Nutrition and diet Flashcards
1
Q
How can nutrition affect tooth development ?
A
affect in utero tooth development
affect posteruptive tooth development
affect caries and periodontal disease
2
Q
What are the macronutrients ?
A
fat
carbohydrate
protein
3
Q
What is the purpose of the macronutrients ?
A
provide energy
4
Q
What are the micronutrients ?
A
vitamins minerals and trace elemnts
5
Q
What can energy be measured in ?
A
kJ or kcal
6
Q
How many kcal per fat gram ?
A
9 kcal per gram of fat
7
Q
How many kcal per carbohydrate ?
A
4 kcal
8
Q
How many kcal per protein gram ?
A
4 kcal
9
Q
How many kcal per gram of alcohol ?
A
7 kcal
10
Q
How many kJ in one kcal ?
A
i kcal-4.18 kJ
11
Q
What is EAR ?
A
estimated average requirment
total dietary intake prediced to maintain energy
12
Q
What happens to excess energy ?
A
stored as fat
13
Q
What is EAR required for ?
A
temperature maintenance
breathing
heartbeat
brain function
14
Q
What does EAR maintain ?
A
BMR
basic metabolic rate
15
Q
When is BMR altered ?
A
body builders
pregnant
16
Q
What is a healthy BMI ?
A
18.5 and 24.9
17
Q
What is EAR based on ?
A
body size and composition
gender
age
activity level
18
Q
What 2 things link EAR in an equation ?
A
EAR= BMR x PAL
19
Q
What is the EAR of adult men ?
A
2772 kcL
20
Q
What is the EAR of 1 year old girls ?
A
646 kcal
21
Q
What is the EAR of 1 year boys ?
A
718
22
Q
What is the EAR of adult women ?
A
2079 kcal
23
Q
What are fats composed of ?
A
glycerol and fatty acids
24
Q
What are types of fatty acids ?
A
saturated and monounsaturated and polyunsaturated
25
What are saturated fatty acids ?
no double bonds
| only single carbon carbon bond
26
Where can you find saturated fatty acids ?
animal and dairy fats
27
Where can you find MUFA ?
seeds and nuts
28
Where can you find PUFA ?
oils
29
What are the functions of dietary fats ?
```
make lipid bilayer
energy release
precursors of prostaglandins
precursor of cholesterol
absorption of ADEK
```
30
What are essential fatty acids ?
not made in the body
| must come from diet
31
What is cholesterol needed for ?
fat absorption via chylomicrons
32
What are the essential fatty acids ?
alpha lionlenic
| linoleic
33
Where can you find lionleic and linolenic fatty acids ?
plant oils
34
What are omega 3 fatty acids ?
3 carbon double bonds before the methyl end of the chain
35
Give an example of an omega 3 fatty acid ?
lionoleic fatty acid
36
What odes alpha linolenic acid do ?
converts into EPA and DHA
37
What is EPA ?
EICOSAPENTANOIC ACID
38
What is DHA ?
docosahexanoic acid
39
What is the purpose of DHA and EPA ?
form prostaglandins
decrease cardiovascular risk
prevent periodontal disease
reduce platelet aggregation and hence thromboembolic episodes
40
What is a cis fatty acid ?
hydrogen atoms orinetated in one direaction
41
What is a trans fatty acid ?
hydrogen atoms orientated in different direction
42
What do hydrogenated oils contain ?
trans fatty acids
| cheaper than animal fats
43
What is trans fat intake strongly associated with ?
colon cancer
| cardiovascualr disease
44
What does accumulation of cholesterol rich lipid lead to an increase in ?
increase cardiovascular disease risk
45
Which is the bad type of cholesterol ?
LDL
46
What can saturated fat increase ?
LDL
47
What do trans fatty acids to ?
increase LDL
| decrease HDL
48
What does dietary cholesterol increase ?
increases LDL
49
How can we substitute saturated fat ?
with PUFA- secreases cholesterol
50
What do plant stanols and sterols do ?
prevent cholesterol absorption
| lower LDL cholesterol
51
What is a commercial plant stanol ?
benecol
52
What can also lower cholesterol ?
oat fibre
| soya protein
53
How do oat fibres reduce cholesterol absorption ?
beta glucans in oat fibres bind to cholesterol and sequester it
54
What is obesity associated with ?
cancer
55
What is high animal fat intake associated with ?
bowel
pancreas
prostate
cancer
56
How much of the total dietary intake should come from fat ?
less than 35%
| less than 5% from saturated fat
57
What are the types of carbohydrates ?
starch
sugars
fibre
oligosaccharides
58
What is starch ?
amylose and amylopectin
| bread, pasta. potatoes
59
What are the types of sugars ?
monosaccharidea
| disaccharides
60
What are sugar alcohols ?
xylitol
| sugar substitutes and sweetners
61
How much kcal do sugars produce ?
