUDIES
Milgrom P, Ly K, Roberts MC, Rothen M,
Mueller G, Yamaguchi DK..
(2006)
In comparison to sorbitol and mannitol,
at 5 weeks S mutans decreases 10X
Milgrom P, Ly KA, Tut OK, Mancl
L, Roberts MC, Briand K, Gancio MJ
(2009)
Xylitol oral syrup administered
or 3 times daily at a total daily dose of
g was effective in preventing early
childhood caries.
Lenkkeri AM, Pienihäkkinen K, Hurme
S, Alanen P(2012)
Use of xylitol/maltitol or
erythritol/maltitol lozenges did not
in caries reduction.
Mäkinen KK, Bennett CA, Hujoel PP, et
al(1995)
xylitol-sorbitol mixtures were less
effective than xylitol, but they reduced
caries rates significantly compared with
the no-gum group
Lee W, Spiekerman C, Heima M, et al Xylitol consumption did not have
additional benefit beyond other
preventive measures

LIPIDS
• INDIRECT EVIDENCE THAT DIETARY FATS MAY HELP TO PREVENT CARIES
• E.G:ESKIMOS:WHOSE DIETS ARE SOLELY OF ANIMAL ORIGIN AND FURNISH ABOUT
70-80% OF THEIR TOTAL CALORIE AS FAT EXPERIENCE,HAVE VERY LITTLE DECAY
• MECHANISM :
 COATING OF TOOTH SURFACES WITH AN OILY SUBSTANCE WOULD MEAN THAT
FOOD PARTICLES WILL NOT BE SO READILY RETAINED
 A FATTY PROTECTIVE LAYER OVER PLAQUE WOULD PREVENT FERMENTABLE
SUGAR SUBSTRATE FROM BEING REDUCED TO ACIDS
 HIGH CONCENTRATIONS OF FATTY ACIDS MAY INTERFERE WITH GROWTH OF
CARIOGENICITY
 INCREASED DIETARY FAT WILL DECREASE THE AMOUNT OF DIETARY
FERMENTABLE CARBOHYDRATE NECESSARY FOR ORGANIC ACID FORMATION
DENTISTRY,,1989

PROTEINS
• ANIMAL STUDIES:PROTEIN DEFICIENT DIET FED TO EXPERIMENTAL ANIMALS
DURING PRE ERUPTIVE TOOTH DEVELOPMENT PERIOD INCREASE CARIES
SUSCEPTIBILITY
• HUMANS:SHOW NO DIRECT EVIDENCE
• AFTER TOOTH FORMATION:PROTEIN DEFICIENCY MEANS INCREASED
INGESTION OF CARBOHYDRATES ,
• NUTS,EGGS,MEAT AND SOME DAIRY PRODUCTS DO NOT DECREASE PLAQUE
PH UNDER EXPERIMENTAL CONDITIONS:SCHACHTELE,1984
DENTISTRY,,1989

PHOSPHATES
• REDUCTION OF ENAMEL SOLUBILTY
• BUFFERING EFFECT IN NEUTRALIZING SALIVARY,BACTERIAL,PLAQUE AND
FOOD Ph VALUES
• REACTION WITH FAT,PROTEINS,AND CARBOHYDRATES TO EFFECT
STRUCTURAL CHANGES RENDERING THEM LESS CARIOGENIC
• INTERFERENCE WITH MEMBRANE CONDITIONS OR ENZYMATIC PROCESSES ON
ENAMEL SURFACES TO INCREASE HOST RESISTANCE
• DECREASE IN BACTERIAL ADHESION
• INTERFERENCE WITH SYNTHESIS OF EXTRACELLULAR POLYSACCHARIDE
FORMATION
• MAINTENANCE OR INCREASE OF PLAQUE CALCIUM AND PHOSPHORUS LEVELS
PRACTICE,1982

OTHER INHIBITING SUBSTANCES
• PYRODOXINE
• FAT
• TANNIC ACID
• ZANTHINES
• FIBROUS FOODS
• FOODS LIKE PEANUTS,FRUITS AND RAW VEGETABLES REQUIRE VIGOROUS
MASTICATION WILL STIMULATE SALIVATION RAISING PLAQUE PH AND THE
SALIVA WILL PROMOTE REMINERALIZATION TO HEAL THE INCIPIENT LESION.
PRACTICE,1982

DIETARY FLUORIDE SUPPLEMENTS
<0.3 ppm 0.3-0.6 ppm >0.6ppm
BIRTH TO 6 MO 0 0 0
6 mo-3 yr 0.25 mg 0 0
3 yr-6 yr 0.50mg 0.25 mg 0
6 yr or later 1.00 mg 0.50mg 0
P CASAMASSIMO,H FIELDS,D MCTIGUE,A
NOWAK,PEDIATRIC DENTISTRY,INFANCY THROUGH
ADOLESCENCE,5 th edition

MINERALS
• NAVIA’S CLASSIFICATION
TYPES MINERALS
CARIES PROMOTING ELEMENTS SELENIUM,MAGNESIUM,CADMIUM,PLATINUM,L
EAD,SILICON
MILDLY CARIOSTATIC MOLYBEDNUM,VANADIUM,STRONTIUM,
CALCIUM,BORON,LITHIUM,GOLD
DOUBTFULL EFFECT ON CARIES BERELLIUM,COBALT,MAGNESIUM,ZINC,
BROMINE,IODINE
CARIES INERT BARIUM,ALUMINIUM,NICKEL,IRON,
PALLADIUM,TITANIUM
STRONGLY CARIOSTATIC FLUORINE,PHOSPHORUS
DENTISTRY,,1989

