This seminar includes a brief introduction to Diet and Dental caries along with Role of carbohydrates,Proteins and Fats with Dental caries along with diet charts, diet modifications, Diet counselling,Food log and sugar substitutes

1. Karishma.S
II MDS
DIET and DENTAL CARIES – Role of
Carbohydrates, Proteins, Fats, Vitamins,
Minerals, Diet charts, Diet counselling

2. CONTENTS
• Introduction
• Relationship between Diet and Dental caries
• Epidemiological studies
• Role of carbohydrates in Dental caries
• Protein and Dental caries
• Fats and Dental caries
• Diet counseling
• Nutritional management
• Conclusion
• References

3. INTRODUCTION:
FOOD: Anything that is eaten, drunk or absorbed for maintenance of life, growth &
repair of the tissues (Nizel 1989)
DIET: It is the total intake of substance that furnish nourishment & or calories to the
body (P.M Randelph 1981)
• Total oral intake of a substance that provides nourishment and energy – (Dr.Nizel)
BALANCED DIET:
Is a diet which contains varieties of food in such quantities &
proportions that the need for energy, amino acids, vitamins,
fats, carbohydrates & other nutrients is adequately met for
maintaining health, vitality, and general well being & also
makes provision for short duration of leanness (Chauliac 1984)

4. • One which supplies all the nutrients in the right quantity and
proportion.
• Requirement of an adult sedentary male: 2400 kcal,i.e 1 unit of energy.
Percentage in diet
» Carbohydrates 55-60%
» Proteins 10-15%
» Fats 30-35%
Special considerations in balanced diet
• Supplementation during pregnancy : 300 kilocalories extra
• During lactation: 600 kilocalories extra

5. RELATIONSHIP BETWEEN DIET AND DENTAL CARIES
KEYES TRIAD
NEWBRUN

6. Epidemiological studies
Epidemiological
studies
Interventional
studies
Hopewood study
Vipeholm study
Turku sugar study
Animal studies
Non
interventional
studies
Cross sectional
Observational
Wartime

7. Hopewood house study
• Sullivan and Harris 1958
• 80 children
• Age-3-14 yrs
• No tea
• Absence of white/brown sugar
• Fluoride content insignificant
• Basic vegetarian diet
• Vitamin supplements

8. • At the end of a 10-year period, the 13-year-old children of Hopewood
House had a mean DMF per child of 1.6; the corresponding figure for
the general child population of the State of NSW was 10.7.
• Only 0.4 percent of the 13-year-old state school children were free
from dental caries, whereas 53 percent of the Hopewood children
experienced no caries.
• The children’s oral hygiene was poor, dental calculus was uncommon,
but gingivitis was prevalent in about 75 percent of the children.
• This work shows that in institutionalized children, at least, dental
caries can be reduced to insignificant levels by a spartan diet, and
without the beneficial influence of fluoride and in the presence of
unfavorable oral hygiene.

9. Vipeholm study
• Gustafsson et al.1954
• Sweden
• 5years
• Puropse:
1. Does an increase in the carbohydrates intake
cause increase in dental caries
2. to determine the effects of frequency and
quantity of sugar intake on the formation of
caries.

10. • 436 patients
• 1 control and 6 experimental group
• Control group
• Sucrose group: 300 gm of sucrose given in solution
• Bread group: 345 gm of sweet bread
• Caramel group: 22 sticky candies in 2 portion at meals or in 4
portion between meals
• 8 toffee group: 8 toffee in 2 portion at meals or in 4 portion
between meals
• 24 toffee group: allowed to eat 24 toffess at pleasure throughout
the day
• Chocolate group: milk chocolates in 4 portions between meals.

11. Conclusion : physical form of carbohydrate ( stickiness, oral clearance
time, frequency of intake) are much more important in
carcinogenicity than the total amount .

12. Increase in caries activity due to..
» Increased carbohydrate intake
» sugars retained on the surfaces of teeth
» Consumed between the meals
» Varies between the individual
» Withdrawal of sugar – caries activity rapidly disappears
» Prolonged retention of high concentration sugar in solution
» Clearance time of the sugar

13. Turku sugar study
• Finland
• Scheinin and Makenin 1975
• Compare cariogenicity of sucrose,fructose and xylitol
• 125 subjects wer divided into 3 groups
• An avg age 27.6
• Caries reduction -after 2 years of xylitiol
consumption: acceptable metabolite

14. • The results after 1 year showed that sucrose and fructose had equal
cariogenicity whereas xylitol produced almost no caries.
• But the second year, caries had continued to increase in the sucrose
group but remained unchanged in the fructose group implying that
sucrose was more cariogenic than fructose.
• But the important finding was that in the xylitol group some early
white spot lesions had been remineralized to a point where they could
not be scored.
• These results provided sufficient evidence to link cariogenicity of
carbohydrates, especially sucrose.

