NUTRITION AND ORAL / DENTAL HEALTH
Diet and nutrition play key roles in tooth development, integrity of the gingiva (gums) and mucosa, bone strength, and the prevention and management of diseases of the oral cavity. Diet has a local effect on tooth integrity; that is, the type, form, and frequency of foods and beverages consumed have a direct effect on the oral pH and microbial activity, which may promote dental decay. By contrast, nutrition has a systemic effect. The impact of nutrient intake systemically affects the development, maintenance, and repair of the teeth and oral tissues. Deficiencies of several vitamins (riboflavin, folate, B12, and C) and minerals (iron and zinc) may be first detected in the mouth because of the rapid tissue turnover rate of the
oral mucosa.
Nutrition and diet affect the oral cavity, but the reverse also is true; that is, the status of the oral cavity may affect one's ability to consume an adequate diet and achieve nutrient balance. Oral diseases extend beyond dental caries.
Partial or complete tooth loss (edentulism) is common in persons older than 65 years of age and can have a significant impact on dietary intake, especially fiber and protein. For the aging population, dietary intake, oral health and their influence on nutritional and overall well-being is paramount. The roles of nutrients in the growth, development, and maintenance of the oral cavity structure, bones, and tissues are innumerable.
Periodontal disease is a local and systemic disease. Select nutrients, including vitamins A, C, E; folate; B-carotene; and the minerals calcium, phosphorus, and zinc play a role in this disease. Nutrition strategies and other strategies to modify risk factors for bone loss in osteoporosis also may contribute to reducing the risk of tooth loss.
Oral cancer, often as a result of tobacco and alcohol abuse, can have a significant impact on eating ability and nutrition status. This problem is compounded by the increased caloric and nutrient needs of persons with oral carcinomas. In addition, surgery radiation therapy, and chemotherapy are modalities used to treat oral cancer that
also can affect dietary intake, appetite, and the integrity of the oral cavity.
Several chronic and acute diseases have oral consequences that affect eating ability. Poorly controlled diabetes can result in burning tongue syndrome, candidiasis, and xerostomia, which in turn compromise a person's eating ability and appetite and may exacerbate poor blood sugar control, leading to a cycle of debilitating health. Oral manifestations of immunosuppressive diseases such as human immunodeficiency virus (HIV) / acquired immune deficiency syndrome (AIDS) also have an impact on appetite, dietary intake, and nutrient needs (Touger-Decker and Mobley, 2003). Medications used to treat the diseases, either by prescription or over the counter may have adverse effects, further compromising the ability to ingest an optimal diet.
DENTAL CARIES
Pathophysiology
Dental caries is an oral infectious disease in which organic acid metabolites produced by the metabolism of oral microorganisms lead to gradual demineralization of tooth enamel, followed by rapid proteolytic destruction of the tooth structure.
Cariogenicity refers to the caries-promoting properties of a diet or food. And the cariogenicity of a food varies, depending on the form in which it occurs, its nutrient composition, when it is eaten in relation to other foods and fluids, the duration of its exposure to the tooth, and the frequency with which it is eaten.
Moreover, caries can occur on any tooth surface. The etiology of dental caries involves many factors. Four factors must be present simultaneously: (1) a susceptible host or tooth surface; (2) microorganisms such as Streptococcus or Lactobacillus, in the dental plaque or oral cavity; (3)fermentable carbohydrates in the diet, which serve as the substrate for bacteria; and time (duration) in the mouth for bacteria to metabolize the fermentable carbohydrates, produce acids, and cause a drop in salivary pH to less than 5.5. Once the pH falls below 5.5, oral bacteria can initiate the demineralizatton process. Plaque pH can fall in as little as 5 minutes and take up to 2 hours to return to neutral
levels if no oral hygiene measures are introduced.
Because this article is more concerned on nutrition, I am going to lay more emphasis on the third factor, which is fermentable carbohydrates. Let's go !
Substrate
Fermentable carbohydrates, those carbohydrates susceptible to the actions of salivary amylase, are the ideal substrate for bacterial metabolism. The acids produced by their metabolism cause a drop in salivary pH to less than 5.5, creating the environment for decay. In light of the Dietary Guidelines for Americans and the MyPy'ramid Food Guidance system, both of which support a diet high in carbohydrates, it is important to be aware of the cariogenicity of foods that can affect the potential for bacterial action on fermentable carbohydrates. Individuals should be aware of the form of food consumed and the frequency of intake in order to integrate positive diet and oral hygiene habits to help improve oral health status.