DIETARY RECOMMENDATIONS BY
AAPD
• Breast-feeding of infants to ensure the best possible health and developmental and psychosocial
outcomes, with careto wiping or brushing as the first primary tooth begins to erupt and other
dietary carbohydrates are introduced.
• • Educating the public about the association between fre-quent consumption of carbohydrates
and caries.
• • Educating the public about other health risks associated with excess consumption of simple
carbohydrates, fat, saturated fat, and sodium.
• Furthermore, the AAPD encourages:
• • Pediatric dentists and other health care providers who treat children to provide dietary and
nutrition counseling (commensurate with their training and experience) in conjunction with other
preventive services for their patients.
• • Food and beverage manufacturers to make nutritional content on food labels more prominent
and “consumer-friendly”.
• • Consumers to monitor the presence and relative amounts of carbohydrates and saturated fats
as listed on food labels.
Policy on Dietary Recommendations for Infants, Children, and Adolescents,REFERENCE MANUAL V 37 / NO
6 15 / 16,

• School health education programs and food services to promote nutrition programs
that provide well-balanced and nutrient-dense foods of low caries-risk, in
conjunction with encouraging increased levels of physical activity.
• • Research, education, and appropriate legislation to pro-mote diverse and balanced
diets.
• • Pediatric dentists and other health care providers to recommend or prescribe
sugar-free medications whenever possible.
• • Educating parents of the risks of overdose from excessive consumption of candy-
like chewable vitamin supplements
Policy on Dietary Recommendations for Infants, Children, and Adolescents,REFERENCE MANUAL V 37 / NO
6 15 / 16,

RECOMMENDARY DIETARY ALLOWANCES(INDIAN)
GROUP BODY
WEIGHT
(Kg)
ENERGY
(Kcal
/day)
PROTEIN
S(g/day)
FAT
(g/day)
CALCIUM
(mg/day)
IRON
(mg/
day)
ZINC
(mg/
ay)
MAGNESIUM
(mg/day)
INFANTS 0-6
MNTHS
5.4 92/kg 1.16/kg 19 500 46MIC
ROGR
AM/K
G
30
6-12 8.4 80/kg 1.69/kg 27 5 45
1-3 12.9 1060 16.7 25 9 5 50
CHILDREN 4-6YRS 18.0 1350 20.1 30 600 13 7 70
7-9 25.1 1690 29.5 35 16 8 100
BOYS 10-12 34.3 2190 39.9 35 21 9 120
GIRLS 10-12 35.0 2010 40.4 35 800 27 9 160
BOYS 13-15 47.6 2750 54.3 45 32 11 165
GIRLS 13-15 46.6 2330 51.9 40 800 27 11 210
BOYS 16-17 55.4 3020 61.5 50 28 12 195
GIRLS 16-17 52.1 2440 55.5 35 800 26 12 235

VIT
C(mg/day
)
FOLATE
(microgra
m/day)
VIT B12
(microgra
m/day)
RIBOFLAV
IN
(mg/day)
NIACIN
(mg/day)
VIT B6
(mg/day)
RETIN
OL
B CAROTENE
(microgram/
day)
THIAMINE
(mg/day)
INFANTS 0-6
MNT
S
25 25 0.2 0.3 710
micrgra
m/kg
0.1 350 0.2
6-12 0.4 650
microgr
am/kg
0.4 2800 0.3
1-3 80 0.6 8 400 3200 0.5
CHILDRE
N
4-
6YRS
40 100 0.2-1.0 0.8 11 0.9 0.7
7-9 120 1.0 13 600 4800 0.8
BOYS 10-12 40 140 0.2-1.0 1.3 15 1.6 1.1
GIRLS 10-12 1.2 13 1.0
BOYS 13-15 40 150 0.2-1.0 1.6 16 1.6 1.4
GIRLS 13-15 1.4 14 600 4800 1.2
BOYS 16-17 40 200 0.2-1.0 1.8 17 1.6 1.5
GIRLS 16-17 1.2 14 1.0

VITAMIN D
• The enamel is the most mineralized substance in the body. It is made of calcium and
phosphorus. Vitamin D plays an important role in absorption of calcium and
phosphorus from the food that is consumed.
• Absorption of calcium and phosphorus helps improve the strength of the teeth and
bones surrounding it.
• Also, receptors for vitamin D are found in cells of the immune system which binds to
vitamin D and increases the production of antimicrobial protein which helps to fight
against the bacteria that cause dental caries.
• The cells forming enamel and dentin, ameloblast and odontoblast respectively, has
vitamin D receptors which help to reduce the risk of dental caries:Preetha
Parthasarathy,2016
• The analysis of data from controlled clinical trials suggested that vitaminD was a
promising caries-preventive agent, which lead to a low-certainty conclusion that
vitamin D may reduce the incidence of caries. PP Hujoel.,2013
Preetha Parthasarathy et al /J. Pharm. Sci. & Res. Vol. 8(6),
2016, 459-460

VITAMIN C
• PAPPE E:a contribution to the prophylaxis of caries, to increase the intake of vitamin
C [ascorbic acid] by the mother in pregnancy and continuously by the child after
birth.
• IN GUINEA PIG,ODONTOBLAST ATROPHY AND IRREGULAR DENTIN
FORMATION,THUS MORE SUSCEPTIBILTY TO CARIES
PAPPE, E. "Vitamin C and dental caries." Zeitschrift fur
Vitaminforschung 15 (1944): 367-387.

