Caries and Diet Flashcards
True or False: Caries rates are NOT strongly correlated with nutritional status.
True, not strongly
Poorly mineralized teeth are more susceptible to demineralization, but they will not decay if the _________ for bacterial acid production is not present.
local substrate
Teeth, well-formed and mineralized or not, cannot withstand a strong ________.
environmental challenge
What is the most important variable in the caries process?
the challenge to teeth from products of bacteria-substrate interactions
What type of caries are primarily associated with industrialized societies?
smooth surface caries (processed foods)
In pre-industrialized societeies, caries rates are ____ and primarily confined to ______ and _____ caries.
low
root surface and fissure caries
What kind of diet shows an increase in caries rates?
diets of refined foods
True or False: The amount of sugar consumed per capita per year correlates with caries rates.
True
In a plot of “sugar consumption in non-industrialized nations” against “DMFT” is there a correlation?
Yes, decayed-missing-filled teeth increase as sugar consumption increases in NON-INDUSTRIALIZED nations
In a plot of sugar consumption in industrialized nations” against “DMFT” is there a correlation? Why?
No, there is no clear relationship (increase in caries with increased sugar) in INDUSTRIALIZED nations. This is different from non-industrialized!!! Why? because when sugar consumption is already high at baseline, increasing above that threshold will have very little influence on caries rates
According to the WHO, there is a _________ between amount of free sugar intake and dental caries for both children and adults.
positive assocation
According to the WHO, evidence shows a ______ relationship between sucrose and monosaccharides intake and the progressive lifelong development of caries.
log-linear dose-response relationship
Evidence from the WHO resulted in new guidelines for sugar consumption: Sugar intake be reduced to LESS than ____% of total calories or roughly ____teaspoons/____grams per day.
10%
12 teaspoons
50 grams
*prior guidelines “no more than 10%”…now, “less than”
True or False: Much of the sugar consumed today is hidden in processed foods that are not usually seen as sweet.
True,
ex. 1 tablespoon ketchup= 1 teaspoon sugar
In wartime England (WWII) there was a German blockade of shipments which results in an “accidental experiment.” What were the conclusions?
German blockade= restrictions placed on sucrose
- 1-3 years after blockade: caries rates in children decreased from reduction in sugar
- 1-2 years postwar: caries rates increased dramatically
Describe the Vipeholm study.
From 1945 to 1954 in the mental hospital of Vipeholm in Sweeden: through three phases of the study, diet type and composition were controlled.
1. Vitamins/basic low carb
2. Carbohydrate 1/extreme carbohydrates
3. Carbohydrate 2/average,normal carbohydrates
*CONTROL: no sugar for 3 years
Other groups: Sucrose (300g in solution with meals), Sweetened Bread, Chocolate (between meals), Toffee (between meals), Caramel (snacks)
What were the conclusions of the Vipeholm Study?
The most critical changes in caries rates were related to time of sugar exposure (between meals) and texture of sugar source (sticky *toffee and caramel). The amount of exposures is more important than the weight amount per consumption.
What did the Hopewood Study show us?
That children living in communal homes, even on a normal diet, usually have lower caries rates than children living with their parents…
*strict dietary control (natural diet with limited between meal snacks) results in fewer cavities, even if hygiene is poor and fluoride insufficient
Which has higher preference for high concentration of sugar in sweet tea: urban or rural children?
Urban
Is there learned, genetic, or multiple factors that contribute to sugar preference?
Learned and Genetic:
- sweet preference changes with exposure
- nontaster/taster/supertaster: non-tasters have more caries
True or False: Supertasters have higher caries rates than non-tasters.
False, non-tasters have higher rates! if they can’t taste it, they keep adding more
Dietary modification can reduce ______ counts for extended period of time.
lactobacillus
selection of cariogenic bacteria by high carb diet
Rank cariogenicity of sucrose, cooked starches, and fructose from most to least.
Most cariogenic: SUCROSE
cariogenic: fructose
Least cariogenic: cooked starches
In the dental student experiment where participants were subjected to 9 daily rinses of 50% sucrose and no oral hygiene, white spot lesions were evident after how many weeks?
2 weeks
In the S.mutans experiment, with dental students, sucrose implants with 20% sucrose for 200-270 days, the increase in S.mutans was from 0.5% to _____.
18%
True or False: British children consume more sucrose than U.S. children and have higher proportions of fissure caries.
False…SMOOTH SURFACE CARIES are greater because they consume more sugar-sweetened tea (SUCROSE = SMOOTH SURFACE)
Why is sucrose more important for smooth surface caries than fissure caries?
better formation of biofilms
How much sugar do Americans average per year? Compared to 1816?
140 pounds!
