A comparison of the effects of some extrinsic and intrinsic sugars on dental plaque pH

The Impact of Diet and Nutrition on the Oral Microbiome

At present, it is well known that oral health is essential for the well-being of the body as a whole, thanks to the increasing awareness of how various oral diseases, including periodontal disease, oral carcinomas, and other conditions, have a close connection with various systemic disorders. In recent decades, studies on the oral microbiome have increasingly emphasized how the balance between the host and the microbial species that coexist there is essential for oral health at all stages of life. However, there are many factors capable of interfering with that balance, and diet is precisely one of them. The real influence of diet on the oral microbiota, and consequently on oral health, has been much debated. In this context, the observation of two key periods in human history, the Neolithic and the Industrial Revolution, has proved to be diriment. The foods and processing techniques that emerged in these two historical periods, in association with changes in customs and habits, significantly altered the central constituents of the human diet, including macronutrient proportions, glycemic load, fatty acid composition, sodium and potassium levels, micronutrient levels, dietary pH, and fiber content taken in by human beings. The introduction of these foods into the daily human routine has been linked to a decline in oral health and an increase of several other diseases, including cardiovascular diseases, inflammatory bowel disease, rheumatic diseases, many cancers, and obesity. The aim of this chapter is to update the current knowledge and further discuss the role of diet and nutrition on oral health.

Sports Diet and Oral Health in Athletes: A Comprehensive Review

Food and fluid supply is fundamental for optimal athletic performance but can also be a risk factor for caries, dental erosion, and periodontal diseases, which in turn can impair athletic performance. Many studies have reported a high prevalence of oral diseases in elite athletes, notably dental caries 20-84%, dental erosion 42-59%, gingivitis 58-77%, and periodontal disease 15-41%, caused by frequent consumption of sugars/carbohydrates, polyunsaturated fats, or deficient protein intake. There are three possible major reasons for poor oral health in athletes which are addressed in this review: oxidative stress, sports diet, and oral hygiene. This update particularly summarizes potential sports nutritional effects on athletes' dental health. Overall, sports diet appropriately applied to deliver benefits for performance associated with oral hygiene requirements is necessary to ensure athletes' health. The overall aim is to help athletes, dentists, and nutritionists understand the tangled connections between sports diet, oral health, and oral healthcare to develop mitigation strategies to reduce the risk of dental diseases due to nutrition.

Evaluation and Comparison of Nutritional Status According to Area of Residence and Type of Institute, its Effect on Plaque and Gingival Status: A Comparative Longitudinal Study

Need of the study

Schoolchildren constitute about 113.8 million (2000-2001 census) population of India and around 11,413,000 comprises schoolchildren in Rajasthan (2000-2001 census), with overall 2.4% children suffering from dietary inadequacies. In the causation of nutritional deficiency diseases, dietary inadequacies have been considered a predominant etiological factor. To overcome such dietary problems and initiate any programs for improvement in general and oral health status, the present study was undertaken in the form of a dietary record of five consecutive days among schoolchildren belonging to different geographical areas.

Aim

To evaluate and compare nutritional status according to area of residence and type of institution and its possible effect on plaque and gingival status among 12-15-year-old schoolchildren of Jaipur.

Materials and methods

The list of schools was collected using simple random technique in both rural and urban areas of Jaipur city. Overall, four schools were drawn randomly from the selected area (two from government and two from private).

Results

In the urban area, nutrient scores (NS) were higher compared to rural areas, irrespective of the season. In contrast to this, plaque and gingival scores were higher in private schools of rural areas.

Conclusion

There is a need for awareness regarding applied nutrition among schoolchildren, irrespective of the area.

How to cite this article

Gaur AG, Sharma M, Sharma R, et al. Evaluation and Comparison of Nutritional Status According to Area of Residence and Type of Institute, its Effect on Plaque and Gingival Status: A Comparative Longitudinal Study. Int J Clin Pediatr Dent 2023;16(S-3):S233-S239.

Quantifying Dietary Diversity by Using Food Group Scores among Schoolchildren of Jaipur: A Seasonal Longitudinal Study

Need of the study

Most dentists are concerned that their patients are consuming a record number of sugar-filled sodas, sweetened fruit drinks, and other stuff that affect their oral environment. Children are invariably the victims of these foodstuffs. These items generally have very little nutritional value, albeit their commercial value. Thus, dietary habits and the choice of food among children and teens are important factors that determine how quickly they may develop oral diseases. Thus, to design good intervention programs and preventive strategies, information on food habits and dietary intake of the target population is very important.