VITAMIN A
• VITAMINS A, HAS BEEN ASSOCIATED WITH ENAMEL HYPOPLASIA AND RELATED
INCREASES IN THE SUSCEPTIBILITY OF THE TOOTH TO CARIES LESIONS
• DISTURBANCE WITH DIFFERENTIATION AND FUNCTION OF AMELOBLAST,ENAMEL
FORM IS DISTURBED
DCNA 2003

DEFINITION
• giving advice on food selection based on the individual’s reason for liking or not
liking certain foods.
• Counseling requires obtaining information as to why, when, where, what specific
food are eaten ,how frequently and what feelings are experienced.

OBJECTIVES OF COUNSELING
• The main objective of dietary counseling in pediatric oral health is caries
prevention.
• Diet Counselling aims to help parents change their and their children’s dietary
behaviours so that they choose diets with low or noncariogenic snacks, limit sweet
foods to mealtimes and perform tooth brushing after sugar exposures.
Diet Counselling – A Primordial Level of Prevention of
Dental Caries. Dr. Girish V Chour , Dr. Rashmi G Chour,
Journal of Dental and Medical Sciences, Volume 13, Issue
1 Ver. II (Jan. 2014), PP 64-70

• 1. Correction of diet imbalance, that could affect the patients general health
and sometimes reflect on his oral health.
• 2. Modification of dietary habits, particularly the ingestion of sucrose
containing foods in forms, amt, and circumstances that cause caries
formation.
• 3. Dietary recommendations must be realistic and always based on current
dietary behaviours of the family .It is pointless to prescribe changes that a
patient cannot or will not implement
• Additionally, modifications to the diet can only be made over time, aided by
repitition and reinforcement.
1 Ver. II (Jan. 2014), PP 64-70

DIET COUNSELLING
• DIRECTIVE OR NON DIRECTIVE
• DIRECTIVE COUNSELLING
• PATIENT IS PASSIVE
• DECISIONS ARE MADE BY THE COUNSELLOR
• NON DIRECTIVE COUNSELLING
• COUNSELLOR MERELY AIDS AND GUIDS THE PATIENT
• FINAL DECISIONS ARE MADE BY THE PATIENT

NUTRITIONAL COUNSELLING TECHNIQUES
• Direct approach – counseling technique that focuses on the
dietary problem :
• Role of the patient – patient provides information on the diet; is
passive and listens to the counselor.
• Role of the counselor – counselor controls the session; analyzes
and evaluates the patient’s diet and makes recommendations for
improvement.
• Advantages – easier for the counselor and often requires less
time than a more patient-oriented approach.
• Limitations – fosters patient dependence; little chance of success
if the patient is not committed to dietary changes.

• Nondirect or behaviour modification approach – counseling technique
that focuses on the patient
• Role of the patient – patient actively participates in the diet analysis,
evaluation, and modification program.
• Role of the counselor – counselor provides information on the etiology of
dental disease, the role of the diet, and the use of dietary assessment tools
• Method –
• Assumption – dietary habits are learned behaviors and can be unicamed and
replaced with new behaviors.
• Collection of baseline data
• Patient takes ownership of the dietary problem and is committed to change.
• Patient determines the behavior changes and goals; develops own reward
to use when goals are met.
• Changes are gradually made in small steps; appropriate changes are rewarded
failures ignored.
• Close monitoring of progress until new behaviors become self-reinforcing.
• Advantages – Fosters patient independence; success is more likely since
the patient is in control of the change process.

FIVE W AND ONE H CRITERIA
• WHO, WHAT, WHY, WHEN, WHERE AND HOW.
• WHO may be benefited?
• WHAT are the objectives of diet and nutrition counseling?
• WHY is counseling beneficial?
• WHEN is counseling conducted?
• WHERE should the counseling occur?
• HOW to counsel?
1 Ver. II (Jan. 2014), PP 64-70

PATIENT SELECTION
• Diet counseling will not succeed with every dental
patient.
• Dental health diet score – gives points earned as a result
of adequate intake of foods from each of the food
groups plus points for ingesting foods specially
recommended

dental health diet score.
• Score of 60-100 is acceptable
• If the score is 56 or less diet counseling is indicated and
recommended.

Instructions for calculating Dental Health Diet Score
Step - I
• To ascertain the average daily intake list everything you eat
and drink on an ordinary weekend including snacks.
Lunch
12:00 Noon 4 oz tomato juice
1 chicken (3 oz) sandwich
1 slice of chocolate cake
1 cup of coffee with 1 tsp sugar
P.M. Snack
2:00 P.M.
3:00 P.M.
1 breath mint
1 piece of sugarless gum.

