Intake of dairy products and the prevalence of dental caries in young children

A study on the relationship between cheese intake and caries occurrence based on Mendelian randomization method

Objective

The study aims to investigate the causal relationship between cheese intake and caries occurrence by a two-sample Mendelian randomization method (TSMR).

Methods

Data from a genome-wide association study (GWAS) on cheese intake as an exposure factor were collected, and dental caries was the outcome variable, appropriate SNPs were selected as instrumental variables (IVs). The TSMR was analyzed by the inverse variance weighting (IVW) method, weighted median method, MR-Egger regression method, simple model and weighted model.

Results

We identified forty-four single-nucleotide polymorphisms (SNPs) in the gene encoding group-specific component (cheese) that were associated with cheese intake, and IVW was adopted. The IVW method supported a relationship between cheese intake and the risk of dental caries occurrence[OR,1.00(95 %CI,0.99-1.00), P = 0.039 < 0.05]. There was no horizontal pleiotropy between the IVs(b = -0.0037, P = 0.39), and the sensitivity analysis using the "leave-one-out" method was robust to causal effects.

Conclusion

The results of the TSMR analysis supported that an appropriate intake of cheese could reduce the occurrence of dental caries.

Impact of Dairy Products and Plant-Based Alternatives on Dental Health: Food Matrix Effects

The impact of dairy products on dental health has been researched widely and shows an important role of various constituents, as well as the specific product matrix, in maintaining and improving dental health. These include, for instance, the position of lactose as the least cariogenic fermentable sugar, the high levels of calcium and phosphate, the presence of phosphopeptides as well as the antibacterial peptides lactoferrin and lysozyme and high buffering capacity. With plant-based alternatives for dairy products being developed and marketed these days, the specific benefits of dairy products in relation to dental health are often overlooked and most products contain more cariogenic carbohydrates, lack phosphopeptides, and have fewer minerals and less buffering capacity. Comparative studies performed to date indeed suggest that plant-based products do not match dairy counterparts when it comes to maintaining and improving dental health. Careful consideration of these aspects is required in relation to future developments of products and human diets. In this paper, we review the impact of dairy products and plant-based dairy alternatives on dental health.

Authenticity assessment of dairy products by capillary electrophoresis

Milk and derivatives are a very important part in the diet of the world population. Products from goat, buffalo, and sheep species have a greater economic value than the cow ones, therefore, authenticity frauds by improperly adding cow's milk occur frequently: dairy products are among the seven more attractive foods for adulteration. Milk from each of the above-cited animal species has its own definite profile of whey proteins (variants of α-lactalbumin and β-lactoglobulin) and its definite profile of caseins (variants of α_S1 -, α_S2 -, β-, and κ-casein). Such proteins can be usefully exploited as markers of authenticity by using capillary electrophoresis which is the technique of choice for the analysis of proteins. Due to the multiple adjustable parameters that are unknown to other analytical techniques, capillary electrophoresis is able to detect frauds in milk mixtures and cheese with little use of solvents, fast analysis time, and ease of operation. This makes it attractive and competitive for routine checks that are very important to fight the adulteration market. Advantages and limitations are discussed.

Long-Term Fluctuation of Oral Biofilm Microbiota following Different Dietary Phases

