Dietary effects on dental diseases

Sweets consumption of preschool children--extent, context, and consumption patterns

OBJECTIVES

Sweets consumption is one of the risk factors of caries, especially among children. The aim of our study was to explore the extent and context of preschoolers' sweets consumption and to identify high-risk groups.

MATERIALS AND METHODS

The baseline cross-sectional data used originated from a nutritional intervention study encompassing 879 parental surveys, which were obtained in 52 kindergartens in Baden-Württemberg-the third largest federal state in Germany-between September and March 2009. Our outcome variable "sweets consumption" was operationalized using food-frequency items and analyzed by testing the influence of sociodemographic, educational, cultural, and family context covariates.

RESULTS

Most preschoolers consumed sweets every day-on average 9.7 ± 6.2 times per week. Most popular were cookies, gummy bears, and chocolate. Sweets consumption did not correlate significantly with sociodemographic factors like age and sex but rather was associated with cultural and contextual factors such as immigrant background, parental education, specific nutritional knowledge levels, and access arrangements in the home.

CONCLUSIONS

The consumption patterns identified are a result of high availability and parental influence (factors such as parents' knowledge levels, interest in, and habits regarding their child's nutrition).

CLINICAL RELEVANCE

Dental practitioners should place more emphasis on gathering information from young patients regarding excessive and frequent consumption of sweets and consequently on trying to educate the children and their parents on oral health risks associated with such consumption. Particular attention is to be paid to children of Turkish and Arabic decent, as they have been shown to consume above-average amounts of sweets.

A community-randomized controlled trial against sugary snacking among infants and toddlers

OBJECTIVES

We evaluated the impact of educational interventions on sugary snacking in infants and toddlers in Tehran, Iran.

METHODS

A 6-month intervention was integrated into health staff duties. We assigned 12- to 15-month-olds (n = 242) and their mothers attending the vaccination offices of 18 randomly selected public health centers into the following groups: pamphlet and reminder (A), pamphlet only (B), and one control group (C). The mothers were interviewed at baseline and after follow-up. We recorded the frequency of sugary snacking for both the children and their mothers and calculated changes over 6 months. A reduction in the children's snacking frequency indicated a positive outcome. The family's residential area (affluent/nonaffluent) indicated its socioeconomic level. Associations between the children's and their mothers' snacking frequency were assessed by means of Spearman correlation. The outcomes of each intervention group were compared separately to those of the control group by means of the Mann-Whitney test. In addition, we performed intention to treat analysis. Factors related to a positive outcome were explained by means of logistic regression models.

RESULTS

In all groups, the child's and mother's snacking at baseline correlated (r = 0.4). A positive outcome was found for 62% of the children in group A and for 49% and 32% in groups B and C, respectively. In group A, a reduction in the children's snacking frequency was found despite their residential area (P < 0.05). Controlling for intervention effects, the logistic regression model showed that residential area was unrelated to the positive outcome.

CONCLUSIONS

Oral health education with reminders provided to mothers by general health staff is a valuable tool for reducing sugary snacking in infants and toddlers in a country with developing oral health systems.

[Dietary guidelines for the Brazilian population: implications for the Brazilian National Policy on Oral Health]

Dietary guidelines are intended to orient dietary habits and policies for health promotion and disease prevention. This article discusses Brazil's national dietary guidelines, aiming to identify issues that can support the strategies proposed by the National Policy on Oral Health. The two currently available official guidelines produced by the Ministry of Health were reviewed: the Dietary Guidelines for Children under Two and the Population Dietary Guidelines. The guidelines recommend reduction in sugar intake, essential for caries prevention, and other measures to prevent tooth decay and oral cancer. These guidelines are thus a key part of an oral and overall health promotion strategy and should be integrated into the National Policy on Oral Health.

One-to-one dietary interventions undertaken in a dental setting to change dietary behaviour

BACKGROUND

The dental care setting is an appropriate place to deliver dietary assessment and advice as part of patient management. However, we do not know whether this is effective in changing dietary behaviour.

OBJECTIVES

To assess the effectiveness of one-to-one dietary interventions for all ages carried out in a dental care setting in changing dietary behaviour. The effectiveness of these interventions in the subsequent changing of oral and general health is also assessed.

SEARCH METHODS

The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 24 January 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1950 to 24 January 2012), EMBASE via OVID (1980 to 24 January 2012), CINAHL via EBSCO (1982 to 24 January 2012), PsycINFO via OVID (1967 to 24 January 2012), and Web of Science (1945 to 12 April 2011). We also undertook an electronic search of key conference proceedings (IADR and ORCA between 2000 and 13 July 2011). Reference lists of relevant articles, thesis publications (Dissertations Abstracts Online 1861 to 2011) were searched. The authors of eligible trials were contacted to identify any unpublished work.

SELECTION CRITERIA

Randomised controlled trials assessing the effectiveness of one-to-one dietary interventions delivered in a dental care setting.

DATA COLLECTION AND ANALYSIS

Abstract screening, eligibility screening and data extraction decisions were all carried out independently and in duplicate by two review authors. Consensus between the two opinions was achieved by discussion, or involvement of a third review author.

MAIN RESULTS

Five studies met the criteria for inclusion in the review. Two of these were multi-intervention studies where the dietary intervention was one component of a wider programme of prevention, but where data on dietary behaviour change were reported. One of the single intervention studies was concerned with dental caries prevention. The other two concerned general health outcomes. There were no studies concerned with dietary change aimed at preventing tooth erosion. In four out of the five included studies a significant change in dietary behaviour was found for at least one of the primary outcome variables.

