Nutrition and dental caries. Promotion of sound dietary practices is an essential component of caries management, along with fluoride exposure and oral hygiene practices. ... Fermentable carbohydrates interact dynamically with oral bacteria and saliva, and these foods will continue to be a major part of a healthful diet.

1. DIET,NUTRITION AND DENTAL CARIES
MUK BDS 3

2. ACID PRODUCTION IN DENTAL PLAQUE
 Plaque is a biofilm which tenaciously adherent deposit that forms on tooth surfaces consisting of
an organic matrix and dense concentration of bacteria.
 Biofilms consist of a hydrated viscous phase formed from bacteria and their extracellular
polysaccharide matrices having molecules and ions of concentration different from saliva.

3. DIETARY SUGARS AND DENTAL CARIES EVIDENCE
 There are studies that were done and provided evidence for role of sugars
in dental caries: Stephan’s,Vipeholm studies and the Turku sugar studies.
STEPHAN’S CURVE
 In the late 1930’s and 1940’s , Robert Stephan conducted experiments on
plaque PH In relation to caries and carbohydrate intake.
 Plaque PH was measured using Antimony touch electrodes.
 Stephan’s curve is a graphical representation of the plaque PH plotted
against time after 10% glucose rinse.

4. STEPHAN’S CURVE

5.  At neutral and slightly acid PH levels, there no demineralization.
 However at a certain PH value the environment of the tooth is no longer capable of preventing
dissolution and this is the critical PH which is about 5.3-5.5.
 Below the critical PH demineralization takes place.
 An electrode was placed in contact with the plaque and another electrode was placed in the floor
of the mouth to measure the resting PH .
 One hour after meal when there was no fermentable carbohydrates in the oral cavity ,patients
were asked to rinse their mouth with 25ml 10% glucose solution for 10seconds.
 The PH changes in the dental plaque were recorded frequently and the PH values were plotted
against the time and Stephan’s curve were drawn.
 The curves show that after the glucose rinse ,the PH drops rapidly reaching the critical PH within
2-5minutes (depending on caries activity of the patient).
 The PH remains under the critical level for 10-30 minutes .then the PH slowly rises to the resting
PH level after one hour.

6. VIPEHOLM EXPERIMENT
 The aim of this experiment was to investigate the effect of the total
amount frequency and texture of carbohydrate on caries incidence.
 Gustafson conducted an experiment of 436 adult patients in a mental
hospital in the city of vipeholm in Sweden .
 The experiment was conducted over a 5-year period(1946-1951)
 He divided them in 7 groups all receiving a basic low carbohydrate diet.
Control group received adequate caloric intake by fat.
 Two groups took sugar at meal times either in solution or sweetened
bread.
 Four groups received sweets in the form of tofees, carames or chocolates
between meals.

7. Contin.
 Results showed that eating sticky carbohydrates between meals showed the highest caries
activity.
 The effect of chocolate was less severe.
Conclusion
 Frequency and texture of carbohydrates are more effective on caries activity than the total
amount.
 Sugar in sticky form or eaten at frequent intervals is the most potent cause of dental caries.
TURKU STUDY
 It was carried out on adults in finland in the 1970’s and served as a controlled dietary
intervention study where almost all the sucrose in the diet was substituted by a non-cariogenic
sugar xylitol.
 An 85%reduction in dental caries observed over a period of 2 years.

8. CLASSIFICATION OF SUGARS
 The COMA Report introduced a new method of classifying dietary sugars, as a basis for discussion
of their dietary effects.
 According to this classification, sugars are divided into intrinsic and extrinsic sugars
Intrinsic sugars:sugars present within the cells of whole fruit and vegetables, mainly fructose,
glucose and sucrose and are of low cariogenicity as the sugar is intrinsic, contained within the cell
structure.
Extrinsic sugar:
1.Milk sugars sugars, especially lactose,occuring naturally in milk and milk products minimal
cariogenicity in normal use.
2.Non-milk extrinsic sugars:sugars in fruit juice, honey, sugars added to recipes and table sugar
including sucrose, fructose and glucose; non-milk extrinsic sugars are cariogenic;
 4 major sources of NMEs - confectionery, soft drinks, biscuits & cakes and table sugar it is the
consumption of these sugar-containing foods that should be reduced.

9. DIETARY ANALYSIS AND NUTRITIONAL
COUNSELING
 Dietary counselling is the process of tailoring recommendations for dietary changes to the needs of
the individual patient.
 The first stage of this is to establish the patient’s starting point - dietary analysis. Secondly, based
on this, appropriate dietary advice is given.
 Dietary analysis involves collecting information about the patient’s present diet and assessing their
readiness for change.
 The most useful way of collecting dietary information is to ask the patient, or their parent, to
complete a diet analysis sheet, or diet diary
 They record everything that they eat or drink (including tablets and medicines), usually over a
three or four day period.
 Dietary analysis demands a high level of patient cooperation, so it is important to explain the likely
benefits in advance

10. ALTERNATIVE SWEETENERS
 There are two main types of alternative sweeteners - bulk sweeteners and intense sweeteners:
Bulk sweeteners
 carbohydrates or carbohydrate derivatives calorific value similar to sucrose contribute to bulk and
structure of food;
 Similar sweeteness to sucrose; eg.sorbitol, mannitol and xylitol (sugar alcohols), hydrogenated
glucose syrup, isomalt.
 The sugar alcohols may have a laxative effect if consumed in large quantities by susceptible
persons and should therefore not be recommended for very young children.

11. Intense sweeteners
 non-calorific;much sweeter than sucrose, used in minute
amounts ,no bulk therefore widely used in drinks;
 For example saccharin (300x as sweet as sucrose, some
complain of bitter taste), aspartame (180 x as sweet as
sucrose, not to be taken by people with phenylketonuria,
trade names -Canderel, Nutrasweet), acesulfame K,
thaumatin.

12. END THANK YOU .