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).

Stephan’s Curve
pH Changes Following Sugar Ingestion
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.

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
acidogenic food is cariogenic or not will depend greatly on a
number of factors specific to the individual who eats it, namely, predominant
bacterial flora,
flora, flow rate and buffering capacity of saliva,
saliva, fluoride availability,
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 food’s ability to foster caries in
human under conditions conducive to caries formation.
formation.
Consumption of Sugars
To most people the term sugar refers to the common household foodstuff table
sugar (sucrose
(sucrose),
), a disaccharide that is the most common form of sugar
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.

Role of sucrose in caries formation

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

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).
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.

Cleansing and protective food

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 tooth’s
resistance to caries and enhance remineralization of carious lesion.
Milk, despite being one of the most sources of sugar, is anticariogenic.
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.