AUTHORS' CONCLUSIONS

There is some evidence that one-to-one dietary interventions in the dental setting can change behaviour, although the evidence is greater for interventions aiming to change fruit/vegetable and alcohol consumption than for those aiming to change dietary sugar consumption. There is a need for more studies, particularly in the dental practice setting, as well as greater methodological rigour in the design, statistical analysis and reporting of such studies.

The social and behavioural pathway of dental caries experience among Jewish adults in Jerusalem

AIMS

To report dental caries status, related health behaviours and social determinants among a representative sample of adults residing in Jerusalem.

METHODS

This cross-sectional study was conducted using a stratified sample of 254 Jewish and married adults aged 35-44 years in Jerusalem. Dental caries status was examined according to DMFT, percentage of caries-free persons and of people maintaining all their natural teeth (no teeth missing due to caries). The results were analysed by the independent variables and interpreted by weighted caries scores for the total Jerusalem population.

RESULTS

The mean age was 38.63 years. Weighted DMFT was found to be 10.59; 6.8% of the population were caries-free; 67.1% demonstrated maintenance of all natural teeth. Level of education was the distal factor, associated with number of natural teeth, DMFT and untreated decay. Mediating behavioural determinants included dental attendance, plaque level and sugar consumption.

DISCUSSION

The findings of this study demonstrated that caries experience among Jewish married adults in Jerusalem was moderate with low unmet dental caries needs. Additionally, data confirmed that a low level of education was a strong distal social determinant of caries experience, which affected dental health status via a pathway mediated by behavioural factors.

Food-based dietary guidelines for the arab gulf countries

The concept of food-based dietary guidelines (FBDG) has been promoted by several international organizations. However, there are no FBDG for the countries in the Arab region. As the Arab Gulf countries share similar a socioeconomic and nutrition situation, an attempt was made to develop FBDG for these countries. This paper summarizes the steps taken to develope such guidelines by the Arab Center for Nutrition. The FBDG were developed through 6 steps: (1) determination of the purpose and goals for establishing FBDG, (2) characteristics of FBDG, (3) determination of the food consumption patterns, (4) review the current nutrition situation, (5) determination of the lifestyle patterns that are associated with diet-related diseases and (6) formulating the FBDG. The FBDG consist of 14 simple and practical pieces of advice taking into consideration the sociocultural status and nutritional problems in the Arab Gulf countries. The FBDG can be a useful tool in educating the public in healthy eating and prevention of diet-related chronic diseases.

Dental caries and its association with diet and dental erosion in Libyan schoolchildren

BACKGROUND. The change towards a more Westernised diet in Libya may increase the risk of caries and erosion in children. AIMS. To investigate any association between dental caries, dental erosion, and potential dietary risk factors in Libyan schoolchildren. METHODS. A random sample of 791 schoolchildren aged 12 years underwent dental examination for caries and erosion and completed a questionnaire to provide dietary data. Dental caries was assessed using the WHO (Oral Health Surveys: Basic Methods, 1997) criteria. Erosion was assessed using UK National Diet and Nutrition Survey (NDNS, Young People Aged 4-18 years. Volume 2: Report of the Oral Health Survey, 2000) criteria. Associations between caries and dietary variables were investigated through bivariate and multivariate analyses. RESULTS. Of the 791 12-year olds, 57.8% (457) had caries experience and 40.8% (323) had experience of erosion. One hundred and ninety-two subjects (42%) of the subjects with caries experience also had erosion, whilst 131 subjects (39.2%) of the 334 without caries had clinical signs of erosion (P = 0.464; OR, 1.123; 95% CI, 0.842, 1.497). There was no statistically significantly relationship between dental caries and dental erosion. Frequency of consumption of fruit-based sugared drinks was statistically significantly positively associated with experience of caries (P = 0.002). CONCLUSIONS. Dental caries experience was associated with frequency of consumption of sugared dietary items but not with dental erosion.

Factors associated with self-reported number of teeth in a large national cohort of Thai adults

BACKGROUND

Oral health in later life results from individual's lifelong accumulation of experiences at the personal, community and societal levels. There is little information relating the oral health outcomes to risk factors in Asian middle-income settings such as Thailand today.

METHODS

Data derived from a cohort of 87,134 adults enrolled in Sukhothai Thammathirat Open University who completed self-administered questionnaires in 2005. Cohort members are aged between 15 and 87 years and resided throughout Thailand. This is a large study of self-reported number of teeth among Thai adults. Bivariate and multivariate logistic regressions were used to analyse factors associated with self-reported number of teeth.

RESULTS

After adjusting for covariates, being female (OR = 1.28), older age (OR = 10.6), having low income (OR = 1.45), having lower education (OR = 1.33), and being a lifetime urban resident (OR = 1.37) were statistically associated (p < 0.0001) with having less than 20 teeth. In addition, daily soft drink consumptions (OR = 1.41), current regular smoking (OR = 1.39), a history of not being breastfed as a child (OR = 1.34), and mother's lack of education (OR = 1.20) contributed significantly to self-reported number of teeth in fully adjusted analyses.

CONCLUSIONS

This study addresses the gap in knowledge on factors associated with self-reported number of teeth. The promotion of healthy childhoods and adult lifestyles are important public health interventions to increase tooth retention in middle and older age.