Caries development is associated with shifts in the oral biofilm microbiota and primarily linked to frequent simple carbohydrate consumption. Different nutritional ingredients can either promote or prevent caries development. To investigate the effects of selected ingredients on the oral biofilm microbiota in situ, 11 study participants underwent 3-month-long dietary phases with intake of a regular diet (PI), additional frequent sucrose (PII), milk and yoghurt (PIII), and a diet rich in dietary fiber (PIV) and then returned to their regular diet (PV). Oral biofilm was sampled and analyzed applying 16S rRNA Illumina MiSeq sequencing. Additionally, the effect on the enamel was analyzed by measuring enamel surface roughness with laser scanning microscopy. The beta-diversity results showed that the microbiota in all the following phases differed significantly from PI and that the microbial community in PII was significantly different from all other phases. The abundance of the genus Streptococcus fluctuated over the course of the five phases, with a significant increase in PII (P = 0.01), decreasing in PIII and PIV (PIII and PIV versus PII: P < 0.00001) and increasing again toward PV. Other taxa showed various fluctuations of their abundances, with PV returning approximately to the levels of PI. In conclusion, while elevated sucrose consumption favored caries-promoting non-mutans streptococci, frequent milk and yoghurt intake caused a significant decrease in the abundance of these microbial taxa and in addition reduced enamel surface roughness. These results indicate that modulations of the oral biofilm microbiota can be attained even in adults through dietary changes and corresponding recommendations can be made for the prevention of caries development.IMPORTANCE Caries affects a large proportion of the population worldwide, resulting in high treatment costs. Its etiology can be ascribed to shifts of the microbiota in dental biofilms primarily driven by dietary factors. It is unclear how diet affects the microbial community of plaque biofilm in situ and whether it can be modulated to help prevent caries development. To address these issues, we analyzed changes of the in situ plaque microbiota following 3-month-long dietary changes involving elevated sucrose, dairy, and dietary fiber consumption over a period of 15 months. Applying high-throughput sequencing, we found non-mutans streptococci, a taxonomic group involved in the beginning stages toward microbial dysbiosis, in decreased abundance with elevated dairy and dietary fiber intake. Through analysis of the enamel surface roughness, these effects were confirmed. Therefore, correspondent dietary measures can be recommended for children as well as adults for caries prevention.

Effects of soy and bovine milk beverages on enamel mineral content in a randomized, double-blind in situ clinical study

Soy beverages are promoted as healthy alternatives to bovine milk even though they can contain added sugar.

OBJECTIVES

To compare enamel mineral content after consumption of bovine milk or a soy beverage in a double-blind, randomized, cross-over in situ clinical study.

MATERIALS AND METHODS

Human enamel slabs with subsurface lesions were prepared and inserted into intra-oral appliances worn by volunteers who consumed 200 ml of either bovine milk or a soy beverage over a 60 s period once a day for 15 days. Enamel lesion depth and mineral content were measured using transverse microradiography. Saliva samples were collected immediately after consuming the beverages and calcium, inorganic phosphate and fluoride levels analysed. Data were statistically analysed using a linear mixed model.

RESULTS

Depth of the enamel subsurface lesions increased by 7.1 ± 2.0 μm and mineral content decreased by 47 ± 22 vol% min.μm after consumption of the soy beverage indicating demineralization. However, after consumption of bovine milk the depth of the lesions decreased by 7.6 ± 3.5 μm and mineral content increased by 202 ± 43 vol% min.μm indicating remineralization. The changes were significantly different (p < 0.001) between the two beverages. Fluoride levels were similar in the saliva samples for both beverages, however the calcium and inorganic phosphate levels for the bovine milk group were significantly higher (p < 0.02) than those for the soy beverage group.

CONCLUSIONS

In this randomized, double-blind in situ clinical trial consumption of a soy beverage demineralized enamel whereas bovine milk produced remineralization.

CLINICAL SIGNIFICANCE

Although soy beverages are promoted as healthy alternatives to bovine milk the added sugar and low calcium bioavailability of the soy drink makes frequent consumption a caries risk. (Trial registration no. ISRCTN19137849).

Impact of Nutrition Education on the Compliance with Model Food Ration in 231 Preschools, Poland: Results of Eating Healthy, Growing Healthy Program

To ensure the adequate supply of nutrients, a model food ration (MFR) should be used for planning the menu. The purpose of the study was to determine the effects of the nutrition education program on the compliance with MFR in 231 preschools. The average supply of food products (per child/day) with reference to the MFR was examined on the baseline and 3 to 6 months after education on the basis of 10-day menus and daily inventory reports (4620 in total). According to the recommendations, preschool should implement 70⁻75% of the recommended daily intake standards. Examined menus had too high content of meat and meat products, whereas vegetables, milk and fermented milk beverages, cottage cheese and eggs were served in scarce. Education significantly reduced the amount of meat (47.7 vs. 44.5 g), processed meat (16.2 vs. 14.4 g), sugar and sweets (15.9 vs. 14.4 g) and increased the amount of cereals, groats, rice (17.7 vs. 18.5 g), vegetables (164.3 vs. 170.8 g), milk and fermented milk beverages (200.3 vs. 209.5 g) but the compliance with the MFR remained poor. The evaluation of menus stressed the need for further modifying their composition. Education can positively affect the quality of nutrition; however, introduction of the legal nutritional regulations should be recommended.