15. Seventh day adventist study
• Seventh Day Adventist dietary counsels advise limitation of use of sugar, sticky
desserts, highly refined starches, and between- meal snacking
• Adventist children tends to be lower than that in non- Adventist children in same
geographic location and socioeconomic stratum.

16. Non interventional studies
 Northumberland UK
• 2.5 yrs
• Corelation between diet and dental caries
increment
• Low mean caries increment seen in high starch
low sugars group
 The effect of sugar intake and frequency of ingestion
on dental caries in a 3 year longitudinal study
Burt et al 1988: J Dent Res
 Gisle Bang 1972, Eskimos studies
NEWBRUN, E. (1989). Frequent
sugar intake ? then and now:
interpretation of the main
results. European Journal of Oral
Sciences, 97(2), 103–109

17. Wartime studies
• Scandinavian countries – Toverud 1957
• Japan- Takeuchi
• Norway- G Toverd 1949

18. ANIMAL STUDIES AND INDUSTRIAL RISKS

19. Hereditary fructose intolerance
• Reduced level of hepatic fructose – 1 – phosphate aldolase
• Complete dietary exclusion of sucrose and fructose
• Nausea, vomiting, malaise, tremor, excessive sweating and coma
due to fructosemia.
• Glucose, galactose and lactose containg foods
• Strickingly low dental caries compared to general population –
Marthaler 1967
• 50% caries free and if present only restricted to pits and fissures
Marthaler TM, Froesch ER. Hereditary fructose intolerance. Dental status of eight patients. Br
Dent J. 1967;123(12):597-599.

20. COMPONENTS OF DIET
MAJOR NUTRIENTS:
• Carbohydrates
• Proteins
• Fats/lipids
MICRO NUTRIENTS:
• Vitamins
• Minerals

21. Role of carbohydrates in dental caries

22. Types of sugar
_ Raw sugar , Turbinado sugar ,White granulated
refined sugar, Corn syrup , Honey.
Sugar manufacture’s : 1. Blended sugar.
2. Pure invert sugar.
3. Common invert sugar.
Uses of sugars : - Sweetening agent
- Flavor blender and modifier
- Texture and bodying agent
- Dispersing/ lubricating agent.

23. Classifications of Sugars

24.  Starches, Sucrose, Maltose, Lactose, Fructose, Glucose.
 Sucrose – ‘Arch Criminal’.
St. Mutans - Synthesize dextrans /glucans and levans.
 Dextrans – insoluble ,serve as structural Components of
the plaque matrix.
 Levans – soluble, serve as transient reserves of
fermentable carbohydrates.
The extracellular polysaccharide produced by bacteria
utilizing sucrose, functions in a dual role
• As a structural matrix of dental plaque
• As a reservoir of substrate for the plaque

25. Some hypotheses have been suggested to explain how
sucrose changes the inorganic concentrations in
biofilms:
(1) Constant low-pH values attained in the biofilm matrix,
due to persistent sucrose fermentation, would dissolve
mineral reservoirs or obviate their storage;
(2) Enamel could take up these ions from dental biofilm
fluid;
(3) The low pH values caused by sucrose fermentation in
biofilms would release the reservoir of ions bound to
bacterial cell walls;
(4) Low bacterial density due to high insoluble EPS content
could result in fewer binding sites for these ions; and
(5) Low concentrations of specific ion-binding proteins could
result in fewer mineral reservoirs in biofilms formed in
the presence of sucrose.
Paes Leme, A F et al. “The role of sucrose in cariogenic dental biofilm formation--new
insight.” Journal of dental research vol. 85,10 (2006): 878-87.

26. FACTORS AFFECTING CARIOGENECITY OF
SUCROSE IN DIET
 Frequency of eating
 Effective concentration of Sucrose
 Oral clearance
Weiss and Trithart 1960, Fanning 1969

27. Dental caries and beverage consumption in young children.
Marshall TA, Pediatr Dent 2003
• The impact of contemporary changes in beverage patterns, specifically
decreased milk intakes and increased 100% juice and soda pop intakes, on
dental caries in young children for 5years on 642 children.
• Results of the study suggested that contemporary changes in beverage
patterns, particularly the increase in soda pop consumption, have the potential
to increase dental caries rates in children.
• Consumption of regular soda pop, regular powdered
beverages, and, to a lesser extent, 100% juice was associated
with increased caries risk.
• Milk had a neutral association with caries.