Sugar consumption and preference among Mexican, Chinese, and Nigerian immigrants to Texas

This pilot study investigated the relationship between sugar consumption/ preference and the length of residence in the U.S. among certain immigrant groups. The study sample consisted of 213 volunteers from community organizations and church groups, of Nigerian (45%), Mexican (31%), and Chinese (24%) descent. Data were collected on demographics, sugar consumption/preference (24-hour dietary recall), and oral health status. The age of respondents varied from 18 to 93 years with a mean age of 37.0 ± 11.7 years. The mean length of residence was 9.2 ± 7.2 years, and the mean sugar consumption was 122.4 ± 114.6 g/day. Immigrants from Mexico and Nigeria reported consuming more servings of sweets per day than the Chinese (p= .006); Mexican immigrants had the highest level of sugar preference (p= .001). No significant differences were observed between the length of residence and either sugar consumption or sugar preference. Greater availability of sugar and sweet snacks does not always result in increased sugar consumption or sugar preference.

Contemporary fluid intake and dental caries in Australian children

In Australia, caries experience of 6-year-old and 12-year-old children has increased since the mid to late 1990s. Previously, caries rates had declined, attributable to community water fluoridation. The recent caries increase has been attributed speculatively to changes in fluid intake, including increased consumption of sweet drinks and bottled waters. Increasing urbanization and globalization have altered children's diets worldwide, promoting availability and access to processed foods and sweet drinks. Studies in Australia and internationally have demonstrated significant associations between sweet drink intake and caries experience. Despite widespread fluoride availability in contemporary Australian society, the relationship between sugar consumption and caries development continues and restricting sugar intake remains key to caries prevention. Caries risk assessment should be included in treatment planning for all children; parents should be advised of their child's risk level and given information on oral health promotion. Readily-implemented caries risk assessment tools applicable to parents and clinicians are now available. Public health information should increase awareness that consuming sweet drinks can have deleterious effects on the dentition as well as the potential for promoting systemic disease. Restricting sales of sweet drinks and sweet foods and providing healthy food and drinks for purchase in schools is paramount.

Significance of osmotic temperature treatment and storage time on physical and chemical properties of a strawberry-gel product

BACKGROUND

The development of fruit-based foods that maintain the nutritional and sensory properties of fresh fruit may help to stimulate fruit consumption by consumers. The possibility of formulating a fruit-gel product with osmodehydrated fruit and the reused osmotic solution (OS) obtained from the dehydration step has been demonstrated. However, the conditions of the osmotic process can significantly affect the properties of the obtained product. In this work an osmotic process at 22 °C for 6 h and at 30 °C for 3 h was employed to formulate a strawberry-gel product.

RESULTS

Significant losses of ascorbic and citric acids and anthocyanins were observed and some relevant volatile compounds of the strawberry aroma profile were developed during the osmotic process. Changes in all analysed parameters occurred mainly during the first 2 days of storage. The flux of anthocyanins from the fruit to the gel gave an attractive appearance to the formulated product. These changes were more marked for samples obtained at 30 °C.

CONCLUSION

Osmotic treatment at 30 °C was more suitable for formulation of the product, because the presence of nutritional/functional compounds in the OS, and consequently in the gel matrix, was higher and the aroma and colour were more stable and homogeneous during storage.

Parental perceptions of the Children In Need Of Treatment dental program

This paper discusses the collaborative partnership involving the Middlesex-London Public Health Research, Education and Development site, the Ontario Ministry of Health Promotion and Sport, then Chronic Disease Prevention and Health Promotion Branch, and an academic institution in the first-ever research of parental perceptions of the Children In Need Of Treatment. This paper provides an overview of the Children In Need Of Treatment program, reviews the results of the research (a mailed, self-administered survey with a systematic random sample of parents from three health units whose children received dental treatment that was paid by Children In Need Of Treatment in 2006), and its subsequent recommendations. How these recommendations affected program planning and policy are examined. In conclusion, parents were very satisfied with the treating dentist and the Children In Need Of Treatment program, and found Children In Need Of Treatment to be vital in addressing the health of their children by attending to their urgent dental needs.

Intake of sweet drinks and sweet treats versus reported and observed caries experience

AIM

This was to study the intakes of sweet drinks and sweet treats of children and their caries risk using the Paediatric Risk Assessment Tool (PRAT, 2003) and Caries-risk Assessment Tool (CAT, 2007-8).

STUDY DESIGN

Parents of 266 healthy primary school children completed the PRAT questionnaire during their child's dental appointment at the Royal Dental Hospital of Melbourne, Australia, describing their fluid and sweet treat intakes in the past 24 hours, oral hygiene practices and past caries. A subgroup (n=100) was examined clinically (CAT) for caries requiring restoration, visible plaque, gingivitis, orthodontic appliances, enamel defects, and use of dental care.

RESULTS

The estimated mean daily fluid intake was 1.5+/-0.5L; fluids were consumed 3-5/ day by 57% of children and 78% usually had evening/night drinks. Fluids consumed were: tap water by 90%, milk by 74%, juice by 50%, regular soft drink by 30%; sweet treats were consumed by 62% and confectionery by 25%. Most children (69%) brushed their teeth > or =2/day; 5% flossed daily. Parentally-reported caries was associated significantly with increasing treats frequency (p=0.006). In the subgroup, 81% were at high caries risk; 47% had irregular dental care; 21% had sweet drinks/foods frequently between meals; 49% had visible plaque/gingivitis, and 34% had enamel demineralisation. Caries observed in the past 12 months was associated significantly with evening sweet drinks (p=0.004), and suboptimal fluoride exposure (p=0.009). Caries observed in the past 24 months was associated significantly with treats frequency (p=0.006), intake of sweet drinks plus treats (p=0.000), enamel demineralisation (p=0.000) and irregular dental care (p=0.000).

CONCLUSIONS

The PRAT and CAT are valuable tools in assessing children's caries risk. The risk of caries from frequent intake of sweet drinks, either alone or in addition to sweet treats, must be emphasised to parents. All parents, and particularly those of children assessed at high risk from intakes of sweet drinks and sweet treats, suboptimal fluoride exposure, or enamel demineralisation, must be encouraged to obtain regular dental care for their children.