4 kcal per gra
62
What is excess energy from sugar stored as ?
glycogen and fat
63
What are sugars used for in the body ?
glycoproteins - albulin
GAGs- hyaluronic acid
proteoglycans
64
What can high sugar intake lead to ?
obesity
cardiovascular disease
diabetes
65
What are oligosaccharides ?
2 or more sugar molecules bonded
66
What is fibre?
non glycaemic carbohydrates
67
What are the classifications of fibre ?
NSP
resistant starch
resistant oligosaccharide
68
What is NSP ?
cellulose
pectine
mucilages
69
How is NSP digested ?
not in the digestive tract
passes to the colon and undergoes microbial anaeroic fementation
adds to stool bulk and stimulate peristalsis
70
What is insoluble NSP ?
adds to stool mass
| increases satiety- good for weight loss
71
What is resistant starch ?
starch not digested because enclosed in cells
| green bananas
72
What is resistant oligosaccharide ?
encourage growth of bifodobacterium and lactobacillus so can increase caries risk
73
What are maltodextrins and glucose syrups ?
made from starch hydrolysis
can be found in soya infant formula
increase cariogenic risk
74
What is the recommended intake of free sugars ?
5% of all dietary intake
75
How much sugar intake in children 11+ ?
30 g sugar
76
What are the functions of dietary proteins ?
muscle and tissue maintenance
| hormones and enzymes
77
What are animal sources of proteins ?
meat dairy and fish
78
What are the vegetable protein sources ?
pulses
| nutes
79
What is the nitrogen balance ?
the balance determines requirements for proteins
| amount of nitrogen we intake should equal amount excreted
80
What is a positive nitrogen balance ?
amount excreted in less than amount taken in
| growth and pregnancy
81
What is a negative nitrogen balance ?
amount excreted is more than amount uptaken
| in starvation
82
How much nitrogen is in 6.25g of protein ?
1 g of N
83
How much protein do people require ?
0.75 kg to 1.g kg per kg of weight
| bascially 1 g for every kilo
84
How much of total dietary intake is protein ?
12%
85
What are the 3 types of protein deficiency syndromes ?
marasmus
kwashiorkor
NOMA
86
What is marasmus ?
protein-energy malnutrition
severe muscle wasting
decreased insulin:glucagon
muscle proteins used in liver to make albumin - prevents oedema
87
What is kwashikor ?
protein deficiecny
high insulin: glucagon
reduced amino acids for albumin synthesis causes oedema
88
What is NOMA ?
malnorushment
ulceration and stomatitis
of upper gum. maxilla and cheeks
89
What is beta carotene ?
a yellow pigment antioxidant that is converted to vitamin A
| found in yellow vegetables
90
What are sources of vitamin A ?
```
cheese
eggs
milk
eggs
yoghurt
leafy vegetables
```
91
What are the fucntions of the vitamin A ?
```
sight- retinol production
T cell differentiation
Maintenance of healthy skin
regulates gene expression
anti oxidant
```
92
What is the recommended intake for vitamin A ?
750 micrograms for men
| 650 micrograms for women
93
What are signs of vit A deficiency ?
eczema
night blindness
infertility
94
What are oral healthy symptoms in deficiency ?
increased keratin formation- blocks saliva ducts leading to xerostomia
enamel hypoplasia
delayed tooth eruption
95
What are sources of thiamine ?
meat
| bread
96
What is thiamine (B1) used for ?
metabolic pathways to convert carbohydrates to ATP
97
What are signs of thiamine deficiency ?
weight loss
anorexia
muscle weakness
beri beri disease
98
What are sources of riboflavin (B2) ?
animal products
99
What is the function of B2 ?
metabolism of fats
conezymes
conversion of carbs to ATP
100
What are signs of deficiecny of riboflavin ?
anaemia
cataracts
skin disorders
101
What are oral symptoms of thiamine deficnecny ?
thiamine deficinecy cna cause vomiting effecting enamel
102
What are oral symptoms of riboflavin deficiency ?
ulceration
angular cheilitis
mucosal inflammation
103
What are sources of folate ?
green veg
nuts
beans and dairy
104
What is the fucntion of folic acid ?
neural tube closuure
105
What can happen with folic acid deficiency ?
