Diet And Dental Caries I And Ii

Question 1

Importance of Nutrition in the growth and development of oral tissues and structures

Answer 1

• Optimal nutrition is important during early periods of growth and development. Nutritional problems that occur during these ‘’ critical periods of growth” can have life long consequences.
• For example: When a nutritional insult occurs during initial cell formation (hyperplasia).
• Problems that occur later during periods of cell growth and /or regeneration only (hypertrophy)

Question 2

Talk a bout ORAL SOFT TISSUES TURNOVER

Answer 2

• Oral soft tissues have a more rapid turnover time(3 to 7 days) than other tissues . Which increases the susceptibility of these tissues to problems associated with nutrient variability.
• Because of this rapid tissue turnover, nutrient requirements may be higher in the oral cavity than in the rest of the body, and when nutritional disturbance do exist, they may first manifest in the oral cavity.

Question 3

Talk a bout ‘Effects of Nutritional Problems on Tooth De

Answer 3

Question 4

The systemic effect of diet on dental caries

Answer 4

• Undernutrition is associated with hypoplasia of enamel which increases caries susceptibility
• Undernutrition results in salivary gland atrophy, reduced salivary flow rate, and reduced buffering capacity—these factors increase caries susceptibility
• Deficiency of vitamin D is associated with enamel hypoplasia and increased caries risk
• Undernutrition results in delayed shedding of the primary teeth and delayed eruption of the permanent teeth. This may influence the caries prevalence at a given age
• In undernourished populations where there is exposure to sugars in the diet, caries prevalence is higher than expected from observations in well-nourished populations

Ø Ø Ø Ø

Tooth enamel however is influenced by systemic nutrition only before eruption After eruption the effect of diet is exclusively ???????????????????

Because enamel not contain any capillary or lymphatic vessels to transport nutrients Therefore, chemical interchange in enamel occurs directly via external surface exchange.

Once the tooth erupts into the oral cavity ,mineralization continues throughout life topicallyfrom saliva,food,fluids,dentifrices,oral rinses.

Question 5

Effect of Malnutrition on teeth

Answer 5

• Loss of teeth is a predictor of malnutrition in adult patients,In turn ,oral impairment such as in ill fitting dentures or oral cancer can affect ability and desire to eat and subsequent nutritional status.
• Primary Malnutrition: results from inadequate food intake .The etiology is usually socioeconomic. For example,
• Adequate food may be unavailable
• Cost.
• Lack of knowledge lead to improper food choices, or preparation techniques may result in nutrient destruction.

Secondary Malnutrition:

• occurs when there is interference with adequate digestion, absorption,or utilization of foods.
• The diet chosen is adequate, but physiological factors interfere with proper nutrient utilization,include dental problems,digestive disturbances and malabsorption syndromes.

Question 6

What are ORAL MANIFESTATIONS ASSOCIATED WITH MALNUTRITION

Answer 6

1. Lips. The most common lesion are : Angular Cheilitis

2- Teeth :

The conditions seen in teeth are: Mottled enamel and Melanodontia.

3. Gums: The conditions seen are

A. Scorbutic type.

B. Gingivitis.

C. Hypertrophic gingivitis.

4- Tongue The conditions seen are

A. Filiform and fungiform papillary atrophy or hyperemia.

B. Magenta tongue.

• Scarlet red glossitis.
• Beefy red glossitis.

Question 7

Define • Acidogenic

• Cariogenic.
• Anticariogenic.
• Cariostatic

Answer 7

• Acidogenic :Foods/beverages that readily cause a drop in plaque pH to <5.5 within 30 minutes
• Cariogenic:Foods/beverages that contain fermentable carbohydrates that can be metabolized by oral bacteria to cause a decrease in plaque pH to <5.5 and demineralization of tooth enamel.
• sugars, sweets, desserts
• Anticariogenic :Foods/beverages that can prevent cariogenic activity when eaten with/before an acidogenic product.
• Includes xylitol and cheese
• Cariostatic :Foods/beverages that cannot be easily metabolized by dental plaque bacteria, and therefore do not cause a significant drop in salivary pH.
• Includes protein foods, eggs, fish, meat and poultry; most vegetables, fats.

Question 8

What’s classification of carbohydrates?

