Dietary advice for caries prevention

Question 1

Risk of developing caries:

Answer 1

• 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.

Question 2

Human Observational studies show the link between caries and diet.

Answer 2

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

Question 3

High risk caries group:

Answer 3

• The caries prone-especially early childhood caries [nursing bottle caries]
• Medically physically impaired
• Socially deprived…. Low socio economic groups
Language and cultural barriers

Question 4

Diet advice:

Answer 4

• 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

Question 5

Specific preventative measures for high risk group:

Answer 5

• 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

Question 6

Frequency:

Answer 6

• 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

Question 7

Prevention to minimise plaque deposits:

Answer 7

• mechanical plaque removal
• manual and power brushes – cochrane study
• interdental cleaning
• Fluoride toothpaste 1450 ppm
• chemical plaque control, use of chlorhexidine
Assess saliva flow

Question 8

Toolkits: key message

Answer 8

• Tooth brushing fluoride
• Dietary/healthy eating advice, 
• Sugar free medicines, 
• Improving periodontal health,
• Stop smoking, 
• Alcohol misuse, 
• Prevention of erosion
Behaviour change

Question 9

Steps to dietary counselling:

Answer 9

• 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

Question 10

Assessment:

Answer 10

• 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

Question 11

Cariogenic food, non milk extrinsic sugars (NMES)

Answer 11

• 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

Question 12

Diet Assessment:
• Low risk to caries :
• Medium risk to caries :
High risk to caries:

Answer 12

• 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

Question 13

Children aged up to 3 years

Answer 13

• 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

Question 14

Other than diet what is another source of extrinsic sugars:

Bounus question: name the most common

Answer 14

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

Question 15

Advice Low caries risk

Answer 15

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

Question 16

Advice med caries risk

Answer 16

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

Question 17

Advice high caries risk

Answer 17

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

Question 18

Caries risk- Patient’s Attendance Record

Answer 18

Low-Regular recall intervals
med-Irregular recall intervals
High-Infrequent attendance

Question 19

Patient education and motivation
Low risk to caries :
Medium risk to caries :
High risk to caries:

Answer 19

Low- Dentally aware
med- Dentally aware but lack of motivation
high- Low dental knowledge
Poor motivation

Question 20

Family dental history
Low risk to caries :
Medium risk to caries :
High risk to caries:

Answer 20

Low- No caries in last 24 months
Med- Carious Lesions in last 2 years
High- Carious Lesions in last 6 months

Question 21

Medical history
Low risk to caries :
Medium risk to caries :
High risk to caries:

Answer 21

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

Question 22

Tooth Morphology
Low risk to caries :
Medium risk to caries :
High risk to caries:

Answer 22

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

Question 23

Previous disease or dental treatment
Low risk to caries :
Medium risk to caries :
High risk to caries:

Answer 23

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

Question 24

Saliva
Low risk to caries :
Medium risk to caries :
High risk to caries:

Answer 24

Low- Normal flow and quality
Med- Reduced flow or poor quality
High- Xerostomia

Question 25

Plaque control
Low risk to caries :
Medium risk to caries :
High risk to caries:

Answer 25

Low- No visible plaque deposits
Med- Minimal plaque deposits
High- Heavy mature visible plaque deposits

Question 26

Patient home care
Low risk to caries :
Medium risk to caries :
High risk to caries:

Answer 26

Low- Daily removal of plaque with regular ID care
Med- Little or no ID care
Occasional lapse in toothbrushing routine
High- Irregular, infrequent or ineffective toothbrushing
No ID care

Question 27

Fluoride use
Low risk to caries :
Medium risk to caries :
High risk to caries:

Answer 27

Low- Appropriate fluoride use
Med- Less than recommended fluoride exposure
High- No fluoride exposure