University of Palestine College of Dentistry DR. MUSTAFA I. ELGHOUL B.SC,B.D.S,MS(ORTHO) Master of Orthodontic PREVENTIVE DENTISTRY AND NUTRTION

Nutrition and dental health Good food – healthy teeth and healthy body.

Sugar and Diet The development of dental caries depends on four interrelated factors: (1)diet, (2) inherent factors of host resistance, (3) the number of challenge bacteria located in the dental plaque, and (4) time

Without bacteria, no caries can develop. For the bacteria in the plaque to live, they must have the same amino acids, carbohydrates, fatty acids, vitamins, and minerals that are required for all living organisms Without bacteria, no caries can develop. For the bacteria in the plaque to live, they must have the same amino acids, carbohydrates, fatty acids, vitamins, and minerals that are required for all living organisms

Because these nutrients are also required by the cells of the body, the food that is ingested by the host or that which later appears in the saliva in a metabolized form, provides adequate nutrients for bacterial survival and reproduction. Because these nutrients are also required by the cells of the body, the food that is ingested by the host or that which later appears in the saliva in a metabolized form, provides adequate nutrients for bacterial survival and reproduction.

With three well-balanced meals per day, however, the usual plaque bacteria probably would not release a sufficient quantity of metabolic acids to cause caries development

Did you know ? On average some western countries eat 48 kg of sugar a year !!! On average some western countries eat 48 kg of sugar a year !!! This is approx = to 23 teaspoons of sugar per day This is approx = to 23 teaspoons of sugar per day Many foods in our diets are high in Salt Many foods in our diets are high in Salt

Many foods in our diets are high in Fat (saturated fats) (saturated fats)

Many foods in our diets are high in Sugar (simple sugars)

Thus many diets contain enough too much energy as fat, and sugar. too much energy as fat, and sugar. too much salt. too much salt.

And many diets do not contain enough Dietary fibres and basic complex carbohydrates. Dietary fibres and basic complex carbohydrates. Essential vitamins & nutrients. Essential vitamins & nutrients. Water. Water.

Why is a person ’ s diet important or relevant to B. their dental health ?

A. Diet and overall health Whilst life expectancy has increased - premature deaths due to nutritionally related problems are increasing: Whilst life expectancy has increased - premature deaths due to nutritionally related problems are increasing:  cardiovascular diseases (heart attack)  cerebrovascular diseases (stroke)  gastro intestinal disorders  cancers (especially bowel)  diabetes

B. Diet and dental health Dental caries Dental caries Dental erosion Dental erosion Other oral conditions (oral cancer, malnutrition due to edentulism) Other oral conditions (oral cancer, malnutrition due to edentulism) dietary related diseases which can cause major problems for patients but are entirely preventable.

Diet and dental caries Diet and dental caries Diet – is one of the factors that contributes to dental caries. Diet – is one of the factors that contributes to dental caries. - diet can play a role in caries development in susceptible patients and/or if there is concomitant low F usage and poor plaque control.

Diet and dental caries Diet and dental caries What is the relationship between diet and dental caries ?

Consistency (physical form) of cariogenic foods/drinks Consistency (physical form) of cariogenic foods/drinks Liquid foods eg. Usually is swallowed quickly and thus less available to bacteria Liquid foods eg. Usually is swallowed quickly and thus less available to bacteria compared to Sticky foods eg. lollies are available for bacterial metabolism for long periods of time Sticky foods eg. lollies are available for bacterial metabolism for long periods of time

Caries protective foods Caries protective foods Dairy foods Dairy foods Cheese itself & Chewing cheese - stimulates saliva flow - high calcium and phosphorus content; - cheese proteins help in reduction of demineralisation. Fibrous foods Fibrous foods - stimulates saliva flow

Oral carbohydrate clearance Oral carbohydrate clearance Foods that are retained longer in the mouth tend to be more harmful than foods cleared quickly Foods that are retained longer in the mouth tend to be more harmful than foods cleared quickly Foods are eliminated during and after mastication by Foods are eliminated during and after mastication by – the rinsing effect of saliva –activities of masticatory muscles, tongue, lips and cheeks. Clearance time may be prolonged by retentive factors Clearance time may be prolonged by retentive factors –cavities –poor restorations, bridges and partial dentures –low secretion rate or high viscosity of saliva

How can you increase oral carbohydrate clearance ? i. Toothbrushing immediately after meals ii. Induction of rapid salivary flow (by mechanical or gustatory stimuli) eg: –eating tough or highly flavoured foods at the end of meals eg fresh fruit, raw vegetables, peanuts, cheese –chewing gum (sugar free

Diet and dental erosion Diet and dental erosion Erosion = loss of tooth substance by a chemical process that does not involve known bacterial action. Erosion = loss of tooth substance by a chemical process that does not involve known bacterial action. The aetiology of erosion is multi- factorial: The aetiology of erosion is multi- factorial: One cause is Diet.

Mild erosion may be symptomless, but the first sign of erosion may be sensitivity to hot, cold or sweet foods. The tooth may become increasingly painful as the pulp at the centre is affected, and gradually, as the enamel wears away, the teeth may become shorter and darker in colour Mild erosion may be symptomless, but the first sign of erosion may be sensitivity to hot, cold or sweet foods. The tooth may become increasingly painful as the pulp at the centre is affected, and gradually, as the enamel wears away, the teeth may become shorter and darker in colour

Diet and dental erosion: what acids are involved ? Diet and dental erosion: what acids are involved ? Strong acids - pH < 4.5 eg (regurgitated stomach acid) Strong acids - pH < 4.5 eg (regurgitated stomach acid) Citric acid (eg., lemon juice) = pH Citric acid (eg., lemon juice) = pH

4. Diet and dental erosion Severe erosion requires frequent short contacts or less frequent prolonged contacts of erosive substances (enhanced if there is lowered buffering capacity). Severe erosion requires frequent short contacts or less frequent prolonged contacts of erosive substances (enhanced if there is lowered buffering capacity).

Dietary diary Dietary diary What dietary information should you collect ? What dietary information should you collect ? Also need to collect other information about the patient. Also need to collect other information about the patient.

Knowledge about Nutrition, Dietary Guidelines, Food Guides, role of diet in dental caries/erosion, counselling and motivation techniques is thus important in the prevention/management of dental caries and erosion and other oral conditions.

Nutrition and oral cancer Oral cancer has been found to be related to two factors: Oral cancer has been found to be related to two factors: Tobacco use Tobacco use Alcohol consumption Alcohol consumption These two factors account for a high percentage of observed oral cancer. These two factors account for a high percentage of observed oral cancer.

Nutrition and edentulism People who lose all their teeth (called edentulous) are at risk of malnutrion (poor nutrition) because their inability to chew properly limit their food choices. People who lose all their teeth (called edentulous) are at risk of malnutrion (poor nutrition) because their inability to chew properly limit their food choices.

Conclusion Diet is related to general health as well as oral health. Dentists need to understand the impact of nutrition on oral health to provide patients with appropriate advice. Diet is related to general health as well as oral health. Dentists need to understand the impact of nutrition on oral health to provide patients with appropriate advice.