3 - Aetiology of Dental caries: the impact of sugar on dental caries

Question 1

What is dental caries?

Answer 1

A bacterial disease of the calcified tissues of the teeth characterized by demineralization of the inorganic and destruction of the organic substance of the tooth

Question 2

what are the key facts to remember about dental caries?

Answer 2

• Dynamic process
• Balance between demineralization and remineralisation
• pH < 5.5 favours demineralization
• pH > 5.5 favours remineralisation
• Dependent on an individuals saliva buffering power

Question 3

what is the most common non-communicable disease in children?

Answer 3

dental caries

Question 4

what are the factors in caries aetiology?

Answer 4

• host and teeth
• micro-organisms (normally strep mutans)
• substrate
• time

Question 5

what are the potential ways to change caries susceptibility and risk in the host and teeth?

Answer 5

• increase salivary buffering capactiy
• add trace elements (F) -(change suseptiblity of the tooth )
• use protective coating

Question 6

what are the potential ways to change caries susceptibility and risk in micro-organisms?

Answer 6

• Remove/reduce plaque bacteria (biolfim)

- (Vaccincation?)

Question 7

what are the potential ways to change caries susceptibility and risk in substrates?

Answer 7

restrict free sugar intake

Question 8

what are the potential ways to change caries susceptibility and risk in time?

Answer 8

1. Reduce time substrate in contact with tooth

2. Reduce time specific bacteria in contact with tooth

Question 9

what is the one specific substrate of caries?

Answer 9

sugar

Question 10

what type of disease is caries?

Answer 10

Sugar dependant infectious disease

Question 11

Describe plaque bacteria metabolism of sugars.

Answer 11

• Glucose or sucrose
• rapid metabolism homofermentation (glucose +sucrose are rapidly metabolised)
• lots of acid mainly lactic
• low pH

Question 12

what different types of studies are used to collect evidence for a relationship between diet and dental caries?

Answer 12

• Human Observational Studies
• Human Interventional Studies (Clinical Trials)
• Animal Experiments
• Plaque pH studies
• Enamel slab experiments
• Incubation studies

Question 13

what is involved in epidemiology?

Answer 13

• Concerned with the study of populations

* Looking at groups of people, not individuals

Question 14

What type pf groups are used in epidemiology?

Answer 14

Geogrpahy, where they live, ethnicity, all visit same clinic

person,

Question 15

What are the levels of evidence in the pyramid from the bottom up?

Answer 15

• expert opinions
• cross-sectional studies and case studies
• uncontrolled longitudinal studies
• controlled longitudinal studies
• randomised controlled studies

Question 16

when does dental caries rate change?

Answer 16

change following changes in availability of dietary sugar

Question 17

what case studies prove dental caries rates change following changes in availability of dietary sugar?

Answer 17

• Populations that had reduced sugar availability during the 2nd world war show a reduction in caries
• Island of Tristan da Cuhna
(imported sugar 1940+)

Question 18

In what people are low dental caries rates reported?

Answer 18

reported in people who have habitually low intake of dietary sugar

Question 19

What case studies prove low dental caries rates are reported in people who have habitually low intake of dietary sugar?

Answer 19

• Children of dentists
• Hopewood House 1947-62
• Where strict dietary regimes
are followed

Question 20

Describe the outcome of cross sectional studies in caries.

Answer 20

Numerous cross-sectional epidemiological studies from many countries have related sugar intake with dental caries levels at one point in time

Question 21

what do prevalence studies do?

Answer 21

These look at the prevalence of the disease at

any one time

Question 22

What is prevalence?

Answer 22

the percentage or proportion of people in a population who have a disease or condition at a given point in time

Question 23

what do longitudinal studies show?

Answer 23

stronger evidence for a relationship between diet and dental caries by assessing sugar eating habits over time

Question 24

Describe the 4 year prospective study of sugar sweetened beverages and dental caries in adults.

Answer 24

• Data from 939 patient analysed
• Compared those with reported ‘high sugar sweetened beverage consumption’ to those with low
• Found that drinking SBBs on a daily basis increased caries risk in adults even when tooth brushing with a fluoride toothpaste taken into account

Question 25

what provides some of the strongest evidence for an association between diet and disease?

Answer 25

Human interventional studies

Question 26

Give examples of human interventional studies.

Answer 26

• Vipeholm Study
(Gustaffson et al. 1954)
• Turku Sugar Studies
(Scheinin and Makinen 1975)

Question 27

what is the reason for not carrying out human interventional studies?

Answer 27

ethical constraints

Question 28

What is the evidence that sugar causes caries?

Answer 28

• Epidemiological data show link between sugar consumption and caries
• Caries prevalence higher in communities with high sugar intake
• Caries prevalence increases when sugar introduced to isolated communities
• Caries decreases when sugar restricted

Question 29

Name 2 types of sugars from total sugars.

Answer 29

• extrinsic sugars

- intrinsic sugars

Question 30

what can extrinsic studies be split into?

Answer 30

• milk sugars

- non-milk extrinsic sugars

Question 31

which sugars tend to be cariogenic?

Answer 31

non-milk extrinsic sugars

Question 32

what is definition of free sugars?

Answer 32

‘mono- and disaccharides
added to foods by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit concentrates’

Question 33

what does the definition of free sugars not include?

Answer 33

sugars in dairy products

Question 34

Give the components of the sub-group : monosaccharides.

Answer 34

glucose, galactose , fructose

Question 35

Give the components of the sub-group : Disaccharides.

Answer 35

Sucrose, lactose, maltose, trehalose

Question 36

what do the scientific advisory committee on nutrition advice on free sugar recommendations?

Answer 36

Dietary intake from free sugar should not exceed 5% of total dietary intake

Question 37

what is the recommend maximum intake for adults 11+?

Answer 37

no more than 30g of sugar (7 teapspoons)

Question 38

what is the recommended maximum for 7-10 years?

Answer 38

no more than 24g

Question 39

what is the recommended maximum for 4-6 years?

Answer 39

no more than 19g

Question 40

what is considered a high sugar content?

Answer 40

more than/ equal 15 grams per 100g

Question 41

what is considered a low sugar content?

Answer 41

less than /equal 5 grams per 100g

Question 42

what is the current guidance for caries?

Answer 42

• restrict amount of food and drinks containing sugar consumed daily
• reduce frequency of consumption food and drinks containing sugar
• suggest drinking water or milk between meals
• suggest sugar free snacks
• do not eat or drink after brushing at night
• be aware of hidden sugars in food

Question 43

Give the summary slide.

Answer 43

• Evidence to show tyhat both the frequency and sugar rich food andrinks and the total ampunt of sugars consumed relate to dental caries
• There is also evidenc to show that these two varies are strongly associtaed - amount and freqwuency
• At the level of the indiviaul it is realistic to advise reduce the freqeuncy and consumption of sugar

Question 44

what would be the result of introducing soft drink industry levy?

Answer 44

reformulate the product itself - change recipe to reduce sugar