Food Group Portion Size Considered
One Serving
Number of
Servings
Points
MILK (milk
and cheese)
8 oz (1 c) milk
1½ oz Cheddar cheese
   x 8 = 24
(highest
possible score =
24)
Food Group Recomme
nded
Adult
Servings
Portion
Size
Considere
d One
Serving
Number of
Servings
Points
MEAT 2 2-3 oz lean
cooked
meat, fish,
or poultry
2 eggs
_____ x 12 = 24
(highest
possible score =
24)
NIZEL R,PAPAS
T,NUTRITION IN
CLINICAL
DENTISTRY,THIR
D EDITION

Food Group Recom
mended
Adult
Serving
s
Portion
Size
Considere
d One
Serving
Number of
Servings
Points
FRUITS AND
VEGETABLES
(dark green
and deep
yellow fruits
and vegetables)
1 ½ c cooked
fruit or
vegetable
1 medium
raw fruit or
vegetable
_____ x 6 = ___
(highest
possible score =
6)
BREAD AND
CEREALS
(enriched or
whole grain)
4 1 slice
bread
¾ c dry
cereal
_____ x 6 = ___
(highest
possible score =
24)
TOTAL Score (Highest Possible = 96) NIZEL R,PAPAS T,NUTRITION
IN CLINICAL

Step - II
• Circle the foods in the diary that have been sweetened with
added sugar.
• Classify the uncircled foods into appropriate food groups.

NUTRIENT SCORE:STEP 3
ALL SCORED 7
PROTEIN CHEESE,MILK,MEAT
PROTEIN AND NIACIN CHEEESE,DRIED BEANS,DRIED
PEAS,EGGS,FISH,MEAT,MILK,NUTS,POULTRY
ASCORBIC ACID BROCCOLI,GRAPEFRUIT,GREENS
CALCIUM BROCCOLI,EGGS,MILK
VITAMIN A APRICOTS,BROCCOLI,BUTTER,CANTALOUPE,CARROTS,C
OLLARDS,EGGS,GREENS,LIVER,MARGARINE,MILK,PEACH
ES,SQUASH,SPINACH,SWEET POTATOES
IRON BEEF,BROCCOLI ,EGGS,GREEN LEAFY
VEGETABLES,LIVER,OYSTERS,SARDINES,SHRIMP
FOLIC ACID ASPARAGUS,BROCCOLI,CEREALS,KIDNEYS,LIVER,SPINAC
H,YEASTS
NIZEL R,PAPAS
T,NUTRITION IN
CLINICAL
DENTISTRY,THIR
D EDITION

ALL SCORED 7
RIBOFLAVIN BROCCOLI,CHCKEN
BREATS,EGGS,HAM,LIVER,MILK,MUSHROOMS,O
,OKRA,SPINACH
ASCORBIC ACID BROCCOLI,BRUSSEL
SPROUTS,CANTALOUPE,GRAPEFRUIT,GREEN
PEPERS,GREENS,ORANGES,RASPBERRIES,STRAW
ERRIES,TOMATOES
CALCIUM AND PHOSPHORUS BROCCOLI,CHEESE,EGGS,GREEN LEAFY
VEGETABLES,MILK,ORANGES,STRING BEANS
ZINC BEEF,LIVER,LOBSTER,OYSTER,SHRIMP

Step – IV
Sweets Score
• Classify each sweet into liquid, solid and sticky or slowly
dissolving.
• For each time a sweet was eaten, place a check in the frequency
column.
• In each group add up the number of sweets eaten and multiply
by the number provided.
• Add up all the points for the total score.
NIZEL R,PAPAS T,NUTRITION
IN CLINICAL

FORM FREQUENCY POINTS
LIQUIDS
SOFT DRINKS, FRUIT DRINKS,COCOA,SUGAR
HONEY IN BEVERAGES,NONDAIRY CREAMERS,
ICECREAM, GELATIN, DESSERT,FLAVOURED
YOGURT, PUDDING, CUSTARD, POPSICLES
-------*5=
SOLID AND STICKY
CAKE, CUPCAKES, DONUTS, SWEET ROLLS,
PASTRY, CANNED FRUITS IN SYRUPS, BANANAS,
COOKIES, CHOCOLATE CANDY, CARAMEL,
JELLY BEANS, OTHER CHEWY CANDY, CHEWING
GUM, DRIED FRUIT, MARSHMALLOWS, JELLY,
-------*10=
SLOWLY DISSOLVING
HARD CANDIES, BREATH MINTS, ANTACID
TABLETS, COUGH DROPS
-------*15=

TOTALING THE SCORE
FOOD GROUP SCORE
72-96 EXCELLENT
64-72 ADEQUATE
56-64 BARELY ADEQUATE
56 OR LESS NOT ADEQUATE
SWEET SCORE
5 OR LESS EXCELLENT
10 GOOD
15 OR MORE WATCH OUT ZONE
NIZEL R,PAPAS
T,NUTRITION IN
CLINICAL
DENTISTRY,THIRD
EDITION

GUIDELINES FOR COUNSELLING
• GATHER INFORMATION
• EVALUATE AND INTERPRET INFORMATION
• DEVELOP AND IMPLEMENT A PLAN OF ACTION
• SEEK ACTIVE PARTICIPATION OF THE PATIENT’S FAMILY
• FOLLOW UP TO ASSESS THE PROGRESS MADE

COMMUNICATION TECHNIQUES
• Three rules for achieving effective communication
1. Keep eye-to-eye contact in the patient.
2. Communication can be verbal or non-verbal. Interviewers non-verbal actions are
helpful in helping the patient to change his behavior.
3. Message must be adapted to the patient’s needs and level of understanding.