Self-reported bovine milk intake is associated with oral microbiota composition

Bovine milk intake has been associated with various disease outcomes, with modulation of the gastro-intestinal microbiome being suggested as one potential mechanism. The aim of the present study was to explore the oral microbiota in relation to variation in self-reported milk intake. Saliva and tooth biofilm microbiota was characterized by 16S rDNA sequencing, PCR and cultivation in 154 Swedish adolescents, and information on diet and other lifestyle markers were obtained from a questionnaire, and dental caries from clinical examination. A replication cohort of 31,571 adults with similar information on diet intake, other lifestyle markers and caries was also studied. Multivariate partial least squares (PLS) modelling separated adolescents with low milk intake (lowest tertile with <0.4 servings/day) apart from those with high intake of milk (≥3.7 servings/day) based on saliva and tooth biofilm, respectively. Taxa in several genera contributed to this separation, and milk intake was inversely associated with the caries causing Streptococcus mutans in saliva and tooth biofilm samples by sequencing, PCR and cultivation. Despite the difference in S. mutans colonization, caries prevalence did not differ between milk consumption groups in the adolescents or the adults in the replication cohort, which may reflect that a significant positive association between intake of milk and sweet products was present in both the study and replication group. It was concluded that high milk intake correlates with different oral microbiota and it is hypothesized that milk may confer similar effects in the gut. The study also illustrated that reduction of one single disease associated bacterial species, such as S. mutans by milk intake, may modulate but not prevent development of complex diseases, such as caries, due to adverse effects from other causal factors, such as sugar intake in the present study.

A systematic review of behavioural interventions to increase maternal calcium intake

Pregnancy and lactation are a time when adequate calcium consumption is essential for the development of the fetus and to ensure the health of the mother. Over 50% of Canadian women of childbearing and rearing age fail to meet the recommended daily intake of calcium. Identification of effective behavioural intervention strategies for increasing calcium intake is needed within this specific population. This paper brings together all published behavioural interventions designed to increase calcium consumption in pregnant, lactating or post-partum mothers in a systematic review. Relevant studies were obtained through searches of MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library with no date restrictions. Studies were evaluated using previously published criteria for evaluating calcium behaviour change interventions. This systematic literature review identified five behavioural calcium interventions conducted within this population. Three interventions aimed to improve overall dietary behaviours, the fourth aimed to promote breastfeeding (including increasing calcium consumption) and the fifth aimed to increase daily servings of yoghurt. Only one of the five interventions yielded large effect sizes, with a mean change of 954 mg of calcium per day post-intervention. The number of behavioural change techniques did not appear to be related to intervention efficacy. Only one study used a theoretical framework to guide the intervention. This review highlights the lack of research examining behaviour change interventions aimed at increasing calcium consumption in pregnant, lactating and post-partum women and provides practical suggestions for researchers wishing to intervene with this population in the future.

Association between dairy intake and caries among children and adolescents. results from the Danish EYHS follow-up study

The aim of this paper was to investigate associations between the intake of dairy products and the development in caries (DMFS, decayed, missing and filled surfaces) among children/adolescents over a period of 3 and 6 years, and to investigate whether dairy intake protects against caries incidence. A total of 68.9% of the children were caries free at the age of 9 compared with 34.0% of the adolescents at the age of 15 (measured as DMFS = 0). A larger percentage of children/adolescents with a dairy intake above the mean were caries free compared with the group of children/adolescents with an intake below the mean (72.8 vs. 65.8% at age 9 and 41.1 vs. 30.7% at age 15). The results from the generalized estimation equation showed that dairy and milk intake, as well as intakes of components of dairy such as dairy calcium, whey and casein, was generally inversely associated with childhood/adolescent caries experience (measured as DMFS). With regard to caries incidence, the same inverse association was found for incidence over a period of 3 years and for incidence over 6 years, but the results were only statistically significant for the 3-year incidence and for the unadjusted models of the 6-year incidence. This study found that previous dairy intake, as well as milk intake or intake of dairy components, may be a predictor of future risk of caries measured by the DMFS count level. This relationship was inverse, meaning that a high intake of dairy products was associated with less future caries development. However, more studies on larger cohorts are needed to confirm these findings.

