Relationship between the type of food, frequency of intake and various cariogenic and non-cariogenic factors which influence initiation and progression of caries have been studied over the years.

1. DIETANDDENTALCARIES
–HUMANSTUDIES
R.K.HARITHA

2. CONTENTS
Introduction Classification
Vipeholm
study
Hopewood
house study
Turku sugar
study
Tristan da
Cunha study
Hereditary
Fructose
Intolerance
World War II
Conclusion
2

3. INTRODUCTION
• Multifactorial disease
• Cariogenicity of dietary carbohydrates
 Frequency
 Duration
 Physical form
 Chemical composition
 Nutrient content
• No scientific proof

4. CLASSIFICATION
Historical evidence
• South Africa in
hominides in
Neolithics – 5
million years
• Eskimos skulls free
from caries
Epidemiological
evidence
• Tristan da Cunha
study
• During World War II
• Hereditary fructose
intolerance
Experimental
evidence
• ANIMAL STUDIES
• Orland et al 1954
• HUMAN STUDIES
• Vipeholm study
• Hopewood house
study
• Turku sugar study
4

5. VIPEHOLM
STUDY
Gustaffson et al 1954
Davies 1955
5

6. PARTICIPANTS DIET CARIES ACTIVITY
CONTROL GROUP 60 males i. Low carbohydrate, high fat diet - 2yrs
ii. After 2 yrs, replaced with normal diet +
110gms of sugar a day at meals
i. Completely suppressed
ii. Small but significant rise
SUCROSE GROUP 57 males i. 300gms of sucrose in sol. at meals – 2yrs
ii. After 2yrs, 75gms of sucrose in sol. at meals
i. No significant increase in
increment
BREAD GROUP 41 males 42 females i. 345gms of sweet bread (=50gms of sugar)
with afternoon coffee – 2yrs
ii. After 2yrs, 4 portions of sweet bread with all
meals
i. No demonstrable increase
ii. Significant increase M>F
CHOCOLATE GROUP 47 males i. 300gms of sucrose in sol. At meals – 2yrs
ii. 110gms of sucrose in sol. + 65gms of milk
chocolate b/w meals – 2yrs
i. Low caries
ii. Significant increase
CARAMEL GROUP 62 males i. First 2 yrs-control yrs
ii. 3rd yr – 22 caramels 2 portions b/w meals
iii. 4th yr – 22 caramels 4 portions b/w meals
iv. Isocaloric quantity of fat with meals
i. Completely suppressed
ii. Significant increase
iii. Significant increase
iv. Fall in caries increment
8 TOFFEE GROUP 40 males i. 1st yr – control yrs
ii. 2nd yr – 8 toffees a day with breakfast &
lunch
i. Completely suppressed
ii. Significant increase
24 TOFFEE GROUP 48males i. 24 toffees b/w meals in 3rd & 4th yr
ii. 5th yr - withdrawal
i. Greatest increase
ii. Sharp drop
6

7. ROLE OF DIETARY SUGARS IN
DENTAL CARIES
7

8. CONCLUSION
CARIES INCREASE with
Increase in consumption of sugar
 Increase in consumption of food with strong retentive property
 Increased risk if sugar is consumed between meals
 Varies from individual to individual
CARIES DECREASE with
 Withdrawal of sugar-rich foods
 Maximum restriction of natural sugars & carbohydrates
8

9. HOPEWOOD
HOUSESTUDY
Sullivan and Harris 1942-1967
9

10. DIET
• Lactovegetarian diet - Rich in milk products &
vegetables
• Whole wheat, soyabeans & nuts
• Mostly uncooked
• Poor in cheese, sugar & refined carbohydrates
• Low F in drinking water
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PARTICIPANTS
• Hopewood house, New South Wales, Australia
•82 genetically heterogenous children
• Followed upto 13 yrs of age

11. FINDINGS
• Significant caries reduction
• Exposed to normal diet after 13 yrs  same caries experience as other State schools 
no special protection
11

12. TURKUSUGAR
STUDY
Scheinin & Makinin 1972-1974
Finland

13. Participants:
• 125 subjects of all age groups
Objectives:
• To find out the effect of diet (totally sucrose free)
on dental caries increment
3 Groups:
• 1st group (35) – Chewing gums containing
sucrose
• 2nd group (38) – Chewing gums containing
fructose
• 3rd group (52) – Chewing gums containing
xylitol 13

14. FINDINGS
• Dramatic reduction in dental caries after 2 yrs – Xylitol group
• Caries reduction: Xylitol > Fructose
14

15. TRISTANDA
CUNHASTUDY
Holloway et al

16. Volcanic
eruption
1961
Evacuation
& migration
to England
1962 Dental
examination
– caries
prevalence
0 in 6-19yr
old
1966 Dental
examination
– caries
increase by
50 – 80%
16

17. HEREDITARY FRUCTOSE INTOLERANCE
Fructose & fructose
containing dietary factors
Malaise, nausea, vomiting,
sweating, cramps, tremors,
convulsions, coma, & finally
death
Avoid fructose & fructose
containing dietary factors
Dental caries experience
very low
17

18. DURING WORLD WAR II
18
Rationing (sugar
reduction) in World War
1939-1944
Reduced dental caries in
Civilians
Increased dental caries in
army personnel due to
increased ready-made food

19. CONCLUSION
STUDIES FINDINGS
VIPEHOLM STUDY
i. Caries increase
ii. Caries decrease
• Increase consumption of sugar
• Consumption of sticky food
• Consumption between meals
• Varies from individual to individual
• Withdrawal of sugar rich foods with maximum restriction of natural
sugars & carbohydrates
HOPEWOOD HOUSE STUDY i. Significant caries reduction on diet restriction inspite of poor oral
hygiene & low F consumption
ii. No special protection
TURKU SUGAR STUDY Caries prevalence
Sucrose > Fructose > Xylitol (anticariogenic)
TRISTAN DA CUNHA STUDY Caries increase on consumption of refined carbohydrates
HEREDITARY FRUCTOSE INTOLERANCE Avoiding fructose & sucrose reduces dental caries
WORLD WAR II Caries increase on consumption of refined carbohydrates 19

20. REFERENCES
1. SS Hiremath Textbook of Public Health Dentistry 3rd edition, Elsevier publication
2. Gustafsson, B. E., Quensel, C. E., Lanke, L. S., Lundqvist, C., Grahnen, H., Bonow, B.
E., et al. (1954). The Vipeholm dental caries study; the effect of different levels of
carbohydrate intake on caries activity in 436 individuals observed for five years
3. Soben Peter Essentials of Public Health Dentistry 6th edition, Arya publishers
4. Harris, R. (1963). Biology of the Children of Hopewood House, Bowral, Australia. 4.
Observations on Dental-Caries Experience Extending over Five Years (1957-61)
5. Scheinin, A., Makinen, K. K., & Ylitalo, K. (1976). Turku sugar studies. V. Final report
on the effect of sucrose, fructose and xylitol diets on the caries incidence in man.
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