Aim and objective

To determine dietary diversity using food group score (FGS) among 12–15 years schoolchildren of urban and rural areas of Jaipur.

Materials and methods

Jaipur district is divided into 13 Tehsils. Based on a simple random number table, Bhanpur (Rural) and Central Jaipur (Urban) were selected for the present study. Food group scores were calculated from the 5-day diet diary of the study subjects.

Results

Scores were found to be higher in winters as compared to the summer season and this difference is observed to be highly statistically significant. Scores were found to be higher in urban schoolchildren as compared to rural and the difference was highly statistically significant among urban schoolchildren in winters. Scores were found to be higher among private schoolchildren as compared to government and this difference was highly statistically significant among schoolchildren belonging to urban areas.

Conclusion

There is a need for nutritional counseling and basic oral health care in the study area irrespective of the season. The dietary diversity of children is determined by social, psychological, and economic factors. Thus, counseling should be given accordingly in conjunction with a team of health professionals including physicians, dieticians, and dentists under the supervision of parents, guardians, and schoolteachers and management.

How to cite this article

Gaur A, Sharma M, Sharma R. Quantifying Dietary Diversity by Using Food Group Scores among Schoolchildren of Jaipur: A Seasonal Longitudinal Study. Int J Clin Pediatr Dent 2021;14(3):376–382.

The Impact of Carbohydrate Quality on Dental Plaque pH: Does the Glycemic Index of Starchy Foods Matter for Dental Health?

Sugary carbohydrate foods have long been associated with increased risk of dental caries formation, but the dental health impact of starchy carbohydrates, particularly those with a high glycemic index (GI), has not been well examined.

AIM

To investigate the effect of different starchy foods varying in their GI, on acute changes in dental plaque pH.

METHODS

In a series of sub-studies in healthy adults, common starchy carbohydrate foods, including white bread, instant mashed potatoes, canned chickpeas, pasta, breakfast cereals, white rice, and an oral glucose solution were consumed in fixed 25 g available carbohydrate portions. The change in dental plaque pH was assessed postprandially over 1 h and capillary plasma glucose was measured at regular intervals over 2 h.

RESULTS

Higher GI starchy foods produced greater acute plaque pH decreases and larger overall postprandial glucose responses compared to lower GI starchy foods (white bread compared with canned chickpeas: -1.5 vs. -0.7 pH units, p = 0.001, and 99 ± 8 mmol/L min vs. 47 ± 7 mmol/L min, p = 0.026). Controlling for other food factors (food form and nutritional composition), lower GI versions of matched food pairs produced smaller plaque pH excursions compared to higher GI versions of the same food. Using linear regression analysis, the GI value of starchy carbohydrate foods explained 60% of the variation in maximum plaque pH nadir and 64% of the variation in overall acute dental plaque pH excursion (p < 0.01).

CONCLUSION

The findings imply that starchy foods, in particular those with a higher GI, may play a role in increasing the risk of dental caries.

The effects of fruit smoothies on enamel erosion

OBJECTIVES

This prospective, randomised in vitro study was to investigate the pH and titratable acidity of fruit smoothie drinks and to assess the effect of these drinks on enamel erosion.

METHOD

Fifty enamel slabs were divided into five groups which were allocated to the sample solutions groups: Innocent(®) smoothie strawberries and bananas (SB), Innocent(®) smoothie mangoes and passion fruit (MP) and Diet Coke. Distilled deionised water (DD) was used as negative control and citric acid 0.3% as positive control. All the slabs were subjected to a 21-day pH cycling regime involving 2 min of immersions, five times a day with appropriate remineralization periods in between. Measurement of surface loss was assessed using profilometry. Independent sample t tests were used to compare mean.

RESULTS

The titratable acidity for both test smoothies were 3.5-4 times more than that needed to neutralise Diet Coke and citric acid 0.3%. The pH of SB, MP smoothie and Diet Coke was found to be 3.73, 3.59 and 2.95, respectively. MP smoothie caused the greatest amount of surface loss followed by Diet Coke. Both smoothies were found to cause significant surface loss. MP smoothie resulted in significantly higher surface loss compared with MB smoothie and citric acid 3 %.

CONCLUSION

The smoothies tested were acidic and had high titratable acidity. They produced a significant erosion of enamel in vitro. The results of this study suggest that there should be increased awareness of the erosive effects of smoothies especially as their consumption seems to be on the increase.