28. Sugars and Dental Caries: Evidence for Setting a Recommended Threshold
for Intake Paula Moynihan
Advances in Nutrition, Volume 7, Issue 1, January 2016, Pages 149–156, Published:07 January 2016
Dental caries affects ≤80% of the world's population with almost a quarter of US adults having untreated caries.
Dental caries is costly to health care and negatively affects well-being. Dietary free sugars are the most important
risk factor for dental caries. The WHO has issued guidelines that recommend intake of free sugars should provide
≤10% of energy intake and suggest further reductions to <5% of energy to protect dental health throughout life.
These recommendations were informed by a systematic review of the evidence pertaining to amount of sugars and
dental caries risk, which showed evidence of moderate quality from cohort studies that limiting free sugars to ≤10%
of energy reduced, but did not eliminate, dental caries. Even low levels of dental caries in children are of concern
because caries is a lifelong progressive and cumulative disease. The systematic review therefore explored if there
were further benefits to dental health if the intake of free sugars was limited to <5% of energy.
Available data were from ecologic studies and, although classified as being of low
quality, showed lower dental caries when free sugar intake was <5% of energy
compared with when it was >5% but ≤10% of energy. The WHO
recommendations are intended for use by policy makers as a benchmark when
assessing intake of sugars by populations and as a driving force for policy change.
Multiple strategies encompassing both upstream and downstream preventive
approaches are now required to translate the recommendations into policy and
practice.

29. STARCHES AND CARIES
 Cannot directly serve as substrate .
 Two varieties of Starch – Cooked Starches and Uncooked
Starches.
 Cooked Starches Ex : Rice , Potatoes and Bread – Less
cariogenic.
 Uncooked Starches – Virtually non cariogenic.
 Untreated Starchy foods – lower caries promoting potential.
 Addition of sugars – Increases cariogenicity.
 Less refined Starchy foods – Protect teeth

30. FIBERS:
• Soluble fibers: Fruits, vegetables, grains, beans, oats
and apples.
• Insoluble fibers: Vegetables, whole grains, wheat
bran and apples.
• Function: - Lower cholesterol
- Sense of satiety
- Reduce constipation
- Stabilizes blood sugar

31. Problems associated with Carbohydrates:
• Lactose intolerance.
• Excessive fiber intake can decrease mineral absorption
and cause cramping.
• Cause dental caries.
• Excess consumption of simple CHO can cause a
temporary elevation in blood triglycerides, which
can increase risk for heart disease.

32. Food and Nutrition Board, Institute of Medicine, National Academies
Recommended Daily Allowance:
Carbohydrates should comprise 55% to 60% of
calorie requirements, with no more than 10%
from simple sugars in toddlers older than 2
years of age. In addition, the recommended
daily grams of dietary fiber should be equal to 5
plus the child's age in years ."

33. The Use and Misuse of Fruit Juice in Pediatrics
American Academy of Pediatrics
• Give juice only to infants who can drink from a cup (approximately 6 months or
older).
• Prolonged exposure of the teeth to the sugars in juice is a major contributing factor
to dental caries.
• The AAP and the American Academy of Pedodontics recommendations state that
juice should be offered to infants in a cup, not a bottle, and that infants not be put
to bed with a bottle in their mouth.
• The practice of allowing children to carry a bottle, cup, or
box of juice around throughout the day leads to excessive
exposure of the teeth to carbohydrate, which promotes
development of dental caries.

34. • Fruit juice should be used as part of a meal or snack. It should not be
sipped throughout the day or used as a means to pacify an unhappy
infant or child. Because infants consume fewer than 1600 kcal/d, 4 to 6
oz of juice per day, representing 1 food serving of fruit, is more than
adequate. Infants can be encouraged to consume whole fruits that are
mashed or pureed.

35. Studies showing relationship between sugars and dental caries

37. pH modulation and salivary sugar clearance of different chocolates in
children : a randomized trial
J Indian Soc Pedod Prev Dent. Jan-Mar 2016;34(1):10-6
Svsg Nirmala 1, Mohammed Akhil Quadar, Sindhuri Veluru
Objectives: To compare the acidogenicity and salivary sugar clearance of 6 different commercially available
chocolates in the Indian market.
Materials and methods: Thirty subjects aged 10-15 years were selected randomly from one of the available
public schools in Nellore city. Six commercially available chocolates in the Indian market were divided into
three groups, unfilled (dark and milk chocolate), filled (wafer and fruit and nuts chocolate), and candy (hard
milk and mango-flavored candy) groups. Plaque pH values and salivary sugar clearance rates are assessed
at baseline, 5, 10, 15, 20, and 30 min after consumption. All the data obtained were statistically evaluated
using independent sample t-test and one-way ANOVA for multiple group comparisons.
Results: Mango-flavored candy had maximum fall in plaque pH and least fall in
plaque pH was recorded with milk chocolate. Fruit and nuts chocolate had a
maximum clearance of salivary sugar and least fall in the salivary sugar clearance
was recorded with dark chocolate. When the plaque pH and salivary sugar
clearance of all the chocolates were assessed, it was seen that the values were
statistically significant at all the time intervals (P < 0.05).
Conclusion: Dark chocolate had a high fall in pH and milk chocolate had low
salivary sugar clearance which signifies that unfilled chocolates are more
cariogenic than other chocolates. Even though mango-flavored candy had
maximum fall in plaque pH, its salivary sugar clearance was high.