Caries prevalence of permanent teeth: a national survey of children in Iceland using ICDAS

OBJECTIVES

The Icelandic Oral Health Survey aimed to obtain new national data on the oral health of Icelandic children and teenagers.

METHODS

A representative stratified random cluster sample of 2251 Icelandic children in first, seventh and 10th grade, aged approximately 6-, 12- and 15-years old was examined for caries prevalence using the ICDAS criteria. Bite-wing digital radiographs were obtained for the children in 7th and 10th grade.

RESULTS

D(3)MFT scores by visual examination of 6-, 12- and 15-year olds were 0.12, 1.43 and 2.78 respectively but when including radiographs, the D(3)MFT rose to 2.11 at 12 years and 4.25 at 15 years. The Significant Caries Index, SiC, by visual examination for 12 and 15 y was 3.7 and 6.7 respectively but was 4.7 for 12 y and 8.9 for 15 y with radiographs. In all age groups and at most disease levels, caries was active in the majority of the lesions (58-100%). The percentage of children with no visually detectable caries at D(3)/D(1) level was 93%/74% for 6 years, 48%/22% for 12 years and 35%/16% for 15 years. When radiographs were included the percentage reduced to 34%/15% for 12 years and 20%/6% for 15 years. Approximately 80% of 12- and 15-year-olds had at least one of their first molars sealed, with the mean number of sealed first molars being 2.2 among 12 y and 2.0 among 15 y.

CONCLUSIONS

Caries levels were higher than expected in this national survey and further away from the goals of the National Health Plan for 2010 than anticipated. Caries distribution was skewed with more than half of the children having low caries scores but a wide distribution of caries experience was seen among the remaining population.

Is sugar consumption detrimental to health? A review of the evidence 1995-2006

Many countries set quantitative targets for added sugars, justifying this by expressing concern about the likely impact of sugar on weight control, dental health, diet quality, or metabolic syndrome. This review considers whether current intakes of sugar are harmful to health, and analyses recent literature using a systematic approach to collate, rank, and evaluate published studies from 1995-2006. Results from high quality obesity studies did not suggest a positive association between body mass index and sugar intake. Some studies, specifically on sweetened beverages, highlighted a potential concern in relation to obesity risk, although these were limited by important methodological issues. Diet adequacy appeared to be achieved across sugar intakes of 6 to 20% energy, depending on subject age. Studies on metabolic syndrome reported no adverse effects of sugar in the long-term, even at intakes of 40-50% energy. The evidence for colorectal cancer suggested an association with sugar, but this appeared to have been confounded by energy intake and glycemic load. There was no credible evidence linking sugar with attention-deficit, dementia, or depression. Regarding dental caries, combinations of sugar amount/frequency, fluoride exposure, and food adhesiveness were more reliable predictors of caries risk than the amount of sugar alone. Overall, the available evidence did not support a single quantitative sugar guideline covering all health issues.

Cariogenicity of soft drinks, milk and fruit juice in low-income african-american children: a longitudinal study

BACKGROUND

The authors conducted a study to test the hypothesis that high consumption of soft drinks, relative to milk and 100 percent fruit juice, is a risk factor for dental caries in low-income African-American children in Detroit.

METHODS

Trained dentists and interviewers examined a representative sample of 369 children, aged 3 to 5 years, in 2002-2003 and again two years later. The authors used the 2000 Block Kids Food Frequency Questionnaire (NutritionQuest, Berkeley, Calif.) to collect dietary information. They assessed caries by using the International Caries Detection and Assessment System.

RESULTS

Soft drinks, 100 percent fruit juice and milk represented the sugared beverages consumed by the cohort. A cluster analysis of the relative proportion of each drink at baseline and follow-up revealed four consumption patterns. Using zero-inflated negative binomial models, the authors found that children who changed from being low consumers of soft drinks at baseline to high consumers after two years had a 1.75 times higher mean number of new decayed, missing and filled tooth surfaces compared with low consumers of soft drinks at both time points.

CONCLUSION

Children who consumed more soft drinks, relative to milk and 100 percent fruit juice, as they grew older were at a greater risk of developing dental caries.

CLINICAL IMPLICATIONS

Health promotion programs and health care providers should emphasize to patients and caregivers the caries risk associated with consumption of soft drinks.

Processo de desenvolvimento de um questionário para avaliação de abuso e dependência de açúcar

Este estudo descreve o processo de desenvolvimento de um questionário para avaliação de possível abuso e dependência de açúcares extrínsecos não lácticos. Pesquisas recentes mostram que o consumo excessivo de açúcares extrínsecos não lácticos pode levar a alterações no sistema nervoso central a partir da influência destas substâncias no sistema neuroquímico de recompensa. O desenvolvimento desse instrumento ocorreu com base na adaptação do módulo "L" do questionário MINI-Plus por quatro grupos focais, e pela avaliação feita por uma comissão de especialistas na área de dependência química. O questionário apresenta algumas modificações de conteúdo em relação ao instrumento original, como substituições de palavras que estariam de melhor acordo com a substância em estudo; entretanto, manteve a estrutura original com vinte questões sobre abuso e dependência. Um instrumento de avaliação de dependência e abuso de açúcares extrínsecos não lácticos poderá no futuro ajudar os profissionais da saúde a prevenir e tratar problemas relacionados ao consumo de açúcar. É importante salientar que o diagnóstico de abuso e dependência de açúcar ainda deverá ser melhor avaliado pela comunidade científica, assim como as propriedades psicométricas desse instrumento.