Feeding practices in infancy associated with caries incidence in early childhood

BACKGROUND

Early-life feeding behaviors foretell later dietary habits and health outcomes. Few studies have examined infant dietary patterns and caries occurrence prospectively.

OBJECTIVE

Assess whether patterns in food and drink consumption before age 12 months are associated with caries incidence by preschool age.

METHODS

We collected early-life feeding data within a birth cohort from low-income families in Porto Alegre, Brazil. Three dietary indexes were defined, based on refined sugar content and/or previously reported caries associations: a count of sweet foods or drinks introduced <6-months (e.g., candy, cookies, soft drinks), a count of other, nonsweet items introduced <6-months (e.g., beans, meat), and a count of sweet items consumed at 12 months. Incidence of severe early childhood caries (S-ECC) at age 38 months (N = 458) was compared by score tertile on each index, adjusted for family, maternal, and child characteristics using regression modeling.

RESULTS

Introduction to a greater number of presumably cariogenic items in infancy was positively associated with future caries. S-ECC incidence was highest in the uppermost tertile of the '6-month sweet index' (adjusted cumulative incidence ratio, RR, versus lowest tertile: 1.46; 95% CI: 0.97, 2.04) and the uppermost tertile of the '12-month sweet index' (RR: 1.55; 95% CI: 1.17, 2.23). The association was specific for sweet items: caries incidence did not differ by tertile of the '6-month nonsweet index' (RR: 1.00; 95% CI: 0.70, 1.40). Additionally, each one-unit increase on the 6-month and the 12-month sweet indexes, but not the 6-month nonsweet index, was statistically significantly associated with greater S-ECC incidence and associated with more decayed, missing, or restored teeth. Results were robust to minor changes in the items constituting each index and persisted if liquid items were excluded.

CONCLUSIONS

Dietary factors observed before age 12-months were associated with S-ECC at preschool age, highlighting a need for timely, multilevel intervention.

Caries in adolescents in relation to their skeletal status

OBJECTIVE

Despite well-known evidence of association of caries with bone metabolic diseases, there are only a small number of studies about caries and bone mineral density (BMD) on pediatric population. We evaluated the possibility of bone mineralization and metabolism disturbances in children with caries and compared them with healthy individuals.

MATERIALS AND METHODS

A total of 123 patients with caries (63 boys and 60 girls), aged 12-15 years, were included. The children were divided according caries stage: the decayed, missing, and filled tooth (DMFT) group (n=73) and the initial caries (IC) group (n=50), which have clinically active initial caries lesions on the enamel ("white spots"). Caries-free (CF) children (n=42) were the healthy controls. Bone mineralization was measured in all children with caries and healthy controls by dual-energy X-ray absorptiometry of the lumbar spine (L1-L4). For the assessment of bone metabolism, osteocalcin, carboxy terminal telopeptide of type I collagen (CTX), parathyroid hormone, Ca²⁺, inorganic phosphate, and total alkaline phosphatase were used.

RESULTS

Children with DMFT have low BMD and BMD Z score in association with low osteocalcin and high CTX levels, compared with IC (p=0.008 and p=0.0001, respectively) and CF children (p<0.0000 and p=0.0001, respectively). In DMFT, Ca²⁺ was significantly higher compared with IC (p=0.01) and CF (p=0.003). Caries stages negatively correlated with BMD (r=-0.86, p<0.001). A differently directed correlation between CTX and osteocalcin was detected: CTX was negatively related to osteocalcin in the DMFT group (r=-0.22, p=0.043) and positively related in the IC (r=0.42, p=0.002) and CF children (r=0.58, p=0.0000).

CONCLUSIONS

Children with any caries stage have decreased BMD accompanied with increased bone resorption. We consider that caries could be a marker of impact bone mineralization and metabolism.