DIET COUNSELLING
• BEFORE COUNSELLING
(1)EXPLAIN THE PATIENT THE REASON FOR COUNSELING
(2)DENTAL HEALTH DIET SCORE
(3)FOOD INTAKE – DIET DIARY
• THE COUNSELING VISIT
4) REASONS FOR DIET
5) EDUCATION ABOUT THE ROLE OF DIET IN DEVELOPMENT AND PREVENTION
OF DENTAL CARIES
6) CARIOGENIC POTENTIAL OF DIET
7) ADEQUACY OF DIET LISTED IN FOOD DIARY

8) DIAGNOSIS OF PROBLEM
9) DIET PRESCRIPTION
10) COMPARE OLD AND NEW DIET
11) SUMMARY
12) FOLLOW- UP

MOTIVATING PATIENTS TO MODIFY
FOOD HABITS
• A person passes through four preliminary decision stages in
changing a dietary pattern –
e.g.
• If giving up a hard candy to prevent dental decay is used as an
example, the stages can be illustrated as :-
1. Awareness – Hard candies produce acid, which can cause my
teeth to decay.
2. Interest – May be I should give up the hard candies.
3. Involvement – I definitely will give up hard candy.
4. Action – I have given up hard candies.
5. Habit – I haven’t had a hard candy in six months.

Motivation
A study was conducted to compare the effect of a motivational
interviewing counseling treatment with that of traditional health
education on parents at high risk of developing dental caries. Parents
of 240 infants aged 6-18 months were randomly assigned either a
motivational interview (MI) or traditional health education. The results
showed that the children in MI group had 0.71 new carious lesion while
control group had 1.91 lesion and thus motivational intervening was
concluded as a promising approach
(Weinstein P, Harrison R et al. Motivating patients to prevent caries in their
young children. JADA vol 135, June 2004.)

ASSESSMENT OF DIETARY HABITS
• Food Balance Sheet
• Weighing Method and Duplicate – Portion
Technique
• Interview Methods
• Questionnaires Jee-Seon Shim Kyungwon Oh and Hyeon Chang Kim
Dietary assessment methods in epidemiologic
studiesEpidemiol Health 2014; 36

WEIGHING METHOD AND
DUPLICATE – PORTION TECHNIQUE
• Most accurate data on food consumption are
obtained by weighing.
• A special form of this method is the double
portion method.
• Portions similar to those consumed are collected by the subjects
and then analyzed by the investigator.
• Advantages.
• Amounts consumed can be recorded and analyzed more
accurately, then by any other method.
Jee-Seon Shim Kyungwon Oh and Hyeon Chang Kim

• Disadvantages :
• Size of sample is limited.
• Potential risk that the person involved do not
consume and buy all types of foods e.g. sweets
that they normally do.
• Highly trained personnels are needed for
supervision.

INTERVIEW METHOD
• It is a new technique for collecting food
consumption data.
• There are two variations of the interview method
i.e. diet recall and diet history.
• In diet recall, food consumed by subject under
survey during 1 or 2 days is recalled by
interviewing.

TWENTY-FOUR HOUR DIETARY RECALL
• Interviewer collects data from the patient on all food consumed over a 24-hour period.
• Advantages
(1) Requires 20 minutes for the interview
(2) Allows nutrient analysis
(3) Allows analysis of food group consumption
(4) Allows sugar-intake evaluation
• Limitations
(1) Requires a trained interviewer
(2) Relies on the patient’s memory
(3) Represents only 1 day of food consumption
(4) Requires a nutrient data file on foods to analyze nutrients

THREE TO SEVEN DAY
FOOD RECORD OR DAIRY
• Patient keeps a record of food and eating times for 3 to 7 days
• Advantages
(1) No interviewer required except to give directions on how to fill
out the record
(2) Allows for both nutrient and food-group analysis
(3) Allows for sugar-intake evaluation
(4) An average intake of several days may be more representative
of the patient’s food intake than 1 day
• Limitations
(1) Represents the food consumption of only the days included
in the record.
(2) Relies on the cooperation and ability of the patient to keep
the record.

Comparing a 7-day diary vs. 24 h-recall for estimating fluid
consumption Sonia Hernández-Cordero et al
BMC Public Health201515:1031:7 DAY DIARY TO BE
MORE CORRECT REPRODUCTION OF DIET THAN 24 HR
RECALL

Food Group Portion size
considered one
serving
1st day 2nd day 3rd day 4th day 5th day Average
MILK (milk &
cheese)
8 oz (1 cup) milk
1½ c cottage
cheese
| || ||| | || 2
MEAT (meat,
fish, poultry,
nuts, dry beans)
2-3 oz lean
cooked meat,
fish or poultry
|| | 0 || | 1+
FRUITS and
VEGETABLES
(including citrus
fruits, dark
and deep yellow
vegetables)
½ c cooked
1 medium raw
|| | ||| ||||| 0 2
BREAD and
CEREALS
(Enriched Or
Whole Grain)
1 slice bread
¾ c dry cereal
½ c cooked
cereal, rice,
noodles,
macaroni
||||| ||||||| |||| |||||| ||| 4
FOOD DIARY

QUESTIONNAIRES
• It is identical with dietary history with the difference that no
interviewer is needed.
• Questionnaires and relevant informations are given to the
respondents, who fill in and written them.