15 pounds in 1816
What has been the effect of the increased intake of carbonated soft drinks in the United States?
fructose (corn sweetener) has surpased sucrose (cane)
What is the leading source of added sugar in the daily diet of young americans?
soft drinks
Do men or women average more in grams of sugar per day from soft drinks?
men (57.7grams)*
compared to women (36.2grams)
The highest average consumption of fluid milk peaks at ____ per day at age 1 and declines to only _____ per day at 18.
2 cups
3/4 cup
When does the rapid increase in carbonated soft drinks begin?
age 8
Dietary guidelines for children: Intake of 100% juice products should be limited to how many ounces per day?
4-6 oz
Dietary guidelines for children: Consume _____ serving of dairy foods daily.
2 or more
Compared to a normal diet, long-term exposure to a high-sucrose diet results in a __________ (pH).
greater drop in pH below 5.5
Sorbitol, Mannitol, Xylitol, and Erythritol are examples of _______.
Monosaccharide sugar alcohols
What is a polyol?
alcohol sugar
In what forms can polyols be of?
Monosaccharide, Disaccharide, or Polysaccharide
Lactitol, isomalt, and maltitol are examples of ________
Disaccharide sugar alcohols
Hydrogenated starch and hydrolysates are examples of ________.
Polysaccharide sugar alcohols
True or False: Sugar alcohols are calorie free.
False: they are anywhere from 40-75% the calorie content of sucrose
Both mannitol and Sorbitol are _____% as sweet as sucrose and have a _____ effect.
50-70%
laxative
The polysaccharide polyols are _____% as sweet as sucrose.
25-50%
Lactitol is ____% as sweet as sucrose, Isomalt is ____% as sweet, and Maltitol is ____% as sweet. These are all part of the ________ family of polyols.
30-40 Lactitol
45-65 isomalt
90 maltitol
True or False: Sugar alcohols do not promote tooth decay.
True
Sugar alcohols are described as having a ______ mouthfeel with a ______, ______, and _______ taste.
smooth
sweet, cool, and pleasant
______ gum may be more effective than sorbitol gum at preventing caries.
xylitol
True or False: Chewing sugar-free gum 3 or more times daily for prolonged periods of time be reduce caries incidence no matter which sugar alcohol is used.
True
What is the warning associated with xylitol?
in dogs: causes rapid and severe increase in insulin levels leading to dangerous hypoglycemia and death
What are the five No-Calorie Sweeteners discussed?
- Aspartame
- Saccharin
- Acesulfame-K
- Sucralose
- Stevia
_______ is a dipeptide of phenylalanine and aspartic acid, is not safe in people with phenylketonuria and is ____ times sweeter than sugar.
Aspartame (Equal)
200 times
True or False: Aspartame is not digested and is heat stable.
False: it is digested but in such small amounts that it can be considered calorie-free…it is NOT heat stable
______ has been associated with a “bitter after taste”, is not metabolized, and is temperature stable.
Saccharin (sweet n low)
Which zero calorie sweetener is 200 times sweeter than sucrose, has no aftertaste, is not metabolized, is heat stable, and is associated with a major ion?
Acesulfame-K
potassium!
Which zero calorie sweetener is 600 times sweeter than sucrose and is derived from a chlorination process?
Sucralose (splenda)
How is sucrose chemically altered in order to make sucralose?
three atoms of chlorine are substituted in place of three hydroxyl groups on the sugar molecule
Of the five zero calorie sweeteners, only one is digested. Which one?
Aspartame (slightly digested only!)
______ is derived from plant leaves, is heat stable, non-cariogenic, and is considered a _____ glycoside.
Stevia
steviol gylcoside
What are the two measurements of cariogenicity?
- pH (bacteria + food = pH drop)
2. Micro-electrodes on tooth surface (Stephan Curves)
How can physical properties of food influence cariogenicity (3 ways)?
- Adhesion to teeth (ex. cooked starch retained longer)
- Salivary stimulation (ex.gum)
- Mechanical cleansing (not supported by data)
______ which is used in gum has been shown to raise plaque pH.
Carbamide
Which component of baking soda will raise the plaque pH?
sodium bicarbonate
Which “foodstuff” has be associated with an inhibition of demineralization and promotion of remineralization?
casein phosphopeptide
______, such as phytate, will stabilize crystals by reducing solubility and protecting calcium.
phosphates
_____ and _____ are associated with acid inhibition when consumed with sugar (think about cream in your coffee).
Calcium and Fat
True or False: Scientific evidence shows that natural sugars in fruits/vegetables are not harmful.
False: no scientific studies show that they aren’t harmful. Sugar cane workers? high caries rates
What are two downsides to dietary counseling?
- Effectiveness: lifestyles are very hard to change
2. Targeting
To thrive on a smooth surface it’s helpful to be able to elaborate a strong extra-cellular matrix. _________ does this very well using glucosyl transferase with _____ as the substrate
Strep mutans
sucrose
*beware of the triple-“s”… s.mutans, smooth, sucrose
