Diet

Question 1

What are the four main factors involved in the Caries Biomedical Model?

Answer 1

1. The tooth
2. Bacterial Biofilm
3. Fermentable Carbohydrates
4. Time

Question 2

Protective factors from caries in the biomedical model

Answer 2

saliva and fluoride

Question 3

What are the steps in the Caries Disease Process? (5)

Answer 3

1. Frequent Sugar intake
   - or decreased sugar clearance: low salivary secretion/xerostomia
2. Repeated conditions of low pH in tooth biofilm (less than 5.5 pH) since bacteria produces more acid
3. Microbial shift to more acidogenic and aciduric microflora in tooth biofilm (this shift happens in result of the previous two conditions^ )
4. Shift in demineralization/ remineralization balance to NET mineral LOSS on the tooth surface
5. if imbalance continues, caries lesion will be seen clinically

Question 4

Diet vs Nutrition

Answer 4

Diet refers to the total amount of food consumed by individuals. It denotes the local actions of foods on oral tissues and includes the composition of food, its consistency, and the pattern and frequency of eating.

Nutrition describes the systemic effects of nutrients on the development, regeneration and repair of tissues. It involves ingestion, digestion, absorption, transport, incorporation into cells, and excretion.

Question 5

Sugar VS sugars*

Answer 5

Sugars:
any sweet-tasting, soluble carbohydrate in the form of either monosaccharides [glucose, Fructose, Galactose] or disaccharides [Sucrose, Maltose, Lactose]
Examples: Sugar Beets (table sugar); Sugar Cane (cane sugar), Corn syrup, Agave syrup

“Sugar”: refers to “sucrose” (produced industrially from sugar cane and sugar beets)

sugar is a TYPE of sugars. they are NOT separate.

Question 6

Natural Sugars

- their contribution to caries?

Answer 6

sugars physically located in the cellular structure of grains, whole fruits, vegetables and milk

encapsulated by a plant cell wall which contains a fiber known as cellulose o tend to be digested more slowly

** do not make an important contribution to the development of dental caries

-> fiber content, water content, other protective factors such as polyphenolic compounds or calcium or both
-> affect mechanical stimulation of salivary flow
Examples: fruits, vegetables, grains, seeds, milk products

Question 7

Free Sugars

- contribution to caries?

Answer 7

all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, PLUS those naturally present in honey, fruit juices and syrups, dry fruits.

Have high cariogenic potential!
Examples: table sugar, sugars found in confectionery, soft drinks, sodas, biscuits, cakes, cookies, granola bars, sweet cereals, fruit juices, honey and sugars added to recipes, corn syrups, maple syrup, milk desserts, dry resin, dates.

Question 8

Confectioneries

Answer 8

refers to the foods that are generally recognized as sweet treats. This includes candy (such as lollipops, candy canes, mints, candy floss, nut brittles, toffee, jellies, gummies, jujubes, licorice, fudge and caramels); candy bars; chocolate; chocolate coated or chocolate treats; fruit snacks,

VERY CARCINOGENIC
they have FREE sugars, and they are sticky af

Question 9

Sugary drinks

Answer 9

refers to beverages that can contribute to excess free sugars. like soft drinks, FRUIT FLAVOURED drinks, 100% FRUIT juice, energy drinks, iced coffee, sweetened milk etc

THESE ARE CARCINOGENIC

Question 10

Stephan Curve

Answer 10

shows how fast it takes pH to return to base line
after sugar intake it goes below threshold pH of 5.5
It takes 30 MINUTES for it to return above that critical threshold of 5.5 pH*

Question 11

Which type of sugar is LEAST cariogenic?

which is MOST

Answer 11

Lactose is LESS carcinogenic. BUT it is highly prevalent in PLAQUE

While SUCROSE is MOST cariogenic but LOW in plaque

Question 12

Sucrose

Answer 12

The most common form of added sugar in the diet
Highly soluble in oral fluids
Sucrose-mediated synthesis of extracellular glucans by biofilm bacteria
> glucans - a major component of the structural inter-microbial matrix of dental plaque
> water-insoluble glucans increases the diffusion properties of plaque
> deeper penetration of dietary sugar into the biofilm
> greater acid production immediately adjacent to the tooth surface

Question 13

Starch

- what are the two types

Answer 13

Carbohydrate, polysaccharides

Rapidly digestible starches (RDS)
e.g., processed starches: breads, pasta, noodles, cereals
WORSE, cariogenic*
- they can lower pH and cause demineralization IF RETAINED IN THE MOUTH LONG ENOUGH

Slowly digestible starches (SDS)

e. g., unprocessed starches: whole grains, legumes (digested slowly in small intestine)
- not cariogenic

Question 14

In what form does starch increase the risk of dental caries?