38. FOOD INGREDIENT MECHANISM
APPLE CONDENSED TANNINS
ACIDIC NATURE
ANTI-ADHESION OF
BACTERIA
INCREASES SALIVARY
FLOW RATE
CRANBERRY FLAVANOIDS ANTI-ADHESION
DAMAGE TO CELL WALL
GARLIC DIALLYL SULFIDE INHIBIT MICRO-
ORGANISMS
TULSI EUGENOL
URSOLIC ACID
CARVACROL
ANTI-MICROBIAL
ACTION
AJWAIN NAPTHALENE
DERIVATIVE
ANTI-CARIOGENIC
CLOVES EUGENOL ANTI-CARIOGENIC
GINGER GINGER+HONEY MOUTHWASH FOR
DENTAL CARIES
NEEM AZADIRACHTIN ANTI-BACTERIAL
TURMERIC CURCUMIN ANTI-MICROBIAL,
ANTI OXIDANT

39. Assessment of physical properties of foods commonly
consumed by children G Neeraja, Priya Subramaniam, Saranya Kumar(2018)
Aim: The aim is to determine the physical properties of foods that are commonly consumed in India by
children aged 3–6 years and to ascertain the frequency of their consumption.
Materials and Methods: Texture profile analysis of solid foods and viscosity of liquid food samples was
performed. A questionnaire was used to assess the frequency of consumption of these foods.
Results: Among the solid food samples, cheese had the highest hardness (157 ± 20.8 N), chewiness (82 ±
10.4 N), gumminess (82 ± 10.4 N), and adhesiveness (11.2 ± 2.4 Nmm). Noodles had the least hardness,
cohesiveness, gumminess, and chewiness. Among the liquid food samples, peanut butter was the most
viscous (21 Pas) and milk was the least viscous. Milk had the highest pH (6.3) and fruit juice (3.5) had the
lowest pH.
Conclusion: The physical properties and texture of food can be considered to
be a risk factor for evaluating the relationship between food retention and dental
caries. This information can further be used as an educative tool to parents and
caregivers for effective modification of diet.

41. SUGAR SUBSTITUTES
• A sugar substitute is a food additive that duplicates the effect of sugar in taste but
usually has less food energy.
• Therapeutic uses
• To assist in weight loss
• Anticariogenic
• Diabetis mellitus
The search for sugar substitute is for 2 reasons:
1. Indisputable relationship of sucrose consumption to caries
activity
2. 10 fold increase in the incidence of diabetes as well as
atherosclerosis in countries where sugar consumption has
increased .

42. Caloric sweetener(Bulk
sweetener)
• Sorbitol
• Xylitol
• Mannitol
• Maltitol
Low caloric sweetener( Intense sweetener)
• Aspartame
• Saccharin
• Acesulfame –K
• Cyclamate
• Stevia
• Neotame
Other sweeteners derived from plant sources
• Monellin (serendipity berries)
• Licorice ( Ammoniated glycyrrhizen)
• Miraculin ( miracle fruit)
• Dihydrochalcone.

43. SORBITOL ( D- glucitol)
• Sugar alcohol that occurs naturally in many fruits and berries.
• Often used as a “bulk” sweetener in a variety of food substances
such as chewing gum, chocolates, and confectionaries.
• 1gram sorbitol = 4colories
• It is half as sweet as sucrose and is considered noncariogenic but
it may be absorbed from the gastrointestinal tract and can cause
diarrhea if ingested in large quantities (Laxative)
• Only 70% is absorbed
• WHO intake 150mg/kg/day

44. Xylitol
 It was discovered in wood chips in 1890 and in wheat in 1891. It is a
nonfermentable, pleasant tasting, noncariogenic polyol derived from
pentose sugar xylose and is relatively expensive to manufacture.
 Xylitol is as sweet as sucrose and was approved as safe for use in
humans in 1986.
 It is used primarily in chewing gum and possesses approximately the
same sweetness potency as sucrose.
 Recently, xylitol has been credited in
reducing the transmission of cariogenic
bacteria from mother to infant and has
been shown to have bactericidal qualities.

