Challenge 2010

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Dental Caries Handout

Lecture Title : Diet, Nutrient and Dental Caries Provided by: Ahmed Al-Shamari Prof name : Dr. Ghada Maghaireh

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Diet, Nutrient and Dental Caries Dr.Ghada Maghaireh (Lecture Outline)

Diet is one of the most important factors that contribute to the development of dental caries. Fermentable carbohydrates and a cariogenic plaque need to be present on a tooth surface for acid to form. The acid is produced by bacterial metabolism of the carbohydrate substrate. There has been a vast amount of experimental work linking fermentable carbohydrates and dental caries. The process is well illustrated by the Stephan curve (Graphical representation of change n plaque pH over time).

A single sucrose rinse , lasting for seconds, can cause demineralization that can last between 20 minutes and several hours. Following sucrose rinse, the plaque within an active cavity shows a greatest fall in the pH.

Stephans Curve pH Changes Following Sugar Ingestion

Cariogenic Food

Foods that have the capacity to lower the pH of plaque below the critical demineralzation level (pH 5.5 to 5.0) are considered acidogenic. acidogenic. Acidogenesis is a necessary condition for the development of caries, but it is not the only condition. Whether an acidogenic food is cariogenic or not will depend greatly on a acidogenic number of factors specific to the individual who eats it, namely, predominant bacterial flora, flow rate and buffering capacity of saliva, fluoride availability, flora, saliva, availability, and individual immune factors. factors. The outcome will also depend on the quantity and frequency of food eaten. Thus it is very hard to say whether an acidogenic food is cariogenic or not for a particular patient, for much depends on those individual factors that are quiet distinct from the nature of the food itself. However, a non-acidogenic food must also be a non-cariogenic food. A more useful approach in caries control is to refer to the cariogenic potential of a food, which has been defined as the foods ability to foster caries in human under conditions conducive to caries formation. formation.

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Consumption of Sugars

To most people the term sugar refers to the common household foodstuff table sugar (sucrose), a disaccharide that is the most common form of sugar (sucrose), consumed by humans. Sucrose and other sugars, both monosacccharides or simple sugars (glucose, fructose and galactose) and disaccharides (sucrose, lactose and maltose) are added to a wide verity of processed food labeled in supermarkets as canned soup, salad dressing, and processed meat. Consumption of sugar in all forms has been calculated for different countries to indicate the amount of sugar used. For U.S. it was 54.5 kg/person /year, Jordan is 45, Iraq is 55 and UK is 38. Sucrose enhances the colonization and growth of MS in dental plaque more than other monosaccharides and disaccharides. MS ferment sucrose rapidly producing acids, convert sucrose to extracellular polysaccharides that facilitate the adherence of the bacteria to teeth and reduce plaque permeability that in turn decrease the rate at which saliva can neutralize or dilute acids formed n plaque. High Fructose Corn Syrup (HFCS) is now used in place of sucrose in processed foods and soft drinks for economic reasons. It is used by food manufacturers instead of sucrose because it is cheaper and it is available in the markets. markets. HFCS consists mostly of (50% fructose and 50% glucose). Theses sugars do not cause any production of extracellular polysaccrides in the oral cavity and its cariogenicity has been estimated to be 20-25% less that of sucrose. In addition to the considerable shift from sucrose to HFCS and other syrup in processed food, two other changes have taken place in sugar consumption patterns since the early 20th century: 1.The proportion of energy intake from carbohydrate food has changed from that obtained from starches (bread, potato, and whole grain cereals) to those obtained from sugars. 2.The main use of sugar has changed from discretionary (i.e. from the sugar bowl on the table) to consumption by way of processed food (hidden sugar).

Role of sucrose in caries formation

High-fructose corn syrup

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Cariogenicity of different sugars

Sucrose for years was considered so much the more cariogenic than other sugars. The difference between sucrose and different sugars in term of cariogenicity is less pronounced than originally believed. However, sucrose is still has higher cariogenic potential than other sugars. The production of extracellular polysaccharides depends on sucrose and that smooth surface caries can only develop with plaque that adheres by means of extracellular polysaccharides (plaque formation). However, the amount of plaque formed is not necessarily related to cariogenicity since high caries development in the absence of significant plaque has been reported.

Effect of Eating Pattern and Physical Forms of Food

Frequent between-meal snaking on sugars or processed starch containing sugars increases plaque formation and extends the length of time that bacterial acid production can occur. Frequent snaking between meals keeps the plaque pH low and extends the time for enamel and dentin demineralization to occur. High sucrose foods deliver high levels of sugar to the oral bacteria immediately after foods are consumed. Whereas high starch food (such as soft bread and potato chips) deliver increasing concentrations of sugar over a longer period of time. The sequence in which foods are eaten affect how much the plaque pH falls. Sugared coffee consumed at the end of a meal will cause the plaque pH to remain low for a longer time than when unsweetened food is eaten following intake of sugared coffee. If peanuts are eaten before or after sugar-containing food, the plaque pH is less depressed. Some components of food are protective against dental caries. Protein, fat, phosphorous and calcium inhibit caries in rats. Aged natural cheese have been shown to be cariostatic. When cheese is eaten following sucrose rinse, the plaque pH remains higher than when no cheese follows the sucrose rinse. The protective effect of cheese is attributed to their texture that simulate salivary flow and their protein, calcium and phosphate content that neutralize plaque acids. Lipids seem to accelerate oral clearance of food particles. Some fatty acids in low concentrations inhibit growth of MS. Fluoride found in drinking water, foods, and dentifrices increase a tooths resistance to caries and enhance remineralization of carious lesion. Milk, despite being one of the most sources of sugar, is anticariogenic. Page|4

Cleansing and protective food

The sugar in milk is lactose, which is the least cariogenic sugar and milk is also known to contain protective factors due to the presence of calcium, phosphate, casein and lipids.

Midterm Exam The Exam includes all the first 6 lectures including this lecture. Thursday 7/4/2011 at 4:00. 10 H2, 10 H3, 10H4.

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