METHODS FOR COLLECTING DATA ON
FOOD INTAKES
• Nutritional screening questionnaire
• Description – patient indicates frequency of sugar and food-
group intake over a day or week.
• Advantages
• Can be filled out by the patient while waiting in the oral healthcare setting
• Requires 15 to 20 minutes to complete
• Allow analysis of food-group consumption
• Allows sugar-intake evaluation
• Limitations
• No nutrient analysis
• Relies on the patient’s memory

NUTRITIONAL SCREENING
QUESTIONNAIRE
Name___________________
• How many meals do you have a day? ________________
About what times are these eaten? __________________
• Would you consider your appetite to be
Good ___________________
Fair __________________
Poor __________________
• How often do you eat between meals?
Never ___________________
Occasionally ______________
Often _____________________
What foods do you usually eat between meals? ____________________
_____________________________________________________________

• How often do you drink soft drinks, fruit drinks, or any other sweetened beverages?
Never ___________________
Often _____________________ (time / day)
When do you drink these beverages?
With meals ________________
Between meals ______________
At both / either time(s) _____________
• How often do you drink coffee and / or tea ?
Never ___________________
Often _____________________ (cups/day)
How do you drink your coffee/tea? With :
Milk/ cream __________________
Sweetener ________________
(Specify the kind)

• How often do you use gum and/or mints? ?
Never ___________________
Often _____________________
What brand do you use?
• How often do you use cough drops, throat lozenges, and/or antacid tablets? (Please circle which ones)
Never ___________________
Often _____________________
• How often do you take vitamin or mineral supplements??
Never ___________________
Often _____________________
What is your supplement? ___________________
(Specify the type of vitamins or minerals)

• Are you presently on any special or restricted diet? Yes____ No ____
If so, what kind? _________________________________________
Never Times/day Times/week
10 a How often do you eat/drink milk, cheese, yoghurt,
or other dairy foods?
________ ________ ________
b How often do you eat whole-grain or enriched
breads, cereals, or pasta?
________ ________ ________
c How often do you eat cooked or raw vegetables? ________ ________ ________
d How often do you eat/drink citrus fruit or juice
(orange, grapefruit, tomato)?
________ ________ ________
e How often do you eat one of the following carrots,
pumpkin, sweet potatoes, greens, broccoli,
spinach (or other dark yellow or green vegetable or
fruit)?
________ ________ ________
f How often do you eat meat, fish, poultry or eggs? ________ ________ ________
g How often do you eat peanut butter, nuts, dried
peas or beans, or soybean products?
________ ________ ________
h How often do you eat your meals in restaurants or
fast-food places?
________ ________ ________

SUGAR CLOCK-JHONSON AND
BIRKHED:1991
Advanced Dental Nursing, Robert Ireland,2 ND EDITION

SUGAR CLOCK
Advanced Dental Nursing, Robert Ireland,2 ND EDITION

ELICITS FROM DIET HISTORY
• HOW MANY TIMES A DAY DOES THE CHILD EAT?
• IS THERE DIVERSED SELECTION OF FOODS?ARE MEALS WELL
BALANCED?
• ARE RECOMMENDATIONS REGARDING THE FOUR BASIC FOOD
GROUPS BEING SATISFIED?
• WHAT IF FREQUENCY OF SNAKCING?
• ARE FOODSS HIGH IN (REFINED) CARBOHYDRATES CONSUMED
FREQUENTLY?ARE THEY CONSUMED DURING ,AFTER ,OR BETWEEN
MEALS?
• ARE SNACK FOOD F THE KIND THAT DISSOLVE SLOWLY OR THAT
ADHERE TO THE TEETH?
P CASAMASSIMO,H FIELDS,D MCTIGUE,A
NOWAK,PEDIATRIC DENTISTRY,INFANCY THROUGH
ADOLESCENCE,5 th edition

DIET PRESCRIPTION TO AID IN
DENTAL CARIES PREVENTION
AND CONTROL
I. Evaluation of your diet suggests that
a) The QUALITY of your diet can be improved by including :
• More milk
• More fresh fruit
b) The BALANCE of your meals can be improved by including :
• Fruit juice at breakfast
• Milk at lunch
• Salad at dinner
NIZEL R,PAPAS T,NUTRITION IN
CLINICAL DENTISTRY,THIRD
EDITION

II. Dental plaque and the decay-producing potential of your diet can
be decreased by
a) Eliminating these sugar-containing items :
• Hard candies and cough drops
• Chocolates and pastries
b) Substituting the following non-plaque-promoting items :
• Toasted bread and butter
• Nuts, cheese curls, apples, oranges.