45. Advantages of xylitol as sugar substitute
• Pleasant taste
• Stabilise metabolic situation in diabetics
• Non- cariogenic
• Source: Fruits, Strawberries, Plums, Raspberries, Vegetables,
Lettuce, Cauliflower, Mushrooms
Adverse effects: - Urinary bladder calculi,
- Epithelial hyperplasia,
- Neoplasia of the bladder
- Pelvic nephrocalcinosis

46. • It was discovered in 1965 and is approximately 200 times sweeter
than sucrose.
• Aspartame is the most widely used noncariogenic artificial
sweetener.
• Its primary use is in diet soft drinks, yogurt, puddings, gelatin and
snack foods.
• Aspartame has been shown to have a protective effect against
some mycotoxins and is claimed to be safe for use by type II
diabetics.
• But some of the disadvantages of this are reduced number of sickle
cells in the blood of patients with homogeneous sickle cells
anemia, relative toxic affects on growth, glucose homeostasis, and
liver functions with long-term usage.
ASPARTAME

47. • A non-nutritive produce, approved by the potassium FDA in 1988 for
use as a sweetener in dry food products.
• The use of Acesulfame potassium is approved for use in foods,
beverages, cosmetics and pharmaceutical products in more than 30
countries.
• Although considered safe for consumption by humans there have been
some health issues raised relative to dose-dependent cytogenetic
toxicity.
ACESULFAME- K:

48. • It is 200 to 500 times sweeter than sucrose and is the
oldest of the artificial sweeteners used.
• It is noncariogenic and noncaloric and is available in
liquid and tablet form as a table sweetener but has a
slightly bitter after-taste.
• But in 1970 saccharin was identified as a potential
bladder carcinogen and its use has hence been
limited.
SACCHARIN

49. • It is a non-nutritive, noncaloric, trichlorinated derivative of
sucrose.
• Sucralose is widely used throughout the world in many food
products such as tea and coffee sweetener, carbonated and
noncarbonated beverages, baked goods, chewing gum and
frozen desserts.
• No health concerns have been reported with it.
SUCRALOSE

50. • It is natural occurring, heat stable sweetener, which is extracted
from a member of the chrysanthemum family.
• The active ingredient, stevioside, is a white crystalline material that contains three
glucose molecules and steviol, a diterpenic carboxylic alcohol.
• Its sweetness potency is 100 to 300 times greater than sucrose. Stevia is calorie free,
noncariogenic.
STEVIA
• It is widely used commercially in Brazil
and Japan, and to a lesser extent in
China, Germany.
• In 1995, the FDA approved the
importation and use of Stevia as dietary
supplement, but not as a sweetener.

51. • It is a new product similar in chemical structure to aspartame.
• Neotame is a high intensity sweetener reported to have a clean taste
with no unpleasant characteristics.
• It has sweetness potency 6000 to 9000 greater than sucrose and is
reported to be heat stable in baking applications.
• Neotame is reported to be functional and stable in carbonated soft
drinks, powdered soft drinks, yellow cake, and yogurt.
• Neotame has been submitted to the FDA or consideration as a new
sweetener in several food categories. However, it has not yet been
approved.
NEOTAME

52. Protein and Dental caries
PROTEINS
 “prime importance”, because it mediates most of the actions
of life.
 The body builders
 Function:
• Essential for all body tissues: skin, tendons, bone matrix,
cartilage , and connective tissue.
• Forms hormones, enzymes, antibodies and acts as a chemical
messenger within the body.

53. Major sources:
• Animal sources: Meat, milk, eggs, fish
• Plant sources: Legumes, peas ,beans, grains
RDA: 40g-65g/day
• Quality of protein:
That provides amino acid pattern close to that of tissue protein
Breast milk and egg protein satisfy this criteria.
Egg: called reference protein: provides all essential amino acids.
• Quantity of protein:
Measured as nitrogen in the diet: Nitrogen balance

54. Effect of protein deficiency on jaw and tooth formation, eruption,
and alignment
Pregnancy-protein diet-osseous and dental development-4:271-278,1945.
• Protein deficiency during pregnancy and lactation have shown to lead to
smaller teeth, delayed eruption, reduced salivary volume and greater
susceptibility to caries. (Shaw 1970,Navia 1979).
• Crowded and rotated teeth-inadequate development of jaw bone matrix-
protein deprivation.-1954
• Kwashiorkor-Nigerian children-delayed eruption and hypoplasia
of deciduous teeth-1969
• Third molar –protein deficit offspring-erupt late and altered
cuspal pattern—1969
• Animal study-1956-lysine and tryptophan deficiencies-irregular
pre dentin layer and a number of inter globular spaces in poorly
calcified dentinal matrix

55. Gross protein deficiencies are rare .
 Adding of Casein to diet – significantly less caries susceptibility
 Amount and quality of protein – Important factors.
 Lysine-glucine also prevent dental caries
 No evidence in humans
The Association of Basic Proline-Rich Peptides From Human Parotid Gland Secretions With Caries Experience, M Ayad
1, B C Van Wuyckhuyse, K Minaguchi, R F Raubertas, G S Bedi, R J Billings, W H Bowen, L A Tabak(2000)
• The salivary peptides derived from caries-susceptible subjects
appeared larger than those found in the saliva of caries-free subjects.
• The peptides that were more abundant in saliva obtained from the
caries-free group differed from those isolated from the caries-
susceptible group.
• Precursor protein, IB-7, was found to be higher in saliva collected from
caries-free individuals