Variation in assessing the need for change of snacking habits in schoolchildren's oral health counselling

OBJECTIVES

This study examined counselling communication activities that were used for assessing schoolchildren's need for change of snacking habits. In addition, the schoolchildren's assessment of their need for change was explored after a follow-up year (2002-2003).

MATERIAL AND METHODS

The follow-up research data included 66 counselling sessions in 2002 and 31 counselling sessions in 2003, with 31 schoolchildren. The sessions were conducted by four dental hygienists. The audio-taped data were analysed qualitatively by using content analysis.

RESULTS

In 2002, the needs assessment was realized in three ways. Infrequently, the schoolchildren either disclosed their need for change or the counsellor explicitly determined the schoolchildren's need for change. Usually, however, the schoolchildren's needs assessment for change occurred through the counsellors' communication activities of assessment, advice, and change-inducing questions. In one-third of the cases, the schoolchildren's need for change remained ambiguous during the sessions in 2002. With respect to positive changes in 2003, the schoolchildren themselves were aware of the need for change. Alternatively, the sessions included change discussion that addressed readiness for change and making changes during the counselling in 2002.

CONCLUSION

Our results revealed that a thorough needs assessment of schoolchildren's snacking habits provides a foundation for behaviourally focused counselling.

Sources of total, non-milk extrinsic, and intrinsic and milk sugars in the diets of older adults living in sheltered accommodation

The WHO recommends limiting non-milk extrinsic sugars (NMES) consumption to < or = 10 % energy to reduce the risk of unhealthy weight gain and dental caries, and to restrict frequency of intake to < or = 4 times/d to reduce risk of dental caries. Older adults, especially those from low-income backgrounds, are at increased risk of dental caries, yet there is little information on sugars intake (frequency of intake and food sources) in this age group. The aim of this report is to present baseline data from a community-based dietary intervention study of older adults from socially deprived areas of North East England, on the quantity and sources of total sugars, NMES, and intrinsic and milk sugars, and on frequency of NMES intake. Dietary intake was assessed using two 3-d estimated food diaries, completed by 201 participants (170 female, thirty-one male) aged 65-85 years (mean 76.7 (sd 5.5) years) recruited from sheltered housing schemes. Total sugars represented 19.6 %, NMES 9.3 %, and intrinsic and milk sugars 10.3 % of daily energy intake. Eighty-one (40.3 %) exceeded the NMES intake recommendation. Mean frequency of NMES intake was 3.4 times/d. The fifty-three participants (26.4 %) who exceeded the frequency recommendation ( < or = 4 times/d) obtained a significantly greater percentage of energy from NMES compared with those participants who met the recommendation. The food groups 'biscuits and cakes' (18.9 %), 'soft drinks' (13.1 %) and 'table sugar' (11.1 %) made the greatest contributions to intakes of NMES. Interventions to reduce NMES intake should focus on limiting quantity and frequency of intake of these food groups.

Nutrition, oral health and the young child

Oral health is integral to general health and essential to well-being and quality of life. Socio-behavioural and environmental factors play a significant role in oral disease and oral health. Dental caries is a global disease with few populations exempt from its effects. In developing countries, as development increases so does dental caries and children are at the forefront of the disease disadvantage. There is a growing need to identify high caries risk groups accurately to commence prevention from a young age. The effect of early intervention in childhood on general and dental health with both population and high-risk approaches also needs examining. As an educational tool, the paediatric food-based dietary guidelines may play a significant role in nutrition and oral health interventions. This paper provides information on nutrition, including access to fluoride and use of sugar. Oral health concerns, such as early childhood caries, which are important for the young child, are also discussed.

Changes in consumption of sugars by English adolescents over 20 years

OBJECTIVE

Dietary surveys of 11- to 12-year-old Northumbrian children in 1980 and 1990 revealed that consumption of non-milk extrinsic sugars (NMES) was 16-17% of energy intake. This study reports dietary sugars consumption in 2000 and compares it with data collected in 1980 and 1990, using identical methods.

DESIGN

A repeat cross-sectional dietary survey of children aged 1-12 years attending the same schools as in the 1980 and 1990 surveys.

SETTING

Seven middle schools in south Northumberland.

SUBJECTS

All children aged 11-12 years old attending the seven schools.

METHOD

Food consumption was recorded using two 3-day diet diaries. Food composition tables were used to calculate energy and nutrient intakes. NMES, and milk and intrinsic sugars were calculated using previously described methods.

RESULTS

The numbers of children completing the surveys in 1980, 1990 and 2000 were 405, 379 and 424, respectively; approximately 60-70% of eligible children. Total sugars provided 22% of energy consistently over the three surveys. NMES consumption in 2000 provided 16% of energy compared with 16% in 1980 and 17% in 1990. Sources of NMES changed over the three surveys. NMES from soft drinks doubled from 15 to 31 g day(-1), and from breakfast cereals increased from 2 to 7 g day(-1) over the 20 years. Confectionery and soft drinks provided 61% of NMES. Over 20 years, the proportion of energy from fat decreased by 5% and from starch increased by 4%, creating a welcome tilt in the fat-starch see-saw, without an adverse effect on sugars intake.

CONCLUSIONS

Consumption of NMES in 2000 was substantially higher than recommended, and there has been little change over 20 years. Continued and coordinated efforts are required at a national, community and individual level to reduce the intake of NMES.

Comparison of the intakes of sugars by young children with and without dental caries experience

BACKGROUND

Relationships among sugars and dental caries in contemporary societies are unclear. The authors describe young children's intakes of nonmilk extrinsic (NME) and intrinsic/milk sugars and relate those intakes to dental caries.