The effects of beverages on plaque acidogenicity after a sugary challenge

BACKGROUND

Caries prevention traditionally has emphasized the restriction of cariogenic foods and beverages, but it has placed less emphasis on how the choice, combination and sequence of consumed foods and beverages may help reduce plaque acidogenicity. The authors conducted a study to examine whether whole milk, 100 percent apple juice or tap water affect dental plaque acidity in people after a sugary challenge.

METHODS

Twenty adults participated in a randomized controlled crossover study. Participants consumed four combinations of foods: 20 grams of dry sugary Froot Loops (FL) (Kellogg's, Battle Creek, Mich.) cereal, 20 g of FL followed by 50 milliliters of milk (FL/milk), 20 g of FL followed by 50 mL of juice (FL/juice) and 20 g of FL followed by 50 mL of water (FL/water). The authors used a touch microelectrode to take plaque pH readings at the interproximal space just below the contact area between the maxillary premolars on both left and right sides at two and five minutes after FL consumption and at two to 30 minutes after milk, juice or water consumption.

RESULTS

Consumption of FL plaque pH (standard deviation [SD]) was 5.83 (0.68) at 30 minutes, whereas plaque pH (SD) in the FL/milk group was 6.48 (0.30), which was significantly higher than that for FL/juice (5.83 [0.49]) or FL/water (6.02 [0.41]) (P < .005) at 35 minutes.

CONCLUSION

Drinking milk after a sugary cereal challenge significantly reduced plaque pH drop due to the sugary challenge.

PRACTICAL IMPLICATIONS

When discussing the cariogenicity of foods and beverages with patients, dentists and other health care professionals should emphasize that the order of ingesting sugary and nonsugary foods is important and may affect their oral health.

The release of zinc, copper, lead, and cadmium from the mineral tissue of teeth under the influence of soft drinks and sour-tasting food

This study was carried out with the aim of identifying the effects of consuming sour-tasting food and refreshing drinks on the bone tissue of teeth among teenagers. The cumulative effect of a year-long exposure of teeth to the erosive effects of a model system of acidic media (citric acid, lactic acid, acetic acid, apple vinegar, lemonade, the soft drink Sprite, mineral water) was studied. The effects were registered based on the amount of released biometal ions, of zinc and copper, and toxic lead, during a period of 24 hr at room temperature, using the potentiometric stripping analysis. In the given time span, amounts ranging from 75 to 750 ppm of zinc, from 0.1 to 1.0 ppm of copper, and up to 1.5 ppm of lead were released from the dental matrix, while the release of cadmium was below the level of detection. The changes to the mineral structure of the bone tissue were monitored by the Fourier's transformation infrared spectroscopy and scanning electron microscopy technique. These studies have shown that under the influence of an acidic medium significant erosion to the tooth enamel ensues and that the eroded surfaces had a radius of 1-5 μm.

Can pure fruit and vegetable juices protect against cancer and cardiovascular disease too? A review of the evidence

While it is widely accepted that fruit and vegetables (F&V) lower the risk of cancer, and cardiovascular disease (CVD), the role of pure fruit and vegetable (PFV) juices is often downplayed. This review poses two questions: Are the protective benefits of F&V dependent upon constituents lacking in PFV juices (e.g. fibre)? Do PFV juices impact on disease risk when considered separately from F&V? Studies comparing the effects of fibre and antioxidants were reviewed, yielding the finding that the impact of F&V may relate more strongly to antioxidants, than to fibre. For the second question, high-quality published studies that considered PFV juices were reviewed. The impact of PFV juices on cancer risk was weakly positive, although a lack of human data and contradictory findings hampered conclusions. For CVD, there was convincing evidence from epidemiological and clinical studies that PFV juices reduced risk via a number of probable mechanisms. It was concluded that the view that PFV juices are nutritionally inferior to F&V, in relation to chronic disease risk reduction, is unjustified.

Sucrose and dental caries: a review of the evidence

The aim of this study was to conduct a review of the literature to assess the relationship between quantity and pattern of sucrose use and dental caries. Using hand and electronic methods (MEDLINE, EMBASE) the literature was searched for epidemiological papers concerning any relationship of sugars and dental caries published since 1856. Superficial hand searching was carried out between 1856 and 1940, detailed hand searching 1940-1966 and electronic 1966-2007. Selection criteria were set based on, but not confined to, Cochran style standards. Investigations were categorized as A, fulfilling all criteria; B1, relevant fulfilling 19 of 23 criteria; B2, relevant but fulfilling only between 12 and 18 of the selection criteria; and C, all other papers. There were 95 papers meeting most (more than 12) or all of the selected criteria. Only 1 paper was graded A; 31 as B1. There were in addition some 65 as B2 and all the rest as C, which were discarded. There were a wide variety of study designs and those graded A or B1 comprised 23 ecological cross-sectional, 7 cohort and 2 case control studies. Summary results showed that 6 papers found a positive, significant relationship of sugar quantity to dental caries, 19 of 31 studies reported a significant relationship of sugar frequency of use to dental caries. The balance of studies does not demonstrate a relationship between sugar quantity, but a moderately significant relationship of sugar frequency to dental caries.