56. • Williams et al 1982 – Certain fatty acids , antimicrobial action.
• Deficiency of essential fatty acids in man – rare.
• Oleic and lenolic fatty acids – bactericidal activity.
• Oleic acid – protection against decalcification.
• Cheese – Remineralization and Neutralizes acids.
The mechanisms whereby fats act to reduce dental caries.
 Coating of tooth surface with a oily substance.
 Prevent fermentable sugar to acids.
 May interfere with the growth of cariogenic bacteria.
 Increased dietary fat – Decrease the amount of dietary
fermentable carbohydrate.
FATS AND DENTAL CARIES

57. VITAMINS
• Directors of cell processes
• Calorie free molecules needed by the body in very
small quantities to help with metabolic processes.
• Antioxidants
• Boosting immune system
• Alertness of mind
• Hormone production and synthesis of genetic
material.

59. EFFECT ON TEETH
• Tooth - one of the first tissues to show the evidence of vitamin A
deficiency
• Ameloblasts - derivatives of epithelium
– Proliferation and differentiation of Ameloblasts
– Differentiation of odontoblasts
– Formation of dentin matrix
– Formation of enamel matrix
– Calcification of dentin and enamel
– Salivary glands → definite impairment of salivary secretion
both in terms of quality and quantity
• Effect on Odontoblasts -irregular dentin formation usually
scattered as globules of unusual size
• Effect on Ameloblasts - Enamel Hypoplasia

60. Teeth
• Not as complex in bones
• During tooth development-def-enamel and dentin-hypoplastic
• Calcification of cementum is also retarded
Alveolar bone
– Wide osteoid borders in the trabeculae
– Number and size of trabeculae greatly decreased
EFFECT ON TEETH AND ITS SUPPORTING STRUCTURES DUE TO
VITAMIN – D DEFICIENCY
Mellanby and co-workers(1923-36) studied the effect of
vitamin D supplements and found
• Lower incidence of dental caries
• Lower rate of progression of the existing lesions

61. Minerals
• Regulators of body fluid
• Metals
• Inorganic and non caloric
• Sources: Variety of foods and
water
Major minerals:
calcium, chloride, magnesium,
phosphorus
potassium, sodium
Trace minerals:
chromium, copper, fluoride,
selenium, tin, zinc, sulphur, iodine,
lithium, iron, manganese

62.  Gustafson et al 1963 – Level of calcium in the diet is a
determining factor.
 Phosphate – Locally Cariostatic.
 Local effect P+ is due to :
- Reduce the rate of dissolution
- Buffer organic acids
- Redeposit CaPo4
- Desorb proteins

63. Minerals that may inhibit or promote caries :
 Strongly cariostatic : F , P.
 Mildly cariostatic : Mb , Sr, Ca, Bo, Li , Au , Cu.
 Promoting elements : Se, Mg , Ca , Pb , Si.
 Caries inert : Ba, Al , Ni ,Fe , Pa , Ti.

64. Recommended Dietary Allowance(RDA):
MICRO-NUTRIENTS
» CALCIUM 500-1000mg/day
» PHOSPHORUS 500-1000mg/day
» SODIUM 10-15g/day
» POTASSIUM 2-3mEq/kg/day
» MAGNESIUM 200-300mg/day
TRACE ELEMENTS
» IRON 2mg/kg/day
» IODINE 50-150 μg/day
» COPPER 1-2 mg/day
» ZINC 5-15 mg/day
» COBALT Not known
» CHROMIUM 10 μg/day
» FLOURINE 1-5 mg/day

65. NUTRITIONAL GUIDANCE OF THE CHILD

66. DIET COUNSELING
It deals with providing guidance in the art of food
planning and food preparation and food services. It
assist a person to adjust food consumption to his or
her health needs. (Nizel)

67. WHERE SHOULD THE GUIDANCE TAKE PLACE?
In a consultation room or office.
WHO SHOULD GIVE THE COUNSELING?
The 3 best qualified are:
a. Dentist
b. Dental hygienist
c. Nutritionist

68.  Ideally, all children.
 Imperative – Rampant caries
 A sudden increase in new or recurrent carious lesions
 Development of caries in otherwise immune surfaces
 Extensive loss of tooth substance
 Soft-mushy-ivory colored dentin
WHO SHOULD RECEIVE COUNSELING?