Fermentable carbohydrates are found in four of the six of MyPyramid food groups: (1) grains, (2) fruits, (3) dairy products, and (4) added sugars in the category of fats and sweets. Although some vegetables may contain fermentable carbohydrates, little has been reported about the cariogenicity (caries-promoting properties) of vegetables. Examples of grains and starches that are cariogenic by nature of their fermentable carbohydrate composition, which can cause a decrease in salivary pH to less than 5.5, include crackers, chips, pretzels, biscuits, hot and cold cereals, and breads.
All fruits (fresh, dried, and canned) and fruit juices may be cariogenic. Fruits with high water content such as melons have a lower cariogenicity than others such as bananas and dried fruits. Fruit drinks, sodas, ice teas, and other sugar-sweetened beverages; cookies; candies; and cake products may be cariogenic. Dairy products sweetened with fructose, sucrose, or other sugars can also be cariogenic because of the added sugars; however, dairy products are rich in calcium, and their alkaline nature may have a positive influence, reducing the cariogenic potential of the food.
Like other sugars (glucose, fructose, maltose, and lactose), sucrose stimulates bacterial activity. The causal relationship between sucrose and dental caries has been established ( Molmihan, 2005). All dietary forms of sugar, including honey, molasses, brown sugar, and corn syrups, have cariogenic potential and can be used by bacteria to produce organic acid by-products of metabolism. Maltose, found in candies, doughnuts, potato chips, crackers, and other snack foods, also contribute to the cariogenic potential of a food. Salivary amylase breaks down the dietary sugars over time.
Fluoride
Fluoride is a primary anti-caries agent. Used systemically and locally, it is a safe, effective public health measure to reduce the incidence and prevalence of dental caries (Palmer and Wolfe, 2005). Water fluoridation began in 1940; by 1999 the Centers for Disease Control and Prevention listed water fluoridation as one of the top 10 greatest public health
achievements of the 20th century because of its impact on decreasing the rate of dental caries (CDC,2006).
The impact of fluoride on caries prevention continues with water fluoridation, fluoridated toothpastes, oral rinses, and dentifrices, as well as beverages made with fluoridated water. Fluoridation is "the adjustment of fluoride in the water supply to an optimal concentration of 0.7 to 1.2 ppm" (Palmer and Wolfe, 2005). Optimal water fluoridation concentrations (0.7 to 1.2 ppm) can provide protection against caries development without causing tooth staining. But remember that excessive use of fluoride can lead to mottling of teeth (fluorosis), i can tell you authoritatively.
PREVENTIVE CARE
Caries prevention programs focus on a balanced diet, modification of the sources and quantities of fermentable carbohydrates, and the integration of oral hygiene practices into individual lifestyles (Tinanoff, 2005). Meals and snacks should be followed with brushing, rinsing the mouth vigorously with water, non-sweet fruits like eggfruits or cucumber or chewing sugarless gum for 15 to 20 minutes. Positive habits should be encouraged, including snacking on anticariogenic or cariostatic foods, chewing sugarless gum after eating or drinking cariogenic items, and having sweets with meals rather than as snacks.
Despite the potential for a diet that is based on the dietary guidelines to be cariogenic, with proper planning and good oral hygiene a balanced diet low in cariogenic risk can be planned.
Practices to avoid include sipping carbonated beverages over extended periods; frequent snacking; and harboring candy, sugared breath mints, or hard candies in the mouth for extended periods. Over-the-counter chewable or liquid medications and vitamin preparations also may contain sugar. Chewable vitamin C is one example of a sugar-containing acid product that may contribute to tooth decay. Careful label reading is important to avoid or minimize the use of such products.
Fermentable carbohydrates such as candy, crackers, cookies, pastries, pretzels, snack crackers, chips(potatoes, plantain, etc), and even fruits(especially sugary or starchy) should be eaten with meals. Notably, "fat-free" snack and dessert items and "baked" chips and snack crackers tend to have a higher simple sugar concentration than their higher fat-containing counterparts.
Evidence supports the use of xylitol-sweetened gum as an anti- caries agent after meals and snacks (Milgrom, 2006). Xylitol is a five-carbon sugar that cannot be metabolized by oral bacteria. Research has documented its ability to reduce caries incidence by reducing the levels of S. mutans in saliva. The current recommended dose is two pieces after each meal or snack containing fermentable carbohydrates. Tiventy minutes of chewing appears to cause a rise in salivary pH to a level greater than 5.5.
Note that aside other benefits of fibre such as regulation of blood sugar to maintain health, eating fibre-rich diets help cleans the teeth of food particles and sugar during chewing.
Also, brushing and flossing teeth at least once after each meal or snack is highly recommended as being very helpful.
DISCLAIMER:
This is not a medical advice. Consult your Physician, Dentist and Dietitian.
© Dickson O.,RDN,LDN, MDAN, MICDA.
.jpg)
Comments
Post a Comment