Dietary factors influencing dental health

Question 1

The impact of oral diseases

Answer 1

• time off school/work
• reduced QoL: social withdrawal
• pain and discomfort
• functional limitations

Question 2

Oral diseases and dietary risk factors

Answer 2

• dental caries: caused by sugar
• peridontal disease: caused by low vitamin C, D and Ca
• oral cancer: alcohol, smoking, low intakes of fruit and veg

Question 3

Dental caries: prevalence, significance, what causes them

Answer 3

• prevalence is 34% untreated, globally
• 2.9 billion people
• most common cause for hospital admission for tooth extraction in 5-9 year olds
• removal of teeth under general anaesthesia costs the NHS £35 million a year
• has actually reduced over the last 30 years due to the advent of fluoride toothpaste
• caused by excess sugar intake, as cariogenic bacteria in the mouth metabolise, lowering the pH causing bone demineralisation
• The above process can be reversed by salivary bringing the pH up and promoting bone remineralisation. Fluoride toothpaste also promotes bone remineralisation

Question 4

Fluoride toothpaste: what are the recommendations for different age groups?

Answer 4

• under 3s: as soon as teeth erupt should brush twice a day with a smear of 1000 ppm F toothpaste
• 3-9 year olds: brush twice daily with a pea sized amount of toothpaste with >1000 ppm F
• all adults: brush twice a day with 1350-1500 ppm F toothpaste

Question 5

Define: dental fluorosis

Answer 5

• this is where fluoride is used on the teeth in excess in the amelogenesis (enamel formulation) period
• critical window 2 years for the central and lateral incisors

Question 6

Dental erosion

Answer 6

• caused by acidic foods and drink such as fruit juices, citrus fruits, fizzy drinks, vinegar
• not related to bacteria
• BUT do not ask people to limit fruit because the benefits far outweigh the risks

Question 7

Head and neck cancers

Answer 7

• 1 in 55 men and 1 in 108 women
• these are largely preventable, with alcohol and tobacco use accounting for 80% of cases
• fruit and veg could protect against 50% of cases

Question 8

Recommendations for sugar intake

Answer 8

• should be <5% of total daily kcal intake
• currently consuming more than double this
• fruit smoothies and juices all count- anything than has disrupted the plant cell wall and released the sugars is counted
• not just amount but the frequency of sugar can also contribute to caries
• sugar consumption leads to T2DM, obesity and CVD risk

Question 9

Challenges for implementation of policy recommendations

Answer 9

• health education is not effective: knowledge doesn’t always result in behaviour change
• also need to think about social inequalities: sugary and kcal dense foods are cheaper
• sugar is big business: the coca cola industry fund scientists to debunk sugar causing obesity, they also have multitudes higher budget than the WHO. It is estimated that for every £1 the WHO spends on promoting healthy eating, the food industry spends £500 promoting themselves
• upstream legislation are the most effective, but met with concern from the public