failure of neural tube to close
| leads to anencephaly
106
What are sources of B12 ?
animal products
107
What are the fucntions of B12 ?
coenzyme
| DNA and RNA synthesis
108
What does folic acid and B12 deficinecy lead to ?
megaloblastic anaemia
109
What are the oral symptoms of B12 and folate deficinecy ?
lack of keratinisation
pale mucosa
angular cheilitis
110
What are sources of vitamin C ?
oranges
red peppers
brocolli
supplements
111
What are functions of vitamin C ?
collagen synthesis
cartialge and bone
wound healing and scar formation
antioxidant
112
What are symptoms of vitamin C deficiency ?
painful joints
osteoporosis
scurvy
dry skin and hair
113
What are the oral symptoms of vitamin C deficiency ?
swollen , erethematous gingiva
PDL breakdown as it made of collagen
antioxidant- reduce ROS in inflammation
114
What are the fat soluble vitamins ?
A D E K
115
What are sources of vitamin K ?
```
green leafy veg
nuts
seeds
meat
dairy
```
116
What are the fucntions of vitamin K ?
needed in acitivation of vitamin K dependent clotting factors
2,7, 9 and 10
117
Which medication should you not prescribe to someone with folic acid deficiency ?
sulfonamides
| trimethoprim
118
What can vitamin K deficiency lead to ?
haemorhage
excessive bleeding
easy bruising
119
What are oral symptoms of vitamin K deficiency ?
osteocalcin regulates mineralisation and is vit K dependent
120
What are the sources of nicotinic acid (B3) ?
meat
fish
wheat
fortified cereals
121
What are the functions of vitamin B3 ?
protein and fat metabolism
inhibit LDL production
precursor of enzymes- NAD
122
What are signs of nicotinic acid deficinency ?
pellagra- thick scaly rash
123
What are oral symptoms of nicotnic acid deficinecy ?
atrophic glossitis
atrophy of filliform anf fungifomr papillae
angular stomatitis
124
What are sources of vitamin D ?
oily fish
red meat
sunlight
125
What is the function of vitamin d ?
increeases blood calcium via absorption
| 1,25 DHCC converted from D to allow bone resorption and GIT abosrbance
126
What are the signs of vitamin D deficiency ?
rickets
| weak immune system- innate immunity
127
What are the oral symptoms needs of vitamin D ?
allows calcium absorption
| hydroxyapatite formation
128
What are sources of calcium ?
dairy
green veg
tofu
129
What are the functions of calcium ?
muscle contraction
blood clotting
nerve signalling
bone and tooth formation
130
What are the signs of calcium deficiency ?
muscle cramps
brittle fingernails
osteoporosis
insufficinet blood clotting
131
What are sources of magnesium ?
dark chocolate
avocado
legumes
132
What are the functions of magnesium ?
co factor for muscle contraction
glycaemic control
ionic transport
133
What are the symptoms of magnesium deficiency ?
muscle cramps
nausea
seizures
decreased apatite
134
What are the oral symptoms of magnesium deficiency ?
anti inflammatory- lack of can lead to gingival inflammation
can lead to reduced calcium absorption
135
What are the sources of iron ?
liver
beans
fortified cerelas
dark green veg
136
What is the function of iron ?
haemoglobin formation
137
What are the symptoms of iron deficiency ?
tiredness
paleness
shortness of breath
dizziness
138
What are the oral symptoms of iron deficiency ?
pale tongue
| angular cheilitis
139
What are sources of zinc ?
oysters
red meat
phyates can bind to zinc and prevent absorption- soak beans
140
What are the functions of zinc ?
cell division
cell growth
wound healing
T cell development
141
What are the signs of zinc deficiency ?
immune problems
loss of smell and taste
lethargy
acne
142
What is the oral significance of zinc ?
found in saliva to inhibit plaque growth
| inhibits bacterial metabolism
143
What are dietary reference values ?
given for food, energy and nutrients in the UK
| amount of nutrient needed for different groups like age and gender
144
What are dietary reference values given for ?
carbohydrates- free sugars and fibre
protein -
fat- saturated and trans
145
What are DRVs based on ?
popualtions not individulas
146
What is the RNI ?
reference nutrient intake
| amount of nutrient enough to satisfy 97.5% of population
147
Where is RNI on a normal distribution graph ?
near the end
148
What is the estimated average requirement ?