METHODS

The authors conducted cross-sectional analyses of dietary data collected from the Iowa Fluoride Study using three-day diaries for subjects at ages 1, 2, 3, 4 and 5 years and for subjects aged 1 through 5 years according to dental caries experience at 4.5 to 6.9 years of age. They categorized foods and beverages as containing NME or intrinsic/milk sugars.

RESULTS

Subjects' total, NME, food NME and intrinsic/milk sugars intakes at ages studied did not differ between subjects with and without caries experience. Beverage NME sugars intakes at age 3 years predicted caries (P < .05) in logistic regression models adjusted for age at dental examination and for fluoride intake.

CONCLUSIONS

Dental caries is a complex, multifactorial disease process dependent on the presence of oral bacteria, a fermentable carbohydrate substrate and host enamel. A simple NME-intrinsic/milk sugars categorization appears insufficient to capture the complex dietary component of the caries process.

CLINICAL IMPLICATIONS

Cariogenicity is more likely a function of the food and/or beverage vehicle delivering the sugar and the nature of exposure-that is, frequency and length of eating events-than of the sugar's categorization.

Oral candidiasis and nutritional deficiencies in elderly hospitalised patients

The prevalence of oral candidiasis and its association with malnutrition in terms of protein–energy malnutrition and mineral and vitamin depletion were evaluated in ninety-seven hospitalised older adults aged 82·1 (SD 8·6) years. Patients underwent a complete oral examination with microbiological investigation on admission to our geriatric rehabilitation unit. Patients were assessed nutritionally by evaluation of dietary intake and measurement of anthropometric variables, serum nutritional proteins, ferritin, Zn, folate, vitamins B12 and C. The prevalence of oral candidiasis was 37% (n 36); the proportion of patients with BMI <20 kg/m2 was 32% (n 31). The nutritional status of the population was studied by comparing two groups defined according to the absence (group I; n 61) or presence (group II; n 36) of oral candidiasis. The two groups did not differ on the basis of BMI and mid-arm circumference. However, group II had a smaller leg circumference, lower daily energy and protein intakes, lower albumin and transthyretin levels. Patients successfully treated with fluconazole increased their intake on day 30. The proportion of patients with hypozincaemia (<12·5 μmol/l) and vitamin C deficiency (<0·7 mg/l) was higher in group II. Treatment with antibiotics, poor oral hygiene, denture wearing, and vitamin C deficiency appeared as the most significant independent risk factors associated with oral candidiasis. The present findings show that oral candidiasis appears to be related to malnutrition and results in mucosal lesions that have a negative impact on energy intake, which may subsequently worsen nutritional status.

Comparison of methods to estimate non-milk extrinsic sugars and their application to sugars in the diet of young adolescents

Consistent information on the non-milk extrinsic sugars (NMES) content of foods and the NMES intake by the population is required in order to allow comparisons between dietary surveys. A critical appraisal of methods of NMES estimation was conducted to investigate whether the different published methods for estimating the NMES content of foods lead to significantly different values for the dietary intake of NMES by children and to consider the relative practicality of each method. NMES values of foods were calculated using three different published descriptions of methods of NMES estimation, and the values were compared within food groups. Dietary intake values for English children aged 11–12 years were calculated using each method and compared in terms of overall NMES intake and the contribution of different food groups to NMES intake. There was no significant difference in the dietary intake of NMES in children between the method used in the National Diet and Nutrition Surveys (NDNS) (81·9 g/d; 95 % CI 79·0, 84·7) and a method developed by the Human Nutrition Research Centre (84·3 g/d; 95 % CI 81·4, 87·2) at Newcastle University, UK, although the latter gave slightly higher values. An earlier method used by the Ministry of Agriculture, Food and Fisheries gave significantly higher values than the other two methods (102·5 g/d; 95 % CI 99·3, 105·6; P<0·05). The method used in the NDNS surveys and the method used by the Human Nutrition Research Centre at Newcastle University are both thorough and detailed methods that give consistent results. However, the method used in the NDNS surveys was more straightforward to apply in practice and is the best method for a single uniform approach to the estimation of NMES.

Oral health counselling in changing schoolchildren's oral hygiene habits: a qualitative study

OBJECTIVE

This study explored oral health counselling concerning changes of oral hygiene habits in 11- to 13-year-old schoolchildren within a theoretical framework of the transtheoretical model and the motivational interview.

METHODS

The follow-up data (2002-2003) formed two sequential parts: the first part comprised 66 counselling sessions in 2002; the second part included 31 counselling sessions in 2003. Thirty-one (n = 31) schoolchildren were included in the counselling sessions that were conducted by four dental hygienists. The audiotaped and transcribed data were analysed qualitatively by using content analysis.

RESULTS

In 2002, nearly every schoolchild needed to establish changes in oral hygiene habits but the assessment of schoolchildren's readiness for change often remained unclear. In 2002, giving normative advice was the most commonly used counselling strategy when addressing the need for change, but dental hygienist-centred change discussion and goal setting were also apparent and were related to the schoolchildren's rarely manifested changes of oral hygiene habits after a follow-up year.

CONCLUSIONS

Our results suggest that the theoretical framework might be useful in constructing and focusing on oral hygiene counselling for schoolchildren that concentrates on the personal dynamics of change. Further qualitative research is called for.