69.  Usually counsel the mother.
 Coloring, drawing or toys to keep child busy
 If time allows – try to educate the child also
 Repetition is key
COUNSELING FOR CHILD UNDER 6 YEARS:

70. COUNSELING FOR ELEMENTARY SCHOOL CHILD:
 Counsel child with mother as observer
 By 9-10 years – should be fully involved
 Should not exceed 45 minutes

71. COUNSELING FOR THE ADOLESCENT:
 Totally responsible for his food choices
 Can be counseled without parents presence

72. DENTAL HEALTH DIET SCORE
It gives points earned as a result of an adequate intake of food from
each group plus points for ingesting foods specially recommended.
STEP 1 – To ascertain daily average intake
STEP 2 - Circle the food which has been sweetened with sugar and
classify the rest into appropriate food groups
STEP 3 – How many of the foods listed contains one
or more of the nutrients essential for dental and oral
health
STEP 4 – List the sweets and sugar-sweetened foods
STEP 5 – Put it all together

73. FOOD GROUP SCORE:
FOOD GROUP RECOMMENDED NUMBER
OF
SERVINGS
POINTS
MILK
(Milk and cheese)
3 
------- X 8 Highest possible - 24
MEAT
(Meat, fish, poultry, dry
beans and nuts)
2

------- X 12
Highest possible – 24
FRUITS AND
VEGETABLES
VITAMIN A
(Greens and yellow
fruit and veg)
1

------- X 6
Highest possible – 6
VITAMIN C
(Juice and citrus fruits) 1

------ X 6
Highest possible - 6
OTHERS
2 ------- X 6 Highest possible - 12
BREAD AND
CEREALS 4

------- X 6 Highest possible - 24

74. NUTRITION EVALUATION CHART
Protein and Niacin Vitamin A Iron Folic Acid
Cheese
Dried beans
Dried peas
Eggs 
Fish
Meat
Milk
Nuts
Poultry
Apricot Margarine
Broccoli Milk
Butter Peaches
Cantaloupe Squash
Carrots 
Sweet potatoes
Collards
Eggs
Greens 
liver
Beef
Broccoli
Eggs 
Green leafy
Vegetables
Liver
Oysters
Sardines
Shrimp
Asparagus
Broccoli
Cereals 
Kidney
Liver
Spinach 
yeasts
Riboflavin
(Vitamin B2)
Ascorbic Acid
(Vitamin C)
Calcium and
Phosphorous
Zinc
Broccoli
Chicken breasts
Eggs 
Ham
Liver
Milk
Mushroom
Pork
Okra
Spinach 
Broccoli
Brussels sprouts
Grapefruit
Cantaloupe
Greens
Green peppers
Oranges
Raspberries
Strawberries
Tomatoes
Broccoli
Cheese
Eggs
Green leafy
Vegetables 
Milk 
Oranges
String beans
Beef
Liver
Lobster
Oysters
Shrimp
(other red meats and
shell fish)

75. FORM FREQUENCY POINTS
LIQUID
Soft drinks, fruit drinks, cocoa, sugar and
honey in beverages, non diary creamers,
ice cream, sherbet, gelatin dessert,
flavored yogurt, pudding, custard

--------- X 5 = 10
SOLID AND STICKY
Cakes, cupcakes, donouts, sweet rolls,
pastry, canned fruits in syrup, banana,
cookies, chocolate candy, caramel, toffee,
chewy candies, chewing gum, dried
fruits, marshmallows, jelly, jam
 
------------ X 10 = 20
SLOWLY DISSOLVING
Hard candies, breath mints, antacid
tablets, cough drops

----------- X 15 = 15
SWEET EVALUATION CHART

76. TOTALING THE SCORES
4 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*

79. 24 hour recall
• This is used to determine the amt: of food and beverages
consumed during a previous 24 hrs.
• It’s a valuable tool for obtaining a skeletal picture of pts
food intake No comments or opinion should be given at
this time, allow the pt to talk freely.
• This is the most rapid method (15-20min)for recording
current food intake.
• Disadv:- it can be over or under estimation of food taken
in a single day and may not represent the usual diet

80. • An advantage of this method is that dietary information is easily
obtained. It is also good during a first encounter with a new patient in
which there is no other nutritional data.
• A disadvantage of this method is that it is very limited and may not
represent an adequate food intake for the patient.
• Patients should be able to recall all that they have consumed in the
last 24 hours
• Data achieved using this method may not represent the long-
term dietary habits of the patient
• Estimating food quantities and food ingredients may be
difficult especially if the patient ate in restaurants.

81. • The most important advantage of this method is that a computer can
objectively analyze data obtained. Data on calorie, fat, protein and
carbohydrate consumption can be obtained.
• Also, since patients are asked to enter data immediately after eating, the
data is more accurate than other methods
Dietary Food Log
• Disadvantages include patient error in entering accurate
food quantities. In addition, it is possible that the week
long food log does not accurately represent a patient’s
normal eating habits since they know the foods they eat
will be analyzed and therefore may eat healthier.