EAR
estimate of the average requirement of energy or a specific nutrient
approximately 50% of population will need less energy and 50% will need more
149
What is RNI used for ?
reference amount for population groups
150
What is EAR used for ?
energy
151
What is LRNI used for ?
nutritional inadequacy
152
What is the LRNI ?
lower reference nutrient intake
amount of nutrient enough for only a small number of people
they have low requirements- 2.5%
majority of population will need more
153
How much should fat constitute of total energy intake ?
35%
less than 10% saturated
less than 2% trans fat
154
How much should free sugars constitute total energy intake ?
5%
155
How much should protein constitute total energy intake ?
12-15%
156
How much sugar should 11+ have ?
no more than 30g
157
How much sugar should 7-10 years ?
no more than 24g
158
How much sugar should 4-6 years have ?
no more than 19g
159
What is the eatwell guide ?
guide to proportion of each nutrient needed daily
160
What does eatwell guide recommend for fruit and veg ?
5 a day
161
What are the portions of fish required from the eatwell guide ?
2 portions a weel
| 1 should be oily
162
What are portions of red meat needed according to EP ?
limit to less than 70g
163
How much fluid should be taken according to EP ?
6/8 glasses a day
164
Which starchy foods are needed in EP ?
```
bread
rice potatoes
pasta
wholegrain
provide fibre, protein, B vtamins and vitamin E
```
165
What is the recommendend milk and dairy intake ?
moderately
| choose low fat varieties
166
What are the protein requirements according to EP ?
eat moderate amounts
choose low fat- remove skin from chicken
eggs and fish in this group
167
What is enamel hypoplasia ?
structural defect in enamel
| enamel is present and well mineralised but deficient in amount
168
What are the manifestations of enamel hypoplasia ?
alteration of shape
| pits and grooves
169
What is enamel hypomineralisation ?
defects in which enamel matrix is present
reduced mineral content
enamel opacities and chips
170
What are some of the manifestations of hypomineralisation ?
enamel chips
| white and brown marks softer
171
What is one cause of developmental enamel defects ?
nutritional deficiency
172
What is the problem with enamel defects ?
can get stained
| carious risk
173
What is manifestations of enamel hypoplasia ?
pits and grooves
174
What are some of the nutrient deficiencies that can lead to enamel hypoplasia ?
```
vitamin A
vitamin D
hypocalcaemia
PEM
LBW
```
175
What are the causes of LBW ?
placental insufficinecy
| maternal undernutrition
176
What are the conclusions in the guatemalen rats study ?
providing a protein supplement does not reduce the caries incidence.
177
What is the effect of protein insufficiency in mothers diet ?
poor quality milk
increased dental caries
provide the protein in utero nd differneces are abolished
differences not abolished when given post birth
178
What does protein deficiency cause ?
salivary gland atrophy
| xerostomia leads to rampant caries
179
What does vitamin D dependent caries lead to ?
low calcium
low phosphate
hypoplasia
180
What does hypophosphataemia lead to ?
normal calcium
low phosphate
no hypoplasia
181
What does hypoparathyroidism lead to ?
low calcium
high phosphate
hypoplasia
182
Why is hypocalcaemia common in undernourished children ?
diarrhoea induced
183
What is vitamin A deficiency linked to ?
PEM
| linked to defects
184
What is the rat vitamin A deficiency experiment ?
vitamin A deficient rates given a highly cariogenic diet had higher caries
185
What does vitamin A deficinecy lead to ?
salivary gland hypotrophy
| poor quality saliva
186
What happened to dogs on a vitamin D deficient diet ?
poorly aligned teeth
delayed eruption
delayed development
enamel and dentine defects
187
What can be concluded from the may mellanby experiment ?
all teeth with hypoplasia has caries
| vitamin D is a factor responsible for caries
188
What happened when children were given a vitamin D supplement ?
reduced inititiation and spread of caries
189
What happened in world war II ?
```
improvement in childrens teeth due to reduction in sugar
cheap milk (calcium and vitamin d)
Cod liver oil
vitamin A and D added to margarine
calcium carbontae added to flour
```
190
What do the vitamin D studies in india conclude ?
gross enamel hypoplasia due to diarrhoea indiced hypocalcaemia
mild enamel hypolasia is same as UK as the sunshine compensates for it
191
What does vitamin D do with caries ?
may lead to developmental defects
which can lead to more dental caries
low certainty conclusions that it may decrease dental caries incidence
192
What is the PHE advice for vitamin D ?
adults and children over the age of 1 should hvae 10 mcg
| equivalent of 5 sardines
193
What can lead to high caries rates in developing countries ?
poor diet
| high sugars
194
What does under nutrition lead to ?
