Delayed effect of wheat starch in foods on the intraoral demineralization of enamel

Healthy Food, Healthy Teeth: A Formative Study to Assess Knowledge of Foods for Oral Health in Children and Adults

Eating patterns characterised by low intakes of processed carbohydrates and higher intakes of fat- and Vitamin D-rich foods are associated with protection against dental caries. The aim of this formative study was to evaluate the extent to which the knowledge of children and adults of foods for oral health reflects dietary guideline advice, and the evidence base for foods associated with increased and decreased caries burdens. Using a novel card-sorting task, the participants categorised foods according to their knowledge of each food for oral health. There were no differences between children and adults in the categorisation of fresh, minimally processed foods. Fish, chicken, and red meat were categorised as healthy by significantly fewer children than adults. High-sugar foods were correctly characterised as unhealthy by nearly all participants. More children categorised breakfast cereals as healthy than adults. There were no statistically significant differences between children and adults for the categorisation of brown or wholegrain breads categorised as healthy. The alignment of the participants’ beliefs with dietary guideline recommendations suggests education through health promotion initiatives is successful in achieving knowledge acquisition in children and adults. However, recommendations to increase the intake of refined carbohydrates inadvertently advocate foods associated with increased caries burdens.

Prevalence of Dental Caries in Past European Populations: A Systematic Review

OBJECTIVE

Within the fields of anthropology and osteoarcheology, human teeth have long been studied to understand the diet, habits, and diseases of past civilizations. However, no complete review has been published to collect and analyze the extensive available data on caries prevalence in European man (Homo sapiens) over time.

METHOD

In this current study, the two databases, Scopus and Art, Design, and Architecture Collection, were searched using predefined search terms. The literature was systematically reviewed and assessed by two of the authors.

RESULTS

The findings include a significant nonlinear correlation with increasing caries prevalence in European populations from 9000 BC to 1850 AD, for both the number of carious teeth and the number of affected individuals.

CONCLUSION

Despite the well-established collective belief that caries rates fluctuate between different locations and time and the general view that caries rates have increased from prehistoric times and onwards, this is to our knowledge the first time this relationship has been proven based on published data.

Dental markers of biocultural sex differences in an early modern population from Gothenburg, Sweden: caries and other oral pathologies

Background

With the aim to study dental pathological lesions in an early Swedish modern population, with special reference to sex variances of dental caries, the prevalence and distribution of dental caries and tooth wear were determined in complete and partial human dentitions from an early modern-time city graveyard (1500–1620) excavated in Gamlestaden, Gothenburg, Sweden.

Methods

Partial and complete dentitions were examined through visual inspection and using a dental probe. Pathologies were studied, evaluated and presented by teeth and alveoli.

Results

The study population consisted of 308 individuals. A total of 4,951 teeth in adults and 1,660 teeth in children were examined. Caries prevalence in the studied population was 55% and the highest prevalence of caries was found among the adults, where 68% of the individuals had at least one carious lesion. Caries experience (DMT > 0) in the entire population was 60%, and among adults caries experience was 76%. Women had significantly higher caries experience than men (p < 0.05). Caries was most prevalent in the molar teeth and least prevalent in the incisors and canines. Significant age-related increases in tooth wear were found, and a positive correlation between wear in molars and incisors (p < 0.001). Other clinical findings were signs of apical lesions, crowding of teeth, aplasia, non-erupted canines and calculus.

Conclusions

Findings show that dental pathological lesions affected a majority of the studied population, and indicate that women were more predisposed to dental disease than their male counterparts. Results are discussed from a multi-factorial explanation model including dietary, physiological and cultural etiological factors.

The consumption of processed sugar- and starch-containing foods, and dental caries: a systematic review

The relationship between high dietary intakes of sugar (sucrose) and dental caries is well established. Processed sugars and starches have been associated with greater dental caries experience in retrospective studies. The aim of this systematic review was to determine the relationship between the consumption of processed sugar- and starch-containing foods, the frequency of consumption of these foods, and dental caries. Prospective studies were identified in databases searched from 1970 to July 2020, and relevant retrieved papers that examined associations between the consumption of sugar- and starch-containing foods by human participants and dental caries were eligible for inclusion. Five cohort studies were identified for inclusion, all of which evaluated caries risk in young children or pre-adolescents. The between-meal consumption of processed sugar- and starch-containing foods was consistently found to be associated with greater caries experience. There were mixed findings on total consumption of processed sugar- and starch-containing foods, owing to a range of confounding factors, including the simultaneous consumption of caries-protective foods at mealtimes. Although there is a paucity of research of the dietary effects of frequent consumption of processed sugar- and starch-containing foods on dental caries, there is some evidence of plausible associations between this dietary behaviour and dental caries. Future research should investigate the effectiveness of interventions to change the dietary behaviour of high-frequency consumption of processed sugar- and starch-containing foods to decrease the risk of dental caries.