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.

Soft drinks and dental health: a review of the current literature

In recent years there has been increased interest in the role of commercial soft drinks in dental diseases namely as dental caries and erosion. The objective of this paper has been to review the past and current literature to determine the present knowledge on this subject. The literature related to dental caries, erosion, drinks, soft drinks and fruit juices was reviewed. The literature shows efforts have been taken to modify soft drinks by either adding or deleting certain components so as to reduce their harmful effects on teeth. A rational protocol to encourage the sensible use of drinks and the modification of drinks to render them less harmful would be advisable.

Efficacy of fluoride toothpaste in preventing demineralization of smooth dentin surfaces and narrow grooves in situ under frequent exposures to sucrose or bananas

The use of models simulating fissures allows studying demineralization at sites that are most prone to caries in vivo. In practice, most in situ models use flat surfaces. Our objectives were: (1) to compare the demineralizing potential of sucrose solution with that of bananas and (2) to study the effect of fluoride toothpaste on demineralization in situ in an easily accessible site and a plaque stagnation site. Four volunteers wore bovine dentin specimens with narrow grooves and a smooth surface for two 1-week in situ periods, with eight 1-min sugar exposures daily: either by a rinse with 10% sucrose, or by consumption of a piece of banana. Twice daily, the appliance was dipped in toothpaste slurry of a control (fluoride-free) toothpaste at one side and a fluoride toothpaste at the contralateral side. Demineralization was assessed by transversal microradiography. We found no difference in dentin demineralization after frequent exposure to either sucrose solution or bananas. Fluoride toothpaste effectively protected dentin only at the smooth surface. In the grooves, fluoride affected the demineralization pattern; it drove lesions towards the bottom of the groove. We conclude that assessing only smooth surfaces in intraoral tests might lead to underestimated food cariogenicity and to overestimated efficacy of fluoride-containing toothpaste.

Dietary advice in dental practice

This paper aims to provide dental health professionals with practical advice to pass on to patients about diet and dental health. Sugars are the most important dietary factor contributing to dental caries. Different foods carry different dental health risks; those containing non-milk, extrinsic sugars are potentially the most damaging. In the UK, sugared soft drinks and confectionery contribute approximately 50% to total intake of non-milk extrinsic sugars. Patients should be encouraged to reduce the frequency of intake of sugary foods. Intake of acidic foods and drinks contributes to dental erosion and consumption of such foods should also be limited. Dietary advice to dental patients should be positive and personalized if possible and can be in line with dietary recommendations for general health. These are to increase the consumption of starchy staple foods (eg bread, potatoes and unsweetened cereals), vegetables and fruit and to reduce the consumption of sugary and fatty foods.

Dental considerations for dietary counselling

A decline in the prevalence of dental caries over three decades has occurred without a significant change in the consumption of fermentable carbohydrates, indicating that good dental health is achievable with the presence of cariogenic factors in the diet. Since, in many countries 80% of the caries is present in only 20% of the population, 'targeted intervention' would seem a better preventive option, stressing the judicious use of fluoride, plaque control, fissure sealants and a sensible diet. Dietary modification is notoriously difficult to achieve, being incumbent upon the subject's willingness to effect a change in behaviour. Many texts refer to the frequency of consumption of carbohydrates as being all-important, recommending a reduction in the frequency. However, recent evidence suggests it is the frequency of toothbrushing with a fluoride containing dentifrice which is of fundamental importance in promoting remineralisation of enamel. Dietary advice should be formulated which is both realistic and positive. Trying to dissuade children from consuming products, which they perceive to be tasty and pleasurable is counter productive and more emphasis should be given to tooth brushing using a fluoride toothpaste. Also, a fundamental shift away from the idea of 'good foods versus bad foods' is required and more emphasis laid on good diets as opposed to bad diets. Children should be able to enjoy foods traditionally considered 'bad' from a dental viewpoint, as long as they brush their teeth with a fluoride containing dentifrice and have a sensible approach to their consumption.