lack of PE results in developmental defects
making tooth caries prone
salivary gland atrophy
delays eruption
195
What does dental fluorosis lead to ?
opacities
mottling
hypomineralisation
196
What does excess fluoride ingestion lead to ?
alters the rate at which amelogenins are removed enzymatically
alter the action of protease- decrease availability of free calcium
197
What are the manifestations of fluorosis ?
hypomineralised
alteresd optical properties
opaque
198
What does the dean research tell us ?
continued use of water- 1 ppm - 10%
| continued use of water at 1.7 ppm- 40%
199
What does excess fluoride lead to ?
enamel mottling
| hypomineralisation
200
What are the sources of fluorid exposure ?
diet- natural sources like tea, seafood
added- water and food
dental products- topical fluoride varnish, mouthwash, toothpaste
Fluoride supplement s
201
What are the methods of fluoride absorption ?
90% of fluoride is absorbed mainly in stoamch as HF (uncharged)- rapid absoroption
202
What happens to fluoride in the body ?
99% goes to calcified tissues like bones and teeth
203
How is fluoride excreted ?
10% urine and faeces
204
What happens to fluoride metabolism in high fat diet ?
slows down digestion and rate of gastric emptying decreases
increased absorption- positive fluoride balance
leads to fluorosis
205
What happens to fluoride metabolism with a vegetarian diet ?
increased pH of renal tubules
increases urine excretion
more elimination of fluoride leaving in negative fluoride balance
206
What does fluoride do with divalent, trivalent cations ?
forms complexes in the GIT
dont get absorbed and excreted in faces
faecal excretion increases
negative fluoride balance
207
What happens in fluorosis ?
dental fluorosis mottling of enamel, opacities
skeletal fluorosis- brittle bones and teeth
208
How does fluoride act ?
topically- aids remineralisation
| also inhibits anaerobic glycolysis and sunsequent acd production by oral bacteria
209
What are the methods for arresting primary caries ?
eliminate dietary abd microbial factors
| enhance protecitve factros- fluoride, selaant and salivary stimulation
210
What is acute fluoride toxicity ?
acute fluoride sudden poiaoning
sudden ingestion of a lethal dose
nausea, vomiting, diarrhoea and abdominal pain
211
What is a safe fluoridated dose ?
8-16 mg F/kg
212
What is chronic fluoride ingestion ?
smaller dose over long time
affects teeth while still forming
increases risk of dental fluorosis in primary and permenant dentition
affects bone continually
213
What is the optimum safe dose for fluoride ?
0.05-0.07 mg/Kg body weight
214
What are the methods for fluoride therapy ?
public water fluoridation
school water fluoridation
fluoridises, salt and mil
topical mouth rinse, varnish and toothpaste
215
What did H trendley deans graph result in ?
J shaped curve
216
What did H trendly conclude ?
water fluoridation at 1 ppm wa best balance between caries prevention and fluorosis risk
217
What is the effect of water fluoridation on social class ?
```
lower social class have greater caries rates
water fluoridation ahs the biggest caries reduction rate on them
```
218
Why is fluoride beneficial for adults too ?
caries is progressice- fluoride cant protect exposed roots
219
Have studies linked cancer and fluoride ?
no association between water fluoridation and mortality frm any cancer
220
What can happen if water fluoridation is decreased ?
increased caries rate- higher than those of water unfluoridated areas
221
What are the benefits of fluoridated salts ?
decreases caries
gives consumer choice
better if milk/water fluoridation not available
222
What can happen to fluoride in milk ?
F binds to calcium and protein- reduces the topical effect- not free
223
What do trials show about F milk ?
it has preventative effects
| especially if given whilst teeth are developing
224
What do systematic reviews say about milk fluoridation?
milk fluoridation is beneficial
less good evidence than for water fluoridation
cessation associated with worsening dental health
can lead to mild fluorosis but not of concern
225
What are the doses used in fluoridated milk school schemes ?
doses between 0.5-1.5 mg F per drink
| doses used above/below that of water F levels
226
What is the reduction in dental caries rates due to water fluridation ?