Caries, antemortem tooth loss and tooth wear observed in indigenous peoples and Russian settlers of 16th to 19th century West Siberia

OBJECTIVE

Increased prevalence of dental caries evidently is correlated with increasing intake of sugar and carbohydrate-rich foods. Preceding and accompanying this dietary alteration might have been a shift from a hunting-and-gathering subsistence strategy to one based on agriculture. We corroborated this conjecture by means of a study on the prevalence of caries, antemortem tooth loss (AMTL) and tooth wear among 16th to 19th century hunter-gatherers and agriculturalists who co-existed in West Siberia.

DESIGN

Indigenous skeletons (n = 75) exhumed from Tatar, Selkup, Khant, and Nenet graves along with Russian settler skeletons (n = 79) from Izyuk were examined. The prevalence of caries, AMTL and tooth wear among the indigenous peoples were compared with those among the Russian settlers. The resulting statistical inferences were tested using package R.

RESULTS

The agriculturalist Russian settlers showed a significantly higher prevalence of dental caries (11.88%) than did the non-agriculturalist indigenous Siberian people (3.85%). Among the latter, the prevalence was the lowest in the Khanty and the highest in the Tatars, suggesting that caries differently affected each sub-group of indigenous Siberian people. Correspondingly to the case of dental caries, the Russian settlers' AMTL prevalence also was higher than that of the indigenous Siberians, regardless of age. On the other hand, the native Siberians and the Russian settlers did not show statistical differences in tooth wear.

CONCLUSION

In the study on 16th to 19th century West Siberian populations, we were able to corroborate our presumption that agriculturalists ingesting a carbohydrate-rich diet would have higher rates of dental caries and AMTL than would hunter-gatherers.

Effects of Starch on Oral Health: Systematic Review to Inform WHO Guideline

A systematic review was conducted to update evidence on the effect of total dietary starch and of replacing rapidly digestible starches (RDSs) with slowly digestible starches (SDSs) on oral health outcomes to inform updating of World Health Organization guidance on carbohydrate intake. Data sources included MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, LILACS, and Wanfang. Eligible studies were comparative and reported any intervention with a different starch content of diets or foods and data on oral health outcomes relating to dental caries, periodontal disease, or oral cancer. Studies that reported total dietary starch intake or change in starch intake were included or where comparisons or exposure included diets and foods that compared RDSs and/or SDSs. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) statement, and evidence was assessed with the GRADE Working Group guidelines. From 6,080 papers identified, 33 (28 studies) were included in the RDS versus SDS comparison: 15 (14 studies) assessed the relationship between SDS and/or RDS and dental caries; 16 (12 studies) considered oral cancer; and 2 studied periodontal disease. For total starch, 23 papers (22 studies) were included: 22 assessed the effects on dental caries, and 1 considered oral cancer. GRADE assessment indicated low-quality evidence, suggesting no association between total starch intake and caries risk but that RDS intake may significantly increase caries risk. Very low-quality evidence suggested no association between total starch and oral cancer risk, and low-quality evidence suggested that SDS decreases oral cancer risk. Data on RDS and oral cancer risk were inconclusive. Very low-quality data relating to periodontitis suggested a protective effect of whole grain starches (SDS). The best available evidence suggests that only RDS adversely affects oral health.

Evaluation of Fluoride-Releasing Dental Materials by Means of in Vitro and in Vivo Demineralization Models: Reaction Paper

It is essential that we understand the dose-response mechanisms of fluoride delivered intra-orally at sites in intimate contact with dental tissues. Many studies show that extremely low levels of fluoride can inhibit caries. However, few of these studies provide a direct comparison between fluoride release and the inhibition of secondary caries. For this, laboratory, animal, and in situ caries models are required which can predict clinical efficacy. This paper supplements Dr. Erickson's presentation (Erickson and Glasspoole, 1995) by illustrating the adaptation of currently used demineralization and caries models to the development and evaluation of fluoride-containing resin materials. As representative of this class of material, those which release by ion-exchange are reviewed. It is concluded that model systems designed for topical fluorides and non-fluoride dental materials can be adapted for use with fluoride-releasing materials. Further, the use of materials with a long history of clinical efficacy as inhibitors of marginal caries, such as the silicates, is a useful means of determining target values for developing new fluoride-releasing materials. The minimum concentration of F- that must be maintained in the immediate vicinity of a material to provide caries protection at localized sites is not yet known. Nor is it known what combination of release rate, pattern of release, and duration of release is needed to optimize either localized or full-mouth protection. These issues deserve closer examination to aid our understanding of F- action when delivered from dental materials, so that improved caries model systems can be designed for use with dental materials.

