Dietary Implications in Dental Caries

Dental caries is a dynamic process that involves a susceptible tooth, cariogenic bacteria in dental plaque (streptococcus mutans and lactobacillus), and a fermentable carbohydrate. Other considering factors also include absence of fluoride, salivary gland hypofunction, and poor oral hygiene.10 Fermentable carbohydrates are commonly considered to be primarily sucrose (table sugar). However, all simple sugars are potentially cariogenic. The universal sweetener in use today, high fructose corn syrup is made from the simple sugar, fructose.

The frequency of sugar eaten is the primary factor involved in the caries process. Sugary foods or liquids consumed 20 minutes apart allows for separate opportunities for bacteria to feed and produce acid. When the pH of the dental plaque falls below 5.5, the caries process begins. Form and composition of a fermentable carbohydrate plays a secondary role depending on how long it takes for a food or drink to clear the oral cavity. Liquids clear faster than soft, sticky foods. The total amount of sugar consumed is the least important factor to consider while counseling patients. A food that is 80% sucrose may not be any more harmful than one that is 40% sucrose.6

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Destructive effects of soda and juice are a major cause of early childhood caries and decay among both children and teenagers, especially in low income and minority populations. One 12 oz soda contains 10 teaspoons of sugar as well as acid. Diet soda includes both citric and phosphoric acid, which may cause direct demineralization of the tooth enamel. Rinsing the mouth with water, bypassing the teeth by using a straw, and drinking pop or juice with a meal can help reduce the negative effects of liquid fermentable carbohydrates.
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Erosion: Caused by intake of carbonated beverages.
Image source: Copyright © 2003 Lippincott Williams & Wilkins

Protective factors from specific foods and diet sequencing may also be utilized in order to reduce the destructive influence of fermentable carbohydrates. Fats and proteins consumed in a meal help coat the tooth surface to protect it from sugars. Consuming dairy products keeps the saliva rich in calcium and phosphorus, offering benefits of remineralization by preventing the pH of the mouth falling below 5.5. Fluoride in both food and water will also help remineralize the enamel.

Diet and periodontal disease are not as clearly connected as diet and dental caries. Overall nutritional status can affect host susceptibility and influence disease progression. Good nutrition can be protective by helping increase resistance to periodontal infection and help minimize its severity while malnutrition can reduce resistance to periodontal infection.

The physical consistency of food has a direct effect on periodontal health. Crunchy, fibrous foods increase salivary flow which offers antibacterial properties. All nutrients are needed to synthesis the oral tissues and structures, keep them healthy throughout life, enhance the immune system to fight infection, and aid in wound healing. Major nutrients for oral health and their specific roles are shown in the boxes below.

Vitamin D
  • Calcium and phosphorus absorption
  • Builds skeletal bones and teeth
  • Alveolar process support
Vitamin A
  • Forms oral epithelium
  • Enhances immune system
  • Wound healing
B-Complex Vitamins
  • Formation of new cells
  • Cofactor for nutrients
Protein
  • Supports growth of cells
  • Resist infection
  • Makes antibodies
Vitamin C
  • Aids in collagen formation
  • Promotes capillary integrity
  • Enhances immune response
Iron, Zinc, Copper
  • Aids in collagen formation
  • Wound healing
  • Regulates inflammation