Answer 14

Starch increased risk of dental caries when combined with sugars!
(corn snacks, sweetened breakfast cereals, cakes, biscuits)

Question 15

Are cooked staple starchy foods like rice, potatoes and bread of low cariogeneity?

Answer 15

YES LOW cariogenity* among the RDS

Question 16

which is worse, fermentable vs nonfermentable carbohydrates?

Answer 16

FERMENTABLE ones are bad, more cariogenic. anything that is more processed is bad. natural is better

Question 17

What is more important
how much sugar you eat OR
the form of sugar you eat

Answer 17

THE FORM OF SUGAR YOU EAT
starch alone is NOT associated with cariogenic effect

• worse if sugar is consumed BETWEEN meals
• worse if they are sticky, better if it is liquid form
• worse if consumed frequently

Question 18

Foods with high retention rate (bad)

Answer 18

• sweet biscuits
• granola bars
• oatmeal cookies
• potato chips (crisps) - sugared cereal flakes

Question 19

what is the retention rate of these two?
potato chips
caramels

Answer 19

They are counter intuitive
caramels have LOW retention rate
potato chips have a HIGH retention rate

Question 20

effect of the Sequence of eating food?

Answer 20

The sequence of eating cariogenic food products alters its cariogenic properties
• Cheese and peanuts can reduce the acid production after a previous intake of sucrose
containing foods.
• Cooked and highly refined starches can increase the cariogenic properties of sugars if they are consumed at the same time (eg., cakes, sugared cereals).

Question 21

Dietary factors that protect against dental caries

Answer 21

o Cow’smilk
o Breastfeeding (associated with low levels of dental caries)
 o Cheese
o Wholegrain foods
o Vegetables
o Nuts
o Chewing gum (sugar free)
Stimulate saliva flow
Less cariogenic: fresh fruits; raw starches (slowly digestible starches)

Question 22

Relationship between Milk Consumption and Caries?

Answer 22

Milk consumption is associated with lower experience of dental caries.
• Bovine milk can be considered non-cariogenic; an anti-cariogenic role is possible.
• Components of milk that may be considered to be protective against dental caries:
o 80% of the carbohydrate in milk is lactose which has a low cariogenic potential
o high concentrations of calcium and phosphorus (resist demineralization and aid remineralization of enamel and dentine)
o casein (is a phosphoprotein, it prevents adherence of bacteria to enamel and pellicle; reduces the activity of glucosyl transferase, thus reducing glucan formation and plaque adherence; concentrates calcium and phosphate in plaque)
o other proteins and lipids (may reduce the ability of plaque microflora to adhere to enamel and produce acids)

Question 23

Fluoride and Caries relationship

Answer 23

Widespread use of fluoride –> Dramatic decline in dental caries prevalence in 1970s in most Western industrialized countries

Use of fluoridated tooth paste and frequency of sugar consumption (in situ caries model, Duggal et al., 2001)
o Enamel demineralization was found to occur after seven or more sugar intakes/day when the subjects used a
fluoride-containing toothpaste
o Enamel demineralization was observed after only three sugar intakes/day during the use of non-fluoride toothpaste
• Fluoride increased the safe margin of sugar intake
• Restriction of consumption of sugars still has a role to play in the control of caries.

Despite the more widespread use of fluoride, the frequency and amount of sugars intake remain important determinants of caries levels! Fluoride does not eliminate or remove the cause of caries — sugars.

Question 24

Sugary drinks and caries relationship

Answer 24

Sugar in liquid form is cariogenic
Soft drink consumption is related to caries: the more often the soft drinks are
consumed, the greater the extent and severity of caries. (Watt et al., 2000; Marshall et al., 2003)
Regular soda pop and regular beverages from powder are more strongly
associated with caries risk in children than 100% juice or juice drinks (Marshall et al., 2003).
The manner in which beverages are consumed: snack vs meal, prolonged sipping vs quick drinking, daytime vs night feedings.
Soft drinks thus can be viewed as a ‘common risk factor’ in public health (caries, obesity and diabetes, cardio-vascular diseases, periodontal diseases)
Enamel erosion (chemical dissolution of the enamel, low pH)

Question 25

WHO guideline recommendations for daily percentage of sugar intake?

Answer 25

10% of energy from free sugars (50 g or 10 teaspoons of sugars per day) – strong recommendation (children and adults; lower risk but not eliminate dental caries)

5% of energy from free sugars (25 g or 5 teaspoons of sugars per day) – conditional recommendation

Limiting the intake of free sugars to 10% or 5% of energy intake does not necessitate a sugar-free diet, and these limits allow for consumption of a limited amount of sugars-containing foods as part of a balanced diet.