Answer 8

Question 9

Classify total sugars

Answer 9

Question 10

To promote optimal growth and development of oral cavity the dental health care team needs to emphasize the importance of :

Answer 10

❖An adequate diet throughout pregnancy.

❖An adequate intake of folic acid throughout the childbearing years.

❖ Optimum infant and child nutrition from birth.

❖ Avoidance of excessive doses of all vitamins(especially when pregnant).

Question 11

What are Evidence for a relationship between diet and dental caries comes from different types of studies:?

Answer 11

• Human intervention studies (clinical trials). ‘a
• Human observational studies.
• Animal experiments.
• Plaque pH studies.
• Enamel slab experiments.
• Incubation studies.

Question 12

What are Conclusions of Vipeholm study?

Answer 12

• Increased frequency of sugar consumption results in increased caries incidence.
• The increase consumed in a retentive form, particularly is greater when sugar is between meals.
• The total amount of sugar consumed is not critical when consumed at mealtimes.
• The increase in dental caries activity disappears on withdrawal of sugarrich foods
• Dental caries experience showed wide individual variation

Question 13

What’s conclusion of Hopewood House Study?

Answer 13

• The (Hope wood group) had significantly lower caries incidence.
• These findings concur with the Vipeholm study that caries incidence is related to the form of carbohydrate consumed.

Question 14

What’s conclusion of Turku Sugar study

Answer 14

aries development in the , xylitol group was insignificant compared with the other two groups.

Question 15

What’s h.f.i? Why can’t it be digested?

Answer 15

Hereditary Fructose Intolerance (HFI):the inborn error of metabolism that people are unable to metabolize fructose.As a result,they are also unable to metabolize sucrose

since sucrose, a disaccharide, is composed of Glucose and fructose)

• People with (HFI) have a much lower caries incidence than people who do not have HFI.

Question 16

Why experiments on humans can’t be don like animals?.

Answer 16

It would not be possible to test such dietary regimens in human due to problems of palatability and compliance.

The absolute cariogenicity of foods can be determined by administering that food to human volunteers for a period long enough for caries to develop .However, since is impractical as well as unethical(caries could result).

Question 17

Plaque pH studies usually employ one of four methodologies

Answer 17

1. metal probes
2. glass probes: which can be inserted in situ into plaque.
3. miniature glass electrodes built into a partial denture that stays in the mouth for several days to enable plaque to grow on the Recordings of pH are taken from wires coming from the mouth surface.
4. Harvesting method: that involves removing small samples of plaque from representative teeth and the measurement of plaque pH on an electrode outside the mouth.

Question 18

Explain this

Answer 18

Stephan curve The typical plaque pH response to fermentable carbohydrate

It shows that already after a few minutes, pH drops and in this case to a level below the “critical pH” i.e. a level at which the enamel is demineralized (around pH 5.5).

Foods that cause the plaque pH to fall below the critical demineralization level (pH 5.5 to 5.0) are considered acidogenic.

Question 19

Talk about Enamel slab experiments

Answer 19

Enamel slab experiments use oral appliances that hold slabs of bovine or human enamel. Plaque forms on the enamel slabs that remain in the mouth for 1 to 6 weeks. The slabs are exposed to the dietary factor being tested, by either consumption with the slabs in situ or by removal of the appliances several times a day containing the dietary test substances. to dip into vessels Changes in enamel hardness or degree of demineralization may be measured at the end of the experimental period.

Question 20

Talk about Incubation Experiments

Answer 20

Incubation studies are simple in vitro tests that measure if plaque bacteria can metabolize carbohydrate in a test food to produce acid.

Rapid acid production and/or a low final pH is mean that a food is potentially cariogenic.While a slow rate of acid production or higher final pH is likely to be of little clinical significance.

Question 21

What are sweeteners and their classification

Answer 21

A sugar substitute is a food additive that duplicates the effect of sugar in taste, but usually has less food energy.

Recently, they have gained popularity as a caries preventive agent.

Classification of Sugar Substitutes

• Bulk Sweeteners (Caloric ,Nutritive).
• Intense Sweeteners (Noncaloric, Non Nutritive).

Question 22

Properties of Xylitol?

Answer 22

§ § § § §

Reduces the quantity of dental plaque.