20-50 %
227
Why is water fluoridation more effective ?
hits everyone
228
What are the advantages and disadvantages of public water supply ?
advantages- hits everyone
| disadvantages- no chocie
229
What are the advantages and disadvantages of milk fluoridation ?
advantage- children- high ECC risk
| disadvantage- not everyone taking milk
230
What are advantages of salt and disadvantages of salt fluoridation ?
advantage- gives choice
| disadvanteg- hypertesnion if excess
231
What are the classifications of carbohydrates ?
sugars (monsaccharides and disaccharides)
polyols
oligosaccharides (malto and non digestivle)
polysacchrides
232
What are types of polysaccharides ?
starch
| non starch polysaccharides
233
Where are digestible carbohydrates absorbed and digested ?
in the small intestine
234
What happens to non-digestible polysaccharides ?
resistant to hydrolysis in small intestine
reach large intestine
partially fermented by commensal bacteria in colon
235
What is dietary fibre ?
constituents of non digetible carbohydrates
| associated with plant cell walls
236
What is the classification of sugars ?
total sugars split into
free sugars
intrinsic sugars
milk sugars
237
What are intrisnsic sugars ?
in whole fruits, veg and grains
238
What are milk sugars ?
naturally present in milk and milk products
239
What are free sugars ?
free sugars,added sugars and sugars in honey, syrups, fruit and juices and fruit juice concentrates
monsaccharides and disaccharides
240
What do you need to be careful about with fruit ?
blending can change composition
241
Why do we care about sugars ?
high levels of sugar intkae- tooth decay
greater higher energy intake
weight gain and increases BMI- hard to GA
too many high sugar beverages increases type 2 diabetes
242
What is the impact of dental diseases ?
```
cost to health services
multiple extractions under GA
self esteem
pain and anxiety
time lost from school/work
```
243
What is children dental health in UK like ?
DMFT has decreased over time, decay experience has decreased
however inequality is increasing- the actual amount of decay is increasing - repeat GA is high
244
What percentage of 5 year old children have decay experience ?
31%- this is obvious decay as well
| mean number of teeth efffected-0.7
245
How many dentate adults have decay ?
30%
| hard to manage
246
What percentage of 55-66 year olds have root caries ?
11%
247
What percentage of 75-84 year olds have root caries ?
20%
ageing population
polypharmacy- xerostomia and increased caries
248
What are problems of root caries ?
hard to manage
hard to control diet
endentulous end up
affects all teeth usually
249
What are the SACN free sugar recommendations ?
no more than 5% of daily dietary intake
250
What are the WHO guidelines for free sugar intake ?
do not exceed 10% intake
251
What is the problem with diluting juice ?
says no added sugar
not actually sugar free
high frequency of attacks
252
What does the WHO say about limiting free sugars ?
get down to less than 5% of energy intkae
| dental caries tracks from childhood to adulthood
253
What is the recommended dietary reference value for carbohydrate intake ?
50% of total dietary intake
254
By reducing the free sugar intake which is part of carbohydrate intake what can we replace the deficient sugar with ?
starches
sugars contained in cellular structure of foods
lactose naturally present in milk and milk products
255
What is helpful for parents and sugar intake ?
sugar cubes
256
How much sugar should 11 year olds have ?
no more than 30g
7 cubes
6-7 teaspoons
257
How much sugar ahould 7-10 year olds have ?
no more than 24g
6 cubes
5-6 teaspoons
258
How much sugar should 4-6 year olds have ?
5 cubes
| 4-5 teaspoons
259
How much sugar is one sugar cube ?
4g
260
What is significant about honey ?
protects agaisnt dental caries
| propolis bee glue contains flavanoids and esters that decrease enamel dissolution
261
How can we transition from a high sugar to low sugar cereals ?
sprinke on top
262
What are RCTs ?
preferred- gold standard
doesnt work for dental caries
wouldnt be ethical- giving a high sugar diet
263
What are non randomised intervention studies ?
open to bias
264
What is the strongest data after RCT ?
cohort studies
265
What are cohort studies ?
look at the effect of specific risk factors
266
What are population ecological studies ?
use per capita sugars data- people in popualtion
267
What are cross sectional studies ?
measure one point in time only
268
What are case studies ?
weak evidence and only suggestive
269
What are the weaker forms of evidence ?
```
animal expriments
enamel slab- in vivo
plaque pH studies-
lab experiments- in vitro
weak unless there is evidene from epidemiological studies
```
270
What is the problem with cross sectional studies ?
