Dietary advice for caries prevention Flashcards
what are the 4 factors that could cause caries
- bacterial plaque
- tooth surface
- refined carbohydrates- non milk extrinsic sugars
- time
How does plaque biofilm form
- formation of salivary pellicle
- microorganisms
- large proportion of streptococcus - strep sangria, strep oxalis
- after 1-14 days the streptococcus dominated plaque changes to actinomyces dominated plaque
Name some specific sites where caries is found
- pits and tissues on occlusal surfaces of molars and premolars
-approximal surfaces - margins of restorations
what appearance does the early, initial or incipient lesion bring
- characteristic chalky surface
what link does human observational studies show
link between caries and diet
Tristan de Cuna, Vipeholm, Hopewood house , 2nd world war sugar rationing
Describe the observational study of the Tristan da Cuna
- many of the population was displaced
- moved to the uK
- Availability of sugar was low population
- On return to the island they monitored to see if caries has resulted in dental decay
describe the Hopewood House study
- 1947-1963
- children are in a home without oral hygiene regime and the evidence of fluoride did not develop caries
- diet-facto-vegrtarian
- lack of availability of fluoride on toothpaste
how much percentage of the West Midlands population consume fluoridated water?
70%
- these areas have better oral health at every level of deprivation
how can the frequency of intake of sugar be affected?
- diet analysis to identify sugar intake and hidden sugars
- intrinsic and extrinsic sugars
- medication that contains sugars
- identifying foods and drinks with high potential for dental caries(cariogenic)
- reducing sugary snacks
- modifying behaviour
which population provides a higher risk of caries?
- infants and toddlers - bottles who surgary drinks
- patients with reduced salivary flow, radiation, Sjogrens syndrome
- increased carbohydrate intake due to medical problem
- recreational drug users who have a craving for sugar
- athletes taking sport drinks
- occupational .. food sampling
- special diets.. pts needing bulk drinks on a frequent basis to increase their weight
- partners on liquid medication include chronically ill children,frial elderly and adults with special needs. Frequent liquid medications taken for analgesia, infections
what are the most prescribed liquids
Lactulose, Ensure,Amoxicillin, Fortisip, Morph sulphate, amoxicillin, gaviscon, oramorph, paracet
what are the HIGH risk caries groups
- the caries prone esp, early childhood caries (nursing bottle caries)
- medically, physically, chronic illness and impairment
- Socially deprived … Low socio economic groups
- Language and cultural barriers without access to care and treatment
what does reduced salivary flow cause
- xerostomia
- impaired salivary flow
- dry eyes dry mouth
- undergone specific treatment
- atrophy of tissue
- saliva influence caries process
- saliva buffers and neutralises PH
- salivary proteins increase thickness of pellicle
- undergone radiation treatment
- relive systems through salivary stimulants and substitutes
what are the specific preventive measures for high risk groups
- plaque control and regular tooth brushing with fluoride toothpaste
- diet advice to modify intake of cariogenic foods and drinks to prevent dental caries
- use of fluorides
- use of fissure sealants
- regular oral checks with use of radiographs
what is the toolkit advice for preventing dental caries
- confectionary only at meal times
- only milk or water should be given to children in a feeder cup
- reduce soft drinks.. only at meal times… use a straw,.. do not use honey jam on a comforter
- do not give any sugar sweetened drinks at bedtime… only water
what is the recommended frequency of sugar intake
- reduce to 4 times per day
- consumption of sugary foods restricted to meal times only
- Use of non sugar sweeteners, tooth friendly, BDA accredited
- Non cariogenic snacks
what are cariogenic foods and drinks
- highly sugared sweets and drinks
- dried fruits contains high sugar content
- bread
- carrots and tomatoes are safe
- reducing grazing of population
- Keep to 3 meals a day
- confectionery
- cakes, biscuits, buns,pastries, table sugar, breakfast,cereals, jam, ice cream
- fruit smoothies, honey
where are hidden sugars found
processed foods
savoury foods
what are the key messages of the toolkit
- tooth brushing fluoride
- dietary/ healthy eating advice
- Sugar free medicines
- Improving periodontal health
- stop smoking
- alcohol misuse
- prevention of erosion
- behaviour change
what prevention is used to minimise plaque deposits?
- mechanical plaque removal
- manual and power brushes
- interdental cleaning
- fluoride toothpaste 1450 ppm
- Chemical plaque control , use of chlorhexidien
what does the diet diary do
- nutritional assessment
- support patients
- right balance of eating all necessary food groups
- identify eat well plate and give support to patient
what are professional preventive methods
- diet diary
- nutritional support
- behaviour modification
- plaque scores ..disclosing
- oral health advice
- Topical fluoride application- duraphat varnish
-Fissure sealants - Fluoride/ tooth mousse/ chlorhexidine moulded trays
what are the steps to dietary counselling?
Step 1 : Identify higher risk patients
Step 2 : Take detailed dietary history
Step 3 : Set goals
Step 4: Develop action plan
Step 5 : monitor and review
describe diets of :
low risk to caires
medium risk to caires
high risk to caries
low risk to caries : balanced intake of fruit and veg, infrequent sugar consumption primarily at meal times
medium risk to caires: daily and frequent sugar intake between meals
High risk to caries sugar intake > 3 X per day , prolonged exposure to foods and drinks
describe prevention of caries for high risk patients
- assessing the ‘ at risk’ patient for eg siblings with caries/caries in primary dentition, Recall patient regular intervals
-Nutritional assessment/ Diet sheet analysis repeated - Restrict sugary foods and drinks to meal times only
- Chair side toothbrush instruction with carer
what is recommended for children ages up to 3 years (OHI)
- use a smear of toothpaste containing no less than 1,000 ppm fluoride
- Parents should brush or supervise brushing as soon as teeth erupt to at least age 7 (manual dexterity)
- Sugars should not be consumed more than 4X per day
what is the recommended OHI for children ages up to 3-6 years with active caries
- use a pea sized amount of fluoride toothpaste 1350-1500ppm
- professionally fluoride varnish 2.2%
- provide fluoride varnish application professionals every 4 months
- use beaker cups instead of bottles
- Adult fluoride toothpaste 1450 ppm
what does the Stephan curve show
plaque acid causes drop in PH
y axis- PH
x axis- minutes after glucose rinse
plaque remains acid for some time