An in vitro study of the effect of some dietary components on calculus formation: regulation of calcium phosphate precipitation

OBJECTIVE

We studied the effects of food components on the in vitro formation of calcium phosphate precipitates.

MATERIALS AND METHODS

The effects of food components, such as starch, soybean flour, fish meal, rapeseed oil, and coconut oil, on calcium phosphate precipitation were studied using a pH drop method.

RESULTS

Although the addition of starch had no effect on the rate of precipitation of amorphous calcium phosphate (ACP), it increased both the rate of transformation of ACP to hydroxyapatite (HAP) and the induction time (i.e. time for the initiation of transformation of ACP to HAP to occur); this was irrespective of the heat treatment of the starch. Amylopectin (insoluble constituent of starch) was effective in increasing the rate of HAP transformation, but amylose (soluble constituent of starch) was not. Oil specimen obtained from rapeseed (400 microl ml(-1)) increased the entire reaction of calcium phosphate precipitation, but that from coconut did not. Protein food, such as soybean flour and fish meal, decreased the rate of transformation of ACP to HAP and increased the induction time, while they had no effect on the rate of ACP precipitation.

CONCLUSION

These results suggest that carbohydrate and oil (both are staple diets for the humans) enhance oral calcification (dental calculus formation or re-mineralization of tooth enamel), while side dishes of protein food would decrease it.

Tooth wear and dental pathology at the advent of agriculture: New evidence from the Levant

Differences in patterns of diet and subsistence through the analysis of dental pathology and tooth wear were studied in skeletal populations of Natufian hunter-gatherers (10,500-8300 BC) and Neolithic populations (8300-5500 BC, noncalibrated) from the southern Levant. 1,160 Natufians and 804 Neolithic teeth were examined for rate of attrition, caries, antemortem tooth loss, calculus, periapical lesions, and periodontal processes. While the Natufian people manifest a higher rate of dental attrition and periodontal disease (36.4% vs. 19%), Neolithic people show a higher rate of calculus. Both populations manifested low and similar rates of caries (6.4% in the Natufian vs. 6.7% in the Neolithic), periapical lesions (not over 1.5%), and antemortem tooth loss (3.7% vs. 4.5%, respectively). Molar wear pattern in the Neolithic is different than in the Natufian. The current study shows that the dental picture obtained from the two populations is multifactorial in nature, and not exclusively of dietary origin, i.e., the higher rate and unique pattern of attrition seen in the Natufian could result from a greater consumption of fibrous plants, the use of pestles and mortars (which introduce large quantities of stone-dust to the food), and/or the use of teeth as a "third hand." The two major conclusions of this study are: 1) The transition from hunting and gathering to a food-producing economy in the Levant did not promote changes in dental health, as previously believed. This generally indicates that the Natufians and Neolithic people of the Levant may have differed in their ecosystem management (i.e., gathering vs. growing grains), but not in the type of food consumed. 2) Changes in food-preparation techniques and nondietary usage of the teeth explain much of the variation in tooth condition in populations before and after the agricultural revolution.

Dental caries, oral hygiene, and oral clearance in children with craniofacial disorders

The reason that children with cleft palates tend to have a greater prevalence of tooth decay than normal children is unclear. We hypothesized that children with cleft palates would have increased oral clearance times for foods and, consequently, higher levels of caries and caries-associated micro-organisms than control children. Children aged 6-16 yrs, with (n = 81) or without (n = 61) cleft palates, were studied. Children with cleft palates had DMFT and dmft scores greater (p < 0.01) than those of the control group. The number of caries-associated organisms was greater in the saliva of the cleft palate children (all p < 0.001). The oral hygiene, plaque and gingival index scores were greater (p < 0.0001), oral clearance was longer (p < 0.01), and levels of sucrose and starch-derived saccharides higher (p < 0.01) in the cleft palate group. However, salivary concentrations of organic acids were lower in the children with craniofacial disorders, probably reflecting the altered physiology of the more mature dental biofilm. The longer oral clearance times of foods and the consequent generation of fermentable sugars from starches may contribute to the higher caries prevalence observed in children with cleft palates.

Nutrition and dental caries

Promotion of sound dietary practices is an essential component of caries management, along with fluoride exposure and oral hygiene practices. Scientific discoveries have lead to better understanding of the caries process, the ever-expanding food supply, and the interaction between the two. Fermentable carbohydrates interact dynamically with oral bacteria and saliva, and these foods will continue to be a major part of a healthful diet. Dental health professionals can serve their patients and the public by providing comprehensive oral health care and by promoting lifestyle behaviors to improve oral and general health within the time constraints of their practice. Dietary advice given should not contradict general health principles when providing practical guidance to reduce caries risk. The following principles should guide messages: * Encourage balanced diets based on moderation and variety as depicted by the Food Guide Pyramid and the Dietary Guidelines for Americans to provide a sound approach. Avoid references to "bad" foods and focus on "good" diets that include a variety of foods. * Give examples of how combining and sequencing foods can enhance mastication, saliva production, and oral clearance at each eating occasion. Combining dairy foods with sugary foods, raw foods with cooked, and protein-rich foods with acidogenic foods are all good examples. Suggest that eating and drinking be followed by cariostatic foods such as xylitol chewing gum. * Drink water to satisfy thirst and hydration needs as often as possible. Restrict consumption of sweetened beverages to meal and snack times when they can be combined with other cariostatic foods. * When a patient reports excessive dietary intake of a fermentable carbohydrate to the point of displacing other important foods in the diet, identify alternatives that will help the patient maintain or achieve a healthy body weight, oral health status, and a nutrient-dense intake.