```
dental caries takes several years to develop
diet several years earlier leads to it
those with decay may have changed habits
habits change all the time
be careful with data
```
271
What is a cross sectional study ?
snapshot of time
272
What do world wide ecological studies do ?
compare sugar availability and dental data from dental surverys and per-capita data on sugar availability
eg. From food and agricultural organisation
273
What is the relationship between sugar avaialability and DMFT ?
more sugar availabiltiy and higher DMFT
274
What is tristan de cuhna ?
island
low free sugar diet
transport links icnreased- decay increased as sugar access increases
275
What is the relationship between sugar availability and caries ?
reduced sugar availability
reduced caries
ww2 and iraq
276
What can happen with the transition from primary to secondary school ?
increased access to sugar
277
What happened in iraq ?
reduced sugar intake after UN sanctions
| reduced DMFT after sanctions
278
What are intervention studies ?
change diet in one group
and monitor dental caries increment compared with a control group
randomised into intervention and control groups
assessor should be blind
hard to do but could be medically have to reduce sugar diet
279
What conclusions can be drawn from the turku study ?
substituting sucrose in the diet with xylitol (0) leads to a lower caries increment compared with a sucrose diet (4)
starch ewas freely taken as well showing it has no effect on caries
280
Can dental caries still occur in children when free sugar intake is less than 10% ?
yes
281
What do cohort studies tell us about the effect of reducing sugar intake to 5% from 10% ?
japan ww2
lower levels of dental caries when sugar availability was less than 5% than 10%
however not reliable
282
What can we conclude from animal experiments about frequency of food intakes and dental caries ?
increased frequency of intake increases development of caries
same quantity of food
283
What have cohort studies shown about caries and freqency and amount of sugar ?
amount is more important
284
Which type of studies can measure if frequency or amount is more important ?
measure frequency and amount
285
What is the cariogenicity of mono and disaccharides ?
exception of lactose
| cariogenicity of mon/di saccharides is similar
286
What is the cariogenicity of lactose ?
lactose is less carigenic than other mono.disaccharides
287
What do some animal studies say about sucrose ?
more cariogenic
288
What does turku say about fructose and sucrose ?
pre cavity lesions more with sucrose than fructose
289
What is the role of sucrose ?
substrate for extracellualr glucan synthesis
| sucrose has high energy bond
290
What is the evidence about glucan and strep mutans ?
glucans enhance strep mutans in plaque by increasing plaque porosity- acid accumulation at enamel surface
291
How much does fluoride reduce careis by ?
50%
292
Is there still careis in fluoridated areas ?
still a relationship between sugar and careis in fluoridated area
sugar is a moderate risk factor in fluoridaed areas
293
Why are low levels of caries in childhood significant ?
dental caries is progressive and effects of sugars on dentition are lifelong
294
What type of evidence is lacking to show a relationship between frequency of sugar and caries ?
epidemiological evidence is lacking
295
What is the evidence for an association between free sugars and dental caries in intervention studies ?
turku showed that removing sugar from diet and replacing it with xylitol leads to an 85% caries reduction in adults
vipeholm study showed that consumption of sugars inbetween meals increased caries
sugars up to 4 times with meals only had lesser effect
withdrawal of sugars dropped carious activity
296
What is the evidence for cohort studies linking sugar and caries ?
8 cohort studies show higher caries with higher sugars
5 cohort studies show lower caries intake of free sugar is less than 10%
some show low levels of dental caries occur at less than 10%
297
What is the evidence for ecological studies showing a relationship between free sugars and dental caries ?
lower caries when < 5% and lower than when 10%
298
What are the limitations of plaque pH studies ?
indirect measure of dental caries as they only measure acidogenicity
299
What are the limitations of animal experiments ?
differneces in tooth morphology and salivary composition
| caution when extrapolating findings to humans
300
What are the limitations of cross sectional epidemiological studies ?
current diet may be differnet from diet several years ago when caries was initiated
only measure disease and diet at one point
301
What happens in cross sectional studies ?
look at data from a specific population at a specific time
302
What happens in population based ecological studies ?
do not account for confounding factors that use per capita sugars data
eg. assumes sugar consumption is equal across all population groups
303
What happens in cohort studies ?
do not provide such strong data as RCT
| dont control for compounding factors like fluoride
304
What are highly processed starchy foods ?
```
sweetened breakfast cereals
biscuits
cakes
processed corn and potato snacks
sweetened popcorn
```
305
What have aninal studies shown about starch ?
raw starch is not cariogenic
cooked starch can cause caries but less than sucrose
mixes of sugar and starch can increase caries to levels with sugars alone
306
What has lab incubation concluded about processed starchy foods ?
crisps. pretzels, breadksticks and crackers - hydrolysed to glucose - metabolised to lactic acid
307
What do enamel slab experiments show about processed starchy foods ?
cause 1/4 of the demineralisation seen with sugars
308
What happens when total starch intake is unaltered/increases and sugar decreases ?
caries declines
309
What happened in japan and norway ?
sugar decreased
starch increased
dental caries decreased
310
What do children with HFI compared with controls have ?