III. Eating pattern that improves quality of your diet :
a) Breakfast
• One glass of orange juice
• One bowl of cold cereal and fresh fruit.
b) Lunch
• Half grape fruit
• One serving cottage cheese
• One apple

Dinner
• Fresh fruit cup
• Salad
• One piece of bread
• Two lamb chops
Frequency of eating between meals should be minimized and limited to :
• Nuts
• Crackers and cheese
• Milk
• Fresh fruits

THE INDAN PLATE
• Most food plans include three to four carbohydrate choices (45–60 carbohydrate
grams) at each meal and one to two choices (15–30 carbohydrate grams) at each
snack.
• Breakfast (4 choices)
• 1 egg 2 toast or roti (small)
• 1 teaspoon butter
• 1 ⁄2 cup juice
• 1 cup tea with milk
• Snack (2 choices)
• 4 crackers or 1 cookie,
• 3” (7.5 cm) 1 cup tea with milk
INDIAN FOODS:IDC,2010

• Lunch (4 choices)
• 2 chapatis (small)
• 1 cup dhal
• 1 ⁄2 cup yogurt, plain
• 1 cup curried cauliflower
• Dinner (4 choices)
• 11 ⁄3 cups basmati rice 4 ounces
• (120 grams) curried chicken
• 3 ⁄4 cup cucumber, tomato, y
• Yogurt salad (raita)
• 1 cup curried eggplant
INDIAN FOODS:IDC,2010

THE IDEAL SNACK
• PHYSICAL FORM SHOULD STIMULATE SALIVATION
• SHOULD PRODUCE A MINIMAL AMOUNT OF INTRAORAL RETENTION
• CHEMICAL COMPOSITION: SHOULD INCLUDE A RELATIVELY
HIGH PROTEIN AND LOW FAT CONTENT,
• MINIMAL FERMENTABLE CARBOHYDRATES,
• A MODERATE MINERAL CONTENT)PARTICULARLY CALCIUM,PHOSPHATE AND
FLUORIDE)
• AN INHERENT pH ABOVE 5.5 ,SO AS NOT TO INCREASE ORAL ACIDITY, LARGE
INHERENT ACID BUFFER CAPACITY DURING MASTICATION
• LOW SODIUM CONTENT

STUDY
• MORGAN AND LEVIELLE:SURVEYED SNACKING PATTERN OF 200 US
CHILDREN:45.8% SNACKED.EACH CHILD CONSUMED 1.37 SNACKS PER DAY.
• ADDITIONAL NUTRIENTS NEED TO BE PROVIDED
PRACTICE,1982

I. Acceptable Snacks
From the Four Food Groups
Milk Group : Milk, cheese – hard or soft varieties
Meat Group : Turkey, chicken, nuts of all kinds, sunflower
seeds
Fruit & vegetable Group : Raw fruits like oranges, grapes, grapefruit,
peaches, pears
raw vegetables like carrots, celery, cucumbers,
lettuce, salad greens and tomatoes
Unsweetened fruit juices, tomato or vegetable
juices
Bread & Cereal Group : toast, pretzels
II. Snacks to avoid
Candy, mints cake, cookies pie, pastry, ice cream sundaes, caramel
candy apples, candy-coated gum.

MEAL AT SCHOOL
• Regarding meals at schools,the parent must work with school authorities to provide
wholesome and nutritious meals that also have eye appeal for the child
• Parents should work with specific teachers to encourage use of appropriate snacks
and party food for special occasion
P CASAMASSIMO,H FIELDS,D MCTIGUE,A NOWAK,PEDIATRIC
DENTISTRY,INFANCY THROUGH ADOLESCENCE,5 th edition

FOR CHILDREN AFTER AGE 6
MONTHS TILL 5 YEARS
• Breast-milk alone is not enough for infants after 6 months of age.
• Complementary foods should be given after 6 months of age, in addition to breast-
feeding.
• Do not delay complementary feeding. Feed low-cost home-made complementary
foods.
• Feed complementary food on demand 3-4 times a day. Provide fruits and well
cooked vegetables.
• Observe hygienic practices while preparing and feeding the complementary food.
MANUAL OF DIETARY GUIDELINES FOR INIDANS:NATIONAL INSTITUTE FOR NUTRITION

FOOD FOR CHILDREN ABOVE 5
YEARS AND ADOLESCENCE
• Take extra care in feeding a young child and include soft cooked vegetables and
seasonal fruits.
• Give plenty of milk and milk products to children and adolescents. Promote physical
activity and appropriate lifestyle practices
• Discourage overeating as well as indiscriminate dieting.
• recommended dietary allowances for calcium are about 600-800 mg/day
• below the age of 5 years should be given less bulky foods, rich in energy and
protein such as legumes, pulses, nuts, edible oil/ghee, sugar, milk and eggs.
• Vegetables including green leafy vegetables and locally available seasonal fruits
should be part of their daily menu.

