Dietary advice Flashcards
What are the 3 most important factors in caries control?
Plaque control, use of fluoride, dietary modification
What factors place a patient at high caries risk?
high sugar intake, inadequate brushing, no fluoride, irregular dental attendance, medically compromised, xerostomia
What investigations would you do for a patient with high caries?
diet analysis, investigate fluoride intake, MH, OH practices, bitewing radiographs
Which organisation states that dentists are required to give dietary advice?
NICE (2015)
Which medical and dental disorders can be caused by sugar?
Overweight and obesity, type 2 diabetes, dental caries
What dietary factors are associated with caries incidence?
amount of fermentable CHO, sugar concentration, physical form of CHO, oral retentiveness, frequency of meals/snacks, length of interval between eating, sequence of food consumption
What features can increase oral retentiveness?
Ortho appliances, dentures, overhangs, fixed prostheses (plaque retention factor)
Which studies prove the relationship between caries and sugar?
Vipeholm study and Turku study
Why was the Vipeholm study highly unethical?
Conducted human experiments on intellectually disabled patients of Vipeholm hospital and fed them sticky sugars.
What did the Vipeholm study investigate?
the association between sugar consumption and dental caries
What were the conclusions of the Vipeholm study?
The consumption of sugary foods is associated with higher caries incidence. Increasing the frequency increases caries. Decreasing sugar intake reduces caries. Consumption of sticky sugar containing products between meals is associated with high caries risk.
What is xylitol?
A naturally occurring sugar that has a caries-inhibitory effect
What did the Turku study investigate?
Evaluated the caries incidence after partial substitution of dietary sucrose with xylitol
How did the Turku study investigate the effect sucrose and xylitol had on caries incidence?
Compared the effects of sucrose or xylitol containing chewing gums during one year
What did the results of the Turku study show?
There was a big difference in caries rate between the sucrose and xylitol groups. Xylitol has a therapeutic, caries inhibitory effect.
Name of the curve that shows the effect of a sugar exposure on plaque pH over time
Stephan curve
Why does pH decrease after sugar intake?
the bacteria in the mouth convert the sugar to acid
How long does it take for the pH to return to normal after sugar intake?
20-30 minutes (saliva buffering)
What percentage of total energy consumption should free sugars (non milk extrinsic sugars, NMES) not exceed?
10%
Approximately, what is the maximum amount of free sugar an individual should have a day?
50g
Why are the ‘no added sugar’ labels misleading?
Patients don’t realise there is already sugar present (hidden sugar)
Name 4 forms of carbohydrate that can cause caries
sucrose, fructose, glucose, maltose
How can you investigate what aspects of a patient’s diet are causing caries/erosion?
Diet sheet
What needs to be recorded by the patient / mother of child on the diet sheet?
Time, content and amount of all the foods and drinks consumed
How many days should be recorded in a diet sheet?
3 days - 2 weekdays, 1 weekend
How should you analyse the 3-day diet sheet?
Ring main meals, highlight all sugar intakes (including hidden sugar) and acidic drinks, note frequency (snacks), consistency of foods (clearance is longer for sticky, dry foods), whether anything is eaten before bed
Examples of foods with hidden sugar
baked beans, breakfast cereals, ketchup, biscuits
Possible dietary advice
reducing snacks containing sugar, avoid adding sugar, fruit drinks during meal times (highest saliva flow), eat sweets in one and save to special time of week, only drink water/milk between meals, don’t eat/drink after brushing at night, increase fruit/veg, avoid food 20-30min before bedtime
How often should you give dietary advice for a child patient?
At least once a year
Specific additional dietary advice you would give to parents of a child?
do not place sugary drinks, fruit juices, sweetened milk or soy formula milk in feeding bottles or pacifiers
Dental erosion definition
tooth surface loss by a chemical process that does not involve bacterial action
Causes of dental erosion
chronic exposure of dental hard tissues to extrinsic or intrinsic acidic substances
Why does dental erosion lead to ‘cupping’ of the occlusal surfaces?
dentine wears more easily than enamel
What is extrinsic erosion caused by?
acid originating outside the body (e.g. drinks)
What is the general acid strength of extrinsic acidic substances?
pH 2.5 or weaker
What is intrinsic erosion caused by?
Stomach acid reaching teeth
What is the pH of intrinsic acid (stomach)?
pH 1 (100 times stronger than extrinsic erosion)
What should you do if you see extreme acid erosion?
Ask about acidic beverage consumption (frequency and manner in which they drink) or stomach problems
What provides a more accurate assessment of erosion potential of beverages than pH?
titratable acidity (e.g. although coke has a lower pH than grapefruit juice, grapefruit juice has a higher TA so is more erosive)
Titratable acidity definition
a measure of the number of H+ ions available for erosive attack
What is the worst type of acid for dental erosion?
Citric acid (found in red bull)
What dietary advice can you give specific to acidic beverages?
Have drink with meal, do not sip slowly, use a straw, drink diluting squash, do not replace fizzy drinks with fruit juice (high TA)
What can you ask a patient about the manner in which they drink acidic beverages?
whether they sip, swish, froth or hold the drink in their mouth (all prolong acid exposure)
What can you recommend the patient adds to their diet?
Milk/cheese at the end of a meal, sugar-free chewing gum to stimulate salivary flow
When should the parents start brushing their child’s teeth?
As soon as first tooth erupts
What is the term used to describe carious upper teeth while the lower teeth are unaffected in children?
Nursing / bottle mouth caries
What causes nursing / bottle mouth caries?
Consumption of sweetened drinks from bottle (esp if child falls asleep with it) and breast feeding at night over age of 1
Why are only the upper teeth affected in nursing / bottle mouth caries?
Position of tongue and submandibular ducts protect lower anteriors
What should be your advice to parents about night-time feeding?
Only water should be given in the night after 12 months of age