Significantly reduced S. mutans levels Increases saliva production.

Re mineralization of caries lesions Prevents periodontal disease and gingival inflammation.

Question 23

What’s recommendation of Xylitol? And disadvantage?

Answer 23

Xylitol use is recommended for moderate or high caries risk patients with assessment every 6 months.

Dosage Dosing frequency should be a minimum of 2 times a day and should not exceed 8 gl day

One of the disadvantages of the bulk sweeteners is that they have the potential to cause gastrointestinal disturbances when ingested in large quantities.

Question 24

What are intense sweeteners?

Answer 24

Intense Sweeteners (Noncaloric) Intense sweeteners are used in food products like soft drinks, confectionery, desserts, ice cream, and jam. They are also used in dentifrices and in sweetening drops/tablets for use in food, coffee, tea, etc.

§ § § §

Saccharin Aspartame AcesulfameK Sucralose

Question 25

What’s aim and indication of diet analysis?

Answer 25

Aim : To decreased the time for which the teeth are at risk of demineralization and increase the potential remineralization.

Indications:

1. High caries activity.
2. Unusual caries pattern.
3. Suspected dietary erosion.

Question 26

What’s the method of diet analysis?

Answer 26

§

A consecutive 34 day analysis(including at least one weekend day) is the most widely used § The patient recording the time, content, and quantity of food/ drink consumed. In addition, be tooth brushing and bedtime should indicated.

§ When the form is returned the entries should be checked with the patient.

Question 27

What are counseling tips for sugar intake?-

Answer 27

1. To reduce cariogenicity of the diet, for adults suggest limiting eating events to three times a day with no more than two between meal snacks and eliminating highly retentive foods such as crackers, chips, and soft candies.
2. For children who need the energy provided by between meal snacks, they should be healthy food choices low in cariogenic potential such as cheese, raw vegetables, meat rollups, and fresh fruit.
3. Ending a meal with cheese or milk, chewing gum with xylitol, or rinsing with water.
4. Consume sweetened and acidic beverages with meals and snacks that contain other foods that can buffer their cariogenic and acidogenic effects…

Question 28

Effects of eating pattern and physical form of food?

Answer 28

The frequency of eating.
The physical form of the carbohydrate.
Retentiveness of a food on the tooth surtace.
Sequence of eating.
Protective factors of food.

Question 29

Talk about frequency of eating

Answer 29

• The positive relationship between frequency of sugar intake and caries in humans was first demonstrated in the Vipeholm study.
• Frequent snacking between meals keeps themplaque pH low and extends the time for enamel and dentin demineralization to occur.

Question 30

Talk about the physical form

Answer 30

• Whether a food is hard or soft, fresh or cooked; viscous or moisture absorbent, these
physical properties influence caries risk by determining the salivary flow rate and oral clearance.

Question 31

Talk about retention of food an tooth surface

Answer 31

• Bacterial fermentation can continue as long as carbohydrate adheres to the enamel and exposed dentinal tooth surfaces.
• such as soft bread and potato chips, that are retained on tooth surfaces for prolonged periods of time, result in a lowered pH which may last up to 60 minutes.

Question 32

What’s effect of milk?

Answer 32

cheese or milk at the end of the meal decrease the cariogenicity.

Question 33

What are protective factors of food?

Answer 33

• Foods that are good stimuli to salivary flow protect against dental caries; examples include sugar-free chewing gum, peanuts, and cheese.
• A number of foods including cocoa, liquorice, and honey contain protective factors.
• The protective effect of tea may be due to fluoride or the antibacterial action of polyphenols, or both.
• Protein! Lectins, proteins found in plants, appear to interfere with microbial colonization and affect salivary function
• Other trace minerals(molybdenum ,vanadium and strontium) while selenium and lead may promote caries.

Question 34

Diet and nutrition play a key role in

Answer 34

Diet and nutrition play a key role in:

Tooth development
Gingival and oral tissue integrity
Bone strength
Prevention and management diseases of the oral cavity.

Question 35

To promote optimal growth and development of oral cavity the dental health care team needs to emphasize the importance of :

Answer 35

An adequate diet throughout pregnancy.
An adequate intake of folic acid throughout the childbearing years.
Optimum infant and child nutrition from birth.