82. COMMUNICATION TECHNIQUES
Basic tool that can create motivation for change.
3 rules for effective communication:
1. Keep eye contact with patient
2. Communication can be both verbal and on verbal
3. Message should be adapted to patient’s needs and level of understanding
• A combination of interviewing, teaching,
counseling and motivation should be used

83. INTERVIEWING
Purpose :
a. To understand the problem
b. Factors that contribute to it
c. Personality of the patient
• It can serve as a valuable diagnostic tool
• Knowledge of daily routine is important
• Practical research contributions

84. • Relax and feel comfortable
• Brief introduction and statement of purpose
• Allow patient to talk freely
• Guide the phrasing of questions, comments and suggestions
• Listen to the patient
• Do not cross examine
HOW TO INTERVIEW THE PATIENT:

85. TEACHING AND LEARNING:
• Teaching aids may be used
• Visual aids
• Blackboard with chalk
• Involve the patient – will result in optimal learning and
adherence to new regimen

86. COUNSELING
Can be directive or non-directive.
GUIDELINES:
A. Gather information
B. Evaluate and interpret the information
C. Develop and implement a plan of action
D. Seek active participation of patients family
E. Follow up to assess progress made

87. PRINCIPLES OF DIET MANAGEMENT: APPLICATION TO CARIES
PREVENTION
4 RULES TO BE ADOPTED:
1. Maintain overall nutritional adequacy
2. Prescribed diet should vary as little as
possible from normal diet
3. Should meet body requirement for
essential nutrients
4. Should accommodate patients likes and
dislikes

88. a. Limit number of eating periods
b. Decrease carbohydrate
c. Increase intake of protective food
d. Wean the patient from consuming sweets
e. Recommend use of tooth cleansing foods
f. Recommend drinking and cooking with fluoridated
water
GENERAL PRINCIPLES APPLIED:

89.  The interviewing and counseling visit – should be devoted exclusively for
counseling.
Arriving at a diagnosis:
• Chief complaint – Asking questions about the chief complaint will give the
counselor a picture of rapidity of caries.
• Personal and Social history – Gives clues into why a patient chooses a
particular food and about his lifestyle
• Medical History – Questions on general health should be asked
Diet history and evaluation –
a. Adequacy of food intake
b. Amount and type of sugar and frequency of eating it

90. NUTRITIONAL MANAGEMENT
Managing cause of improper diet :
 Accepted household dietary practice
 Compensation for psychosocial stress
 Sooth irritation
Each problem – handled in a different way

91. HOW TO ASSIST PATIENT TO SELECT AN ADEQUATE NON-
CARIOGENIC DIET
STEP 1 – Commend the patient
STEP 2 – Allow patient to suggest improvements and write his/her
own diet prescription
STEP 3 – Allow the patient to delete from the diet sugar sweetened
foods.
• Re-examine the sweet intake chart
• No compromise in deletion of sweets that tend to
be retained

92. STEP 4 – Allow patient to select snack substitutes
STEP 5 – Diet Prescription – improve quality and not
quantity of food
STEP 6 – Compare old diet and new
STEP 7 – Reinforcement by follow-up and Re-evaluation

93. Good Snacks: (Mathewson)
Peanuts Apples
Walnuts Banana
Popcorn Orange
Celery Plum
Radish Cantaloupe
Cucumber Watermelon
Cheese Eggs
Meat slices

94. • It is an incentive for action.
• The counselor’s positive attitude and conviction as to
the necessity and effectiveness of nutrition counseling can
stimulate the patient to initiate an improved dietary
pattern.
• A person passes through five preliminary decision
stages in changing a dietary pattern-awareness, interest,
involvement, action and forming a new habit.
Motivation

95. • Awareness is recognition that a problem exists, but without an inclination to
solve it, e.g. Hard candies produce acid, which can cause my teeth to decay.
• Interest is greater degree of awareness but still with no inclination to act,
e.g. May be I should give up the hard candies; I do not want any more
sensitive or painful
teeth.
• Involvement is a definite intention to act, e.g. Idefinitely will give up hard
candy.
• Action is a trial performance, e.g. I have given up hard
candies and chew sugarless gum instead to prevent
the dry feeling in my mouth.
• Habit is a commitment to perform this action
regularly over a sustained period of time, e.g. I have
not consumed a hard candy in six months.

96. The pedodontist is in a unique position to promote good
nutrition in his patients and their families as he is treating
a disease to which diet contributes dramatically to both
etiology and treatment.
CONCLUSION

97. REFERENCES:
Nikiforuk, Understanding Dental Caries. 1stEdition.
Essentials of preventive and community dentistry, 2nd edition, Soben peter.
Dentistry for the child and adolescent-Eight edition-McDonald.Avery.Dean
Textbook of biochemistry- Vasudevan
Textbook of pediatric dentistry, 3rd edition, Nikhil Marwah
Association of Diet and Dental Caries in preschool children, Norman Tinanoff, DDS, MS
Paes Leme, A F et al. “The role of sucrose in cariogenic dental biofilm formation—
new insight.” Journal of dental research vol. 85,10 (2006): 878-87.

98. THANK YOU