Dietary patterns related to caries in a low-income adult population

The aim of this study was to examine the relationship between dietary patterns and caries experience in a representative group of low-income African-American adults. Participants were residents of Detroit, Michigan, with household incomes below 250% of the federally-established poverty level (n = 1,021). Dietary histories were obtained by trained interviewers in face-to-face interviews with the adult participants, using the Block 98.2 food frequency questionnaire. Caries was measured by the ICDAS criteria (International Caries Detection and Assessment System). There were 200 dietary records whose data were judged to be invalid; these participants were omitted from the dietary analyses to leave n = 821. Factor analysis identified patterns of liquid and solid food consumption, and the resulting factor scores were used as covariates in multivariable linear regression. Caries was extensive, with 82.3% of the 1,021 participants (n = 839) having at least one cavitated lesion. Nearly three quarters of the adult participants were overweight or obese. This population had severe caries, poor oral hygiene, and diets that are high in sugars and fats and low in fruits and vegetables. Apart from tap water, the most frequently consumed food item by adults of all ages was soft drinks; 19% of all energy from sugar came from soft drinks alone. In both the bivariate analyses and in the regression model, frequency of soft drink consumption and the presence of gingival plaque deposits were significantly associated with caries. Interventions to promote oral health are unlikely to be successful without improvements in the social and physical environment.

Dental caries

Dental caries, otherwise known as tooth decay, is one of the most prevalent chronic diseases of people worldwide; individuals are susceptible to this disease throughout their lifetime. Dental caries forms through a complex interaction over time between acid-producing bacteria and fermentable carbohydrate, and many host factors including teeth and saliva. The disease develops in both the crowns and roots of teeth, and it can arise in early childhood as an aggressive tooth decay that affects the primary teeth of infants and toddlers. Risk for caries includes physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, and poverty. The approach to primary prevention should be based on common risk factors. Secondary prevention and treatment should focus on management of the caries process over time for individual patients, with a minimally invasive, tissue-preserving approach.

Diet, nutrition and the prevention of dental diseases

Oral health is related to diet in many ways, for example, nutritional influences on craniofacial development, oral cancer and oral infectious diseases. Dental diseases impact considerably on self-esteem and quality of life and are expensive to treat. The objective of this paper is to review the evidence for an association between nutrition, diet and dental diseases and to present dietary recommendations for their prevention. Nutrition affects the teeth during development and malnutrition may exacerbate periodontal and oral infectious diseases. However, the most significant effect of nutrition on teeth is the local action of diet in the mouth on the development of dental caries and enamel erosion. Dental erosion is increasing and is associated with dietary acids, a major source of which is soft drinks.

Despite improved trends in levels of dental caries in developed countries, dental caries remains prevalent and is increasing in some developing countries undergoing nutrition transition. There is convincing evidence, collectively from human intervention studies, epidemiological studies, animal studies and experimental studies, for an association between the amount and frequency of free sugars intake and dental caries. Although other fermentable carbohydrates may not be totally blameless, epidemiological studies show that consumption of starchy staple foods and fresh fruit are associated with low levels of dental caries. Fluoride reduces caries risk but has not eliminated dental caries and many countries do not have adequate exposure to fluoride.

It is important that countries with a low intake of free sugars do not increase intake, as the available evidence shows that when free sugars consumption is <15–20kg/yr (~6–10% energy intake), dental caries is low. For countries with high consumption levels it is recommended that national health authorities and decision-makers formulate country-specific and community-specific goals for reducing the amount of free sugars aiming towards the recommended maximum of no more than 10% of energy intake. In addition, the frequency of consumption of foods containing free sugars should be limited to a maximum of 4 times per day. It is the responsibility of national authorities to ensure implementation of feasible fluoride programmes for their country.

Breast-feeding at 12 months of age and dietary habits among breast-fed and non-breast-fed infants

Objective:

To analyse factors associated with breast-feeding and use of sweetened drinks at 12 months, and to compare dietary habits among breast-fed and non-breast-fed infants.

Design:

Data were collected by a semi-quantitative food-frequency questionnaire filled in by the parents.

Setting:

National dietary survey in Norway.

Subjects:

In total, 1932 12-month-old infants were included.

Results:

At 12 months, 36% of the infants were breast-fed. The odds of breast-feeding at this age were more than doubled both for mothers ≥35 years compared with mothers <25 years and for mothers in the highest educational group compared with mothers in the lowest. A negative association was found for maternal smoking, and the odds of breast-feeding were 40% lower for mothers who smoked than for non-smokers. Some dietary differences were observed between breast-fed and non-breast-fed infants apart from intake of milk. In particular, breast-fed infants had a significantly lower daily intake of sweetened drinks than non-breast-fed infants and a 16% lower mean daily intake of added sugars (P < 0.001). Furthermore, breast-fed infants had 30% higher odds of not receiving sweetened drinks daily, compared with non-breast-fed infants.

Conclusions:

Maternal age, education and smoking status were important factors for breast-feeding at 12 months. Breast-fed infants had lower intakes of sweetened drinks and added sugars than non-breast-fed infants. From a public health perspective, continued promotion of breast-feeding is needed to reduce inequalities in breast-feeding. Moreover, prevention of high intakes of sweetened drinks and added sugars should start in infancy.

Diet Intake and Caries Prevalence in Four-Year-Old Children Living in a Low-Prevalence Country

Preventive measures have dramatically decreased the prevalence of dental caries in children. However, risk factors for the disease in children living in low-prevalence areas remain elusive. In the present study we evaluated associations between dental caries, saliva levels of mutans streptococci and lactobacilli, and diet with special emphasis on the intake of fermentable carbohydrates and dairy products in 4-year-old children living in an area where the overall caries prevalence was low. Dietary intake was recorded in 234 infants as part of the Study of Infant Nutrition in Umeå, Sweden (SINUS). Of these the parents of 124 children gave consent to participate in a follow-up at 4 years of age. Dietary intake, height and weight, dental caries, oral hygiene, including tooth brushing habits, presence of plaque and gingival inflammation, fluoride habits and numbers of mutans streptococci and lactobacilli in saliva were recorded. Using multivariate stepwise logistic regression, caries experience was negatively associated with intake frequency of cheese (OR = 0.67; 95% CI = 0.44-0.98) and positively associated with the salivary level of mutans streptococci (OR = 1.57; 95% CI = 1.21-2.03). Caries experience was not correlated with intake frequency or amounts of carbohydrate-containing foods, with any other particular food, or with daily intake of energy, carbohydrate or any other macro- or micronutrient. We conclude that cheese intake may have a caries-protective effect in childhood populations where the overall caries prevalence and caries experience are low and the children are regularly exposed to fluoride from toothpaste.