Parental influence and the development of dental caries in children aged 0-6 years: a systematic review of the literature

OBJECTIVE

A well established body of research documents the role of individual factors, such as biology and diet, in the aetiology of early childhood caries (ECC). Recently empirical attention has shifted to the relationships between broader ecological influences (e.g., education, ethnicity and income) and ECC; however, how such determinants interplay in the aetiology of ECC remains unclear. An intermediary mechanism that warrants greater empirical attention is parental influences. This oversight is interesting given the primacy of the parent in governing the child's proximate environment and the likelihood of the child endorsing adaptive or maladaptive health attitudes, beliefs and behaviours. The objective of this paper was to conduct a systematic review of the evidence for parental influences on the development of caries in children aged 0-6 years.

DATA

All studies testing associations between dental caries and socio-demographic factors, feeding practices, parent attributes, behaviours, oral health, attitudes, knowledge and beliefs in children aged 0-6 years, published between 2006 and 2011.

SOURCE

Medline, ISI, Cochrane, Scopus, Global Health and CINAHL databases.

STUDY SELECTION

Fifty-five studies were included from an initial identification of 1805 studies.

CONCLUSIONS

To date, most research has focused on the association between caries and socio-demographic and feeding factors with few studies exploring parents' attributes, attitudes, knowledge and beliefs, and none exploring possible pathways between the multiple layers of influences potentially accounting for how determinants of ECC operate and traverse individual, familial, community, and socio-cultural contexts. Collaboration between Psychologists and Dentists may accelerate the identification and understanding of mechanisms that underlie risk associated with ECC.

Dairy products and calcium intake during pregnancy and dental caries in children

Background

Maternal nutrition status during pregnancy may affect fetal tooth development, formation, and mineralization, and may affect dental caries susceptibility in children. We investigated the association between maternal intake of dairy products and calcium during pregnancy and the risk of childhood dental caries.

Methods

Subjects were 315 Japanese mother-child pairs. Data on maternal intake during pregnancy were assessed through a diet history questionnaire. Outcome data was collected at 41–50 months of age. Children were classified as having dental caries if one or more primary teeth had decayed or been filled.

Results

Higher maternal cheese intake during pregnancy was significantly inversely associated with the risk of dental caries in children, showing a clear inverse dose–response relationship; the adjusted odds ratio (OR) in comparison of the highest tertile with the lowest was 0.37 (95 % confidence interval [CI]: 0.17-0.76, P for trend = 0.01). The inverse associations between maternal intake of total dairy products, yogurt, and calcium during pregnancy and the risk of childhood dental caries were of borderline significance: the adjusted ORs for the highest tertile of total dairy products, yogurt, and calcium were 0.51 (95 % CI: 0.23-1.09, P for trend = 0.07), 0.51 (95 % CI: 0.23-1.10, P for trend = 0.07), and 0.50 (95 % CI: 0.23-1.07, P for trend = 0.08), respectively. There was no evident relationship between maternal milk intake and the risk of childhood dental caries.

Conclusion

These data suggested that high intake of maternal cheese during pregnancy may reduce the risk of childhood dental caries.

Association between breastfeeding and dental caries in Japanese children

BACKGROUND

Studies investigating the impact of breastfeeding on dental caries have produced contradictory results. This cross-sectional study investigated the relationship between breastfeeding and the prevalence of dental caries in young Japanese children.

METHODS

The study subjects were 2056 Japanese children aged 3 years. Information on breastfeeding was obtained by means of a questionnaire. Children were classified as having caries if 1 or more deciduous teeth were decayed, missing, or had been filled at the time of examination.

RESULTS

The prevalence of dental caries was 20.7%. As compared with breastfeeding for less than 6 months, breastfeeding for 18 months or longer was associated with a significantly higher prevalence of dental caries. The relation was J-shaped: the adjusted prevalence ratios for less than 6 months, 6 to 11 months, 12 to 17 months, and 18 months or longer were 1.0, 0.79 (95% confidence interval [CI]: 0.60-1.05), 0.86 (95% CI: 0.66-1.13), and 1.66 (95% CI: 1.33-2.06), respectively (P for linear trend <0.0001, P for quadratic trend <0.0001).

CONCLUSIONS

Breastfeeding for 18 months or longer was positively associated with the prevalence of dental caries, while breastfeeding for 6 to 17 months was nonsignificantly inversely associated with the prevalence of dental caries.