DIETARY SUBSTITUTES FOR INDIAN
CHILDREN

GENERAL PRINCIPLES FOR CARIES
CONTROL AND PREVENTION
• LIMIT THE NUMBER OF EATING PERIOD TO THREE REGULAR MEALS PER
DAY,STRESSING THE NEED TO AVOID BETWEEN MEAL SNACKS.
• INCERASE THE INTAKE OF PROTECTIVE FOODS SUCH AS VEGETABLES,FRUITS,MILK
AND CHEESE,MEAT FISH AND LEGUMES WHICH ARE RICH IN MINERALS,VITAMINS
AND PROTEINS.
• DECREASE THE TOTAL AMOUNT OF CARBOHYDRATES SO THAT THEY PROVIDE NO
MORE THAN 50 % AND NO LESS THAN 30% OF CALORIES.
• IDEALLY,IT IS BEST TO WEAN THE PATIENT FROM THE TASTE OF SWEETS.RESTRICT
THE CONSUMPTION OF SUGAR CONTAINING FOODS TO MEALS.COMPLETE
ELIMINATION OF STICKY,CONCENTRATED SWEETS ESPECIALLY BETWEEN MEALS.

• MINIMIZE SUGAR INTAKE IF ELIMINATION IS NOT FEASIBLE.
• LIBERAL USE OF TOOTH CLEANSING FOODS SUCH AS RAW FRUITS AND RAW
VAGETABLES SO THAT THERE WILL BE SOME CLEARANCE OF FOOD DEBRIS AND
STIMUALTION OF SALIVARY FLOW.
• RECOMMEND DRINKING AND COOKING WITHH FLUORIDATED WATER OR
INGESTION OF FLUORIDE SUPPLEMENTS IF PATIENT LIVES IN A NON
FLUORIDATED AREA FROM BIRTH TO 13 YEARS OF AGE.
• RECOMMEND USE OF FLUORIDE DENTRIFICE AND MOUTH RINSE.

MY PYRAMID AND MY PLATE
DEAN J,AVERY D,MCDONALD R, MC DONALDS AND
AVERY ‘S DENTISTRY FOR THE CHILD AND
ADOLESCENT,10 TH EDITION

CONCLUSIONS
• THUS A BALANCED DIET IS VERY MUCH NECESSARY FOR CONTROL OF
DENTAL CARIES.

REFERENCES
• STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC
FOUNDATIONS AND CLINICAL PRACTICE,1982
• DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE
CHILD AND ADOLESCENT,10 TH EDITION
• NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION
• P CASAMASSIMO,H FIELDS,D MCTIGUE,A NOWAK,PEDIATRIC DENTISTRY,INFANCY
THROUGH ADOLESCENCE,5 th edition

REFERENCES
• Prabhakar, A. R., Kurthukoti, A. J., and Gupta, P. (2010). Cariogenicity and
acidogenicity of 20 human milk, plain and sweetened bovine milk: an in vitro study.
J. Clin. Pediatr. Dent. 34, 239- 248
• Southgate, D. A. T. (2000). Milk and milk products, fats and oils. In: Human nutrition
and dietetics. (ed. JS Garrow, WPT James, A Ralph). Churchill Livingstone, Edinburgh,
pp 375-383.
• Tanaka, K., Miyake, Y., and Sasaki, S. (2010). Intake of dairy products and the
prevalence of dental caries in young children. J. Dent. 38, 579-583.
• Rugg-Gunn, A. J. (1993). Nutrition and Dental Health. Oxford University Press,
Oxford.

REFERENCES
• Lingstrom, P., Johanes Van Houte, and Y. Shelby Kashket. "Food starches and dental
caries." Critical Reviews in Oral Biology & Medicine 11.3 (2000): 366-380.
• Policy on Dietary Recommendations for Infants, Children, and Adolescents,REFERENCE MANUAL
V 37 / NO 6 15 / 16,
• Milgrom P, Ly KA, Tut OK, et al. Xylitol pediatric topical oral syrup to prevent dental caries: a
double blind, randomized clinical trial of efficacy. Archives of pediatrics & adolescent medicine.
2009;163(7):601-607.
• Mäkinen KK, Bennett CA, Hujoel PP, Isokangas PJ, Isotupa KP, Pape HRJr, Mäkinen PL,J Dent
Res. 1995 Dec;74(12):1904-13.Xylitol chewing gums and caries rates: a 40-month cohort study.
• Lenkkeri AM, Pienihäkkinen K, Hurme S, Alanen P. The caries-preventive effect of xylitol/maltitol
and erythritol/maltitol lozenges: results of a double-blinded, cluster-randomized clinical trial in an
area of natural fluoridation.Int J Paediatr Dent. 2012 May;22(3):180-90.
• Leme AFP, Koo H, Bellato CM, Bedi G, Cury JA. The Role of Sucrose in Cariogenic Dental Biofilm
Formation—New Insight. Journal of dental research. 2006;85(10):878-887.

REFERENCES
PP Hujoel.Vitamin D and dental caries in controlled clinical trials: systematic review
and meta-analysisNutrition Reviews 2013; 71(2): 88-97.
PAPPE, E. "Vitamin C and dental caries." Zeitschrift fur Vitaminforschung 15 (1944):
367-387.
Diet Counselling – A Primordial Level of Prevention of Dental Caries. Dr. Girish V
Chour , Dr. Rashmi G Chour, Journal of Dental and Medical Sciences, Volume 13, Issue
1 Ver. II (Jan. 2014), PP 64-70
Weinstein P, Harrison R et al. Motivating patients to prevent caries in their young
children. JADA vol 135, June 2004.)
Sonia Hernández-Cordero Comparing a 7-day diary vs. 24 h-recall for estimating fluid
consumption BMC Public Health201515:1031:7

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