The potential impact of neighborhood empowerment on dental caries among adolescents

OBJECTIVE

Empowerment has been considered a dimension of social capital. It refers to social interaction processes that enable people to enhance their individual and collective skills and to exert greater control over their lives. This relationship has not been explored in relation to dental health. The objective of this study was to investigate the association between neighborhood empowerment and dental caries in adolescents.

METHODS

A multilevel study was designed to assess the individual and neighborhood effects on the oral health of adolescents. Four sources of data were used: (a) clinical examinations (WHO), (b) students' questionnaires, (c) parents' questionnaires and (d) census data. The study population was 1302, 14/15-year-old students from 39 public schools of two cities of the Distrito Federal (DF), Brazil. Data analysis used logistic multilevel modeling at two levels: students (sources a and b) and neighborhood as defined by catchment areas of schools (sources c and d).

RESULTS

High DMFT (DMFT > median, DMFT > or =3) rates were significantly lower in areas with higher levels of empowerment. This relationship was independent of socioeconomic variables at the individual and area levels and of all other individual risk factor variables such as sex, fluoride, sugar consumption, tooth brushing and dental attendance [OR for low compared with high empowerment was 1.54 (95% CI = 1.09-2.18), P = 0.014].

CONCLUSIONS

Neighborhood empowerment may play an important role in explaining inequalities in the levels of dental caries. New perspectives are needed so that more effective interventions can be implemented using area-based perspectives.

The human sweet tooth

Humans love the taste of sugar and the word "sweet" is used to describe not only this basic taste quality but also something that is desirable or pleasurable, e.g., la dolce vita. Although sugar or sweetened foods are generally among the most preferred choices, not everyone likes sugar, especially at high concentrations. The focus of my group's research is to understand why some people have a sweet tooth and others do not. We have used genetic and molecular techniques in humans, rats, mice, cats and primates to understand the origins of sweet taste perception. Our studies demonstrate that there are two sweet receptor genes (TAS1R2 and TAS1R3), and alleles of one of the two genes predict the avidity with which some mammals drink sweet solutions. We also find a relationship between sweet and bitter perception. Children who are genetically more sensitive to bitter compounds report that very sweet solutions are more pleasant and they prefer sweet carbonated beverages more than milk, relative to less bitter-sensitive peers. Overall, people differ in their ability to perceive the basic tastes, and particular constellations of genes and experience may drive some people, but not others, toward a caries-inducing sweet diet. Future studies will be designed to understand how a genetic preference for sweet food and drink might contribute to the development of dental caries.

Assessment of the relationship between neighborhood characteristics and dental caries severity among low-income African-Americans: a multilevel approach

OBJECTIVES

To assess the relationship between neighborhood effects and the severity of dental caries among low-income African-Americans.

METHODS

A multistage probability sample of African-American families living in the poorest 39 census tracts in Detroit was drawn. During 2002-03, cross-sectional data of a cohort that includes 1021 caregivers were collected in the first of three waves of interviews and examinations. Multilevel analyses focused on 27 neighborhood clusters and involved a combination of individual (Level-1) and neighborhood (Level-2) data including census and geocoded (address matching to census geographic areas) information.

RESULTS

There is significant variation in the severity of caries between low-income neighborhood clusters. Caries severity decreases with a higher number of churches, while it increases with a higher number of grocery stores in the clusters after accounting for individual characteristics. Only 14% of the inter-individual variability in caries was explained by classical individual risk factors for this condition.

CONCLUSION

Neighborhoods contribute something unique to caregivers' oral health, beyond socioeconomic position and individual risk factors. Multilevel interventions are necessary to reduce disparities among African-Americans and churches may offer a promising venue from which to conduct them.

The interrelationship between diet and oral health

Diet and nutrition impact on many oral diseases, in particular dental caries. Consumption of fluoridated water coupled with a reduction in non-milk extrinsic sugar intake is an effective means of caries prevention. However, studies on the fluoride concentration of bottled waters suggest increased consumption of these waters, in preference to fluoridated tap water, would lead to a marked decrease in caries protection. Concerns have been raised about the bioavailability of fluoride from artificially-fluoridated water compared with naturally-fluoridated water. This issue has been addressed in a human experimental study that has indicated that any differences in fluoride bioavailability are small compared with the naturally-occurring variability in fluoride absorption. Research has unequivocally shown sugars to be the main aetiological factor for dental caries, and information on intakes guides health promotion. Repeat dietary surveys of English children over three decades indicate that levels of sugars intake have remained stable, while sources of sugars have changed considerably, with the contribution from soft drinks more than doubling since 1980. Dental caries eventually leads to tooth loss, which in turn impairs chewing ability causing avoidance of hard and fibrous foods including fruits, vegetables and whole grains. A very low intake (<12 g/d) of NSP and fruit and vegetables has been found in edentulous subjects. Provision of prostheses alone fails to improve diet. However, initial studies indicate that customised dietary advice at the time of denture provision results in increased consumption of fruits and vegetables, and positive movement through the stages of change. Feasible means of integrating dietary counselling into the dental setting warrants further investigation.