Food starches and dental caries

Sucrose and starches are the predominant dietary carbohydrates in modern societies. While the causal relationship between sucrose and dental caries development is indisputable, the relationship between food starch and dental caries continues to be debated and is the topic of this review. The current view of dental caries etiology suggests that in-depth evaluation of the starch-caries relationship requires the consideration of several critical cariogenic determinants: (1) the intensity (i.e., the amount and frequency) of exposure of tooth surfaces to both sugars and starches, (2) the bioavailability of the starches, (3) the nature of the microbial flora of dental plaque, (4) the pH-lowering capacity of dental plaque, and (5) the flow rate of saliva. Studies of caries in animals, human plaque pH response, and enamel/dentin demineralization leave no doubt that processed food starches in modern human diets possess a significant cariogenic potential. However, the available studies with humans do not provide unequivocal data on their actual cariogenicity. In this regard, we found it helpful to distinguish between two types of situations. The first, exemplified by our forebears, people in developing countries, and special subject groups in more modern countries, is characterized by starch consumption in combination with a low sugar intake, an eating frequency which is essentially limited to two or three meals per day, and a low-to-negligible caries activity. The second, exemplified by people in the more modern societies, e.g., urban populations, is characterized by starch consumption in combination with significantly increased sugar consumption, an eating frequency of three or more times per day, and a significantly elevated caries activity. It is in the first situation that food starches do not appear to be particularly caries-inducive. However, their contribution to caries development in the second situation is uncertain and requires further clarification. Although food starches do not appear to be particularly caries inducive in the first situation, the possibility cannot be excluded that they contribute significantly to caries activity in modern human populations. The commonly used term "dietary starch content" is misleading, since it represents a large array of single manufactured and processed foods of widely varying composition and potential cariogenicity. Hence, increased focus on the cariogenicity of single starchy foods is warranted. Other aspects of starchy foods consumption, deserving greater attention, include the bioavailability of starches in processed foods, their retentive properties, also in relation to sugars present (starches as co-cariogens), their consumption frequency, the effect of hyposalivation on their cariogenicity, and their impact on root caries. The starch-caries issue is a very complex problem, and much remains uncertain. More focused studies are needed. At present, it appears premature to consider or promote food starches in modern diets as safe for teeth.

Interactions of streptococcal glucosyltransferases with alpha-amylase and starch on the surface of saliva-coated hydroxyapatite

The salivary pellicle consists of various proteins and glycoproteins which may interact with one another. Experiments were performed to elucidate the interactions of streptococcal glucosyltransferase (Gtf) enzymes with human salivary alpha-amylase in solution and on the surface of saliva-coated hydroxyapatite (SHA) beads. The Gtf enzymes -B, -C and -D, when immobilized on to SHA beads, reduced the activity of adsorbed amylase; GtfD showed the highest inhibition of salivary amylase activity. The presence of glucan produced by immobilized GtfD did not further reduce amylase activity. The amount of amylase adsorbed on to hydroxyapatite beads was reduced when salivary amylase was added simultaneously with any of the Gtf enzymes, suggesting that amylase and Gtfs may compete with each other for binding sites on hydroxyapatite. Starch hydrolysates produced by SHA-surface-bound salivary amylase were tested for their effect on glucan production from sucrose by Gtf enzymes in solution and on SHA beads; glucan production by SHA-immobilized GtfB was stimulated in the presence of starch hydrolysates. Glucan synthesized by SHA-immobilized GtfB in the presence of starch hydrolysates was less susceptible to hydrolysis by the fungal enzyme mutanase than was glucan made by SHA-immobilized GtfB in the absence of starch hydrolysates. Glucan production by GtfB associated with streptococci immobilized on to SHA was also enhanced in the presence of starch hydrolysates. The adhesion of oral micro-organisms to SHA coated with glucan made in the presence and absence of starch hydrolysates was investigated, and some bacteria displayed higher adhesion activities for the glucan made in the presence of the hydrolysates. Therefore, the interaction of amylase and Gtf enzymes on a SHA surface may modulate the formation of glucan and the adherence of oral micro-organisms.