Dietary advice for caries prevention Flashcards
Risk of developing caries:
• Infants and toddlers – night time 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.
Human Observational studies show the link between caries and diet.
Tristan de Cuna, Vipeholm ,Hopewood house, 2nd world war sugar rationing ,Turku.
Hope wood house:
• 1947-1963 study
Children in a home without a oral hygiene regime and the evidence of fluoride who did not develop caries – diet – lacto –vegetarian
High risk caries group:
• The caries prone-especially early childhood caries [nursing bottle caries]
• Medically physically impaired
• Socially deprived…. Low socio economic groups
Language and cultural barriers
Diet advice:
• Confectionary used 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 drinks at bedtime………only water
Specific preventative measures for high risk group:
- Plaque control and regular tooth brushing with fluoride
- Diet advice to modify intake of cariogenic foods and drinks to prevent dental caries [ diet diary]
• Use of fluorides
• Use of fissure sealants
Regular oral checks with use of radiographs
Frequency:
• 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
Prevention to minimise plaque deposits:
• mechanical plaque removal
• manual and power brushes – cochrane study
• interdental cleaning
• Fluoride toothpaste 1450 ppm
• chemical plaque control, use of chlorhexidine
Assess saliva flow
Toolkits: key message
• Tooth brushing fluoride • Dietary/healthy eating advice, • Sugar free medicines, • Improving periodontal health, • Stop smoking, • Alcohol misuse, • Prevention of erosion Behaviour change
Steps to dietary counselling:
• Step 1 Identify higher risk patients • Step 2 Take detailed dietary history • Step 3 Set goals • Step4 Develop Action Plan Step 5 Monitor and review
Assessment:
• Low risk to caries : Balanced intake of fruit and veg infrequent sugar consumption primarily at meal times
• Medium risk to caries :daily and frequent sugar intake between meals
High risk to caries sugar intake > 3 x per day, prolonged exposure to foods and drinks
Cariogenic food, non milk extrinsic sugars (NMES)
• Confectionary
• Cakes ,biscuits, buns ,pastries, table sugar, breakfast cereals, jam, ice cream , sorbets, fruit in syrups, fresh fruit juices, soft drinks, dried fruits Dept of Health Toolkit
Fruit smoothies, honey
Diet Assessment:
• Low risk to caries :
• Medium risk to caries :
High risk to caries:
• Low risk to caries : Balanced intake of fruit and veg infrequent sugar consumption primarily at meal times
• Medium risk to caries :daily and frequent sugar intake between meals
High risk to caries sugar intake > 3 x per day, prolonged exposure to foods and drinks
Children aged up to 3 years
• 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 4 x per day
Other than diet what is another source of extrinsic sugars:
Bounus question: name the most common
Medication:
• Patients on liquid medication include chronically ill children, frail elderly and adults with special needs. Frequent liquid medications taken for analgesia , infections.
Most prescribed liquids …Lactulose, Ensure, Amoxicillin, Fortisip, Morph sulphate, Amoxicillin, Gaviscon, Oramorph,Paracetomol
Advice Low caries risk
OHI as needed
Fluoride dentifrice 1,350ppm or above
Apply fluoride varnish to teeth twice yearly 2.2.%
Spit out after brushing do NOT rinse
Sugar should be consumed no more than 4 times per day
Observe pits and fissures with stain or early decay, decay in enamel, very early (stable) decay in dentin, old restorations and poor margins
Recall patient every 9 months; consider increasing if remaining low risk
Take BW radiographs every 2 years
Advice med caries risk
Patient education
OHI as needed
Fluoride dentifrice 1,350ppm or above
Apply fluoride varnish to teeth twice yearly 2.2.%
Fluoride mouthrinse daily 0.05% at different time to brushing
Spit out after brushing do NOT rinse
Diet counselling
Diet free medicines
Sugar should be consumed no more than 4 times per day
Observe pits and fissures with stain or early decay in enamel
Restore old restoration with crack and broken margins, decay in pits with halo or shadow, any decay in dentin
Recall patient every 6 months
Take BW radiographs every year
Advice high caries risk
Patient education
OHI as needed
10+ with active caries use 2,800ppm
16+ consider 5,000ppm
Apply fluoride varnish to teeth 3-4 times yearly 2.2.%
Fluoride mouthrinse daily 0.05% at different time to brushing
Spit out after brushing do NOT rinse
Investigate diet and help adopt good dietary habits
sugar free medicines
Fissure seal permanent molars
Observe pits and fissures with stain or early decay in enamel
Restore old restoration with crack and broken margins, decay in pits with halo or shadow, any decay in dentin
Recall patient every 3 months
Take BW radiographs at 6 month intervals
Caries risk- Patient’s Attendance Record
Low-Regular recall intervals
med-Irregular recall intervals
High-Infrequent attendance
Patient education and motivation
Low risk to caries :
Medium risk to caries :
High risk to caries:
Low- Dentally aware
med- Dentally aware but lack of motivation
high- Low dental knowledge
Poor motivation
Family dental history
Low risk to caries :
Medium risk to caries :
High risk to caries:
Low- No caries in last 24 months
Med- Carious Lesions in last 2 years
High- Carious Lesions in last 6 months
Medical history
Low risk to caries :
Medium risk to caries :
High risk to caries:
Low- No relevant mental or physical factors Med- Poly pharmacy Poor manual dexterity Low level learning disability Reduced saliva flow Eating disorders High- Xerostomia Radiotherapy Severe mental or physical capacity Drug/alcohol abuse
Tooth Morphology
Low risk to caries :
Medium risk to caries :
High risk to caries:
Low- Well coalesced pit’s and fissures, Intact sealants
Sound restorations
Med- Overhanging restorations, Heavily restored dentition, Orthodontic appliances, Partial dentures
High- Deep pit’s or fissures
Exposed root surfaces
Previous disease or dental treatment
Low risk to caries :
Medium risk to caries :
High risk to caries:
Low- Unrestored teeth, Sound restorations, No carious lesions in the past year
Med- White spot lesions, Interproximal radiolucencies
1-2 carious lesions or restorations in previous 3 years
High- Visible or radiographic caries, Multiple restorations
≥ 2 restorations in previous 3 years, Smooth surface caries, Extractions due to caries
Saliva
Low risk to caries :
Medium risk to caries :
High risk to caries:
Low- Normal flow and quality
Med- Reduced flow or poor quality
High- Xerostomia
