Lecturer of pediatric dentistry and oral public health Faculty of dentistry Assiut University Diet Diet refers to the customary allowance of food and drink taken by any person from day to day. Nutrition Nutrition is a science of how the body utilises food to meet the requirements for development, growth, repairs and maintenance or as the science of food and its relationship to health. 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 Diet and dental caries
The effect of diet is considered in
two heading •Systemic effect •Local effect Systemic effect i.e. before eruption, while the tooth is still forming.
1-Before birth through placental circulation from mother to
fetus, which provides calcium and vitamin D for proper development of teeth.
2-After birth through general nutrition where the essential
nutrients are carried by the blood stream from the
digestive tract. Local effect
After tooth eruption
Lodgment of fermentable carbohydrates around teeth Diet component
Monosaccharides are the simplest carbohydrates and are classified
according to the number of carbon atoms in the chain, e.g. glucose, fructose and galactose. Disaccharides Disaccharides consist of a linkage of two monosaccharide units. Disaccharides, in general, have a sweet taste, water soluble and are crystalline solids, e.g. sucrose, lactose and maltose. Polysaccharides
Polysaccharides are complex carbohydrates made up of many (more than
10) monosaccharides linked together. Unlike sugars, these are tasteless. Some are used for storing energy and others perform structural functions, e.g. starch, glycogen and cellulose. Sugars The sugars most commonly found in an average diet are sucrose, glucose, fructose, lactose, and maltose, from which some regard sucrose as the most cariogenic. When assessing a patient’s diet, it is essential to differentiate between natural and added sugars. Classification of Sugars
➢ Natural sugars are those intrinsically found in the structure of fresh fruits and vegetables, milk, and dairy products. ➢ Natural sugars do not play a significant role in developing dental caries and other non-communicable diseases. This is probably due to their protective components (polyphenolic compounds, calcium, water, and fiber) and the hardness of some fruits and vegetables, which stimulates saliva production. ➢ Furthermore, cow’s milk is classed as non-cariogenic. It may even protect teeth from dental caries thanks to its high calcium and casein content. Classification of Sugars
➢ Added sugars, also called free sugars by the WHO, are the sugars added to foods and drinks by manufacturers or cooks and sugars present in edible products other than fresh fruit, vegetables, milk, and grains, e.g., fruit juices, honey, and syrups. ➢ Excessive intake of added sugars is closely linked to an extensive list of systemic conditions, including dental caries, diabetes mellitus, obesity, and cardiovascular diseases. Starchy Food ➢ Dietary starches refer to a variety of food rich in starch (a polymeric carbohydrate), including bread, pasta, potatoes, potato products, rice, oats, breakfast cereals, and other grains. ➢ Dietary starches are of low cariogenicity. CARIOGENICITY OF SUCROSE Sucrose is the arch criminal of dental caries, it continues to be the most common form of added sugar in the diet .
➢ Sucrose induces the smooth surface lesion more than any other carbohydrates, especially when treated with Streptococcus mutans. ➢ Sucrose is the only carbohydrate diet degraded to glucans. ➢ Cariogenicity of sucrose does not relate to the ability to increase plaque, but ability of Streptococcus mutans to colonize smooth surface in the presence of sucrose. ➢ Glucans limit the diffusion of acids away from tooth surface Vipeholm study, 1954 :
they divided the participants into nine groups depending on the type of food consumed. 1- Sucrose in solid forms (chocolate group, bread group and caramel group) were given in different frequency and quantity. And they were given in between meals. 2- In caramel group, 24 toffees and 48 toffees were given to one of the groups. Findings 1. Significant caries increase occurred when sucrose-containing snacks were taken
between meals-time factor.
2. More the number of times sucrose was ingested more increase in caries- frequency. 3. Sticky forms of sucrose foods, which can retain high sugar levels, were more
cariogenic than those cleaned rapidly-consistency.
4. Sucrose containing solid foods were more cariogenic than liquid types-form. THE BASIC STEPHAN CURVE
Describes the change in dental plaque pH in
response to a challenge
The challenge could be an inert substance placed
in the mouth with the aim of determining its effect on plaque pH. Example
Dental plaque is challenge with
fermentable carbohydrates
Asking volunteer to rinse the
mouth with 10 ml of 10% sucrose solution for 10 seconds.
Average plaque samples were
removed at intervals and the PH recorded. Characteristically the Stephan Curve reveals a rapid drop in plaque pH, followed by a slower rise until the resting pH is attained. The time course varies between individuals and the nature of the challenge
However, pH recovery can
take anything between 15 and 40 minutes depending to a large extent on the acid- neutralizing properties of the individual’s saliva The initial rapid drop in pH It is due to the speed with which plaque microbes are able to metabolize sucrose. The rise in pH
The pH starts to rise after a few minutes
due to: 1. Acid by-products diffusing out of the plaque. 2. Salivary bicarbonate diffusing into the plaque and neutralizing the acid by- products. It normally takes at least 20 minutes for the plaque pH to reach its resting value