low caries
low intake of sucrose and fructose
normal/higher intake of starch
311
What does WHO say about starch rich staple foods and caries relationship ?
evidence that starch rich food showed no relationship with caries
312
What did the iowa fluoride study say ?
significant associations between consumption of highly processed starch foods and development of caries
313
What are the conclusiosns regarding cooked staple starchy foods ?
low cariogenicity in man
314
What happens if starchy food are eaten frequently, heat treated and ground ?
can cause caries- less than sugars
315
What are conclusions about cariogenicity about cooked starch foods ?
adding sugar increases cariogenicity
| baked starch- same levels of cariogenivity as sucrose
316
What are recommendations to patients on starch ?
consume starchy staples
| avoid highly processed starchy foods
317
What do plaque pH studies show about fruit consumption ?
fruit consumption decreaes pH but not to below critical
318
What do epidemiological studies show about fruit consumption ?
associted wih low levels fo caries
319
What is the advice to parents about frehs fruit ?
fresh whole fruit is a healthy snack
| fruot juices are high in free sugars- limit to one portion a day
320
What is the problem with dried fruits ?
```
syrup / sugar added in drying process
not classified as free suugars
cocnentrated natural sugar
source of micronutrients and fibre
consume at mealtimes
```
321
What is lactose content in human milk ?
7g per 100g
322
What is lactose content in cows milk ?
5g per 100g
323
Is milk classified as cariogenic ?
could be
lactose is least cariogneic of the sugars
calcium and phosphprous help against enamel dissolution
324
Which breastfed children have an increased risk of caries ?
breastfed for more than 12 months
| frequentyl fed and nocurnally fed
325
What are the types of artificial sweetners ?
intense and bulk
326
What are bulk sweeteners ?
```
composed by polyols
derivatives of normal sigars with a carbohydrate strucutre
mild
have to be added in bulk
virtually non cariogenic
```
327
What are some examples of bulk sweeteners ?
xylitol
sorbitol
mannitol
328
What are intense sweeteners ?
range of structures like dipeptides
| much more sweeter than sugar
329
What are some examples of intense sweeteners ?
acesulfame potassium
thaumatin
aspartame
stevia
330
What are plaque pH studies ?
in vitro
| plaque in test tube and look at pH drop
331
What are animal studies ?
comapre sugar and sweetneers and look at incidence of caries
rodents have a different tooth anatomy
332
What are intervention studies ?
clincial trials
333
What are enamel slabs ?
bovine enamel
| attached to tooth and observed
334
What type of sweeteners are sorbitol and mannitol ?
bulk
335
How sweet are sorbitol and mannitol ?
sorbitol- 0.5 times as sweet
| mannitol- 0.7 times a sweet
336
What do incubation studies show about sorbitol and mannitol ?
sweeteners are fermented much slower than sugar
337
What do plaque pH studies show about sorbitol and mannitol ?
slight decrease
338
What do animal studues dhow about sorbitol and mannitol ?
happens but at a lesser extent than curose
339
What do clinical trials show about sorbitol and mannitol ?
non cariogenic
340
What is the risk of using chewing gum in studies and comapring it with no gum ?
gum stimulates salivar production
341
Are there any long term effects of sorbitol and mannitol ?
no
| likely to increase caries in normal people
342
What type of sweetener is xyltoll ?
bulk
343
How sweet is xylitol ?
as sweet as sucrose
344
Is xylitol cariogenic ?
no- it is non cariogenic
345
What did the turku study show about xylitol ?
total sub of sucorse with xylitol- 85% less caries development
346
What does xylitol do ?
increases salivary flow
347
What is sucralose ?
splenda
bulk
chlorinated derivative of sucrose
348
What is aspartame ?
canderel
intense- 200x sweeter
non cariogenic
used in frozen foods
349
What is the problem with aspartame ?
contains phenylalanine
| cant be used by PKU patients
350
What happens in PKU ?
mutations in phenylalanine hydroxylase
cant convert phenyalalanine to tyrosine
leads to irreversable brain damage
351
What is saccharin ?
intense
500 x times as sweet as sucrose
inhibits bacterial growth/metabolism by enzyme inhibition
352
What is acesulfame potassium ?
130 x as sweet as sucrose
non cariogenic but doesnt inhibit caries
used in boiled sweets as it withstands high temperatures
353
What is stevia ?
```
intense
from the leaves of the plant
active comounds are stevoil glycosides
heat stable/pH stable
non fermentable
```
354
What are the types of tooth wear ?
attrition
erosion
abrasion
355
What is erosion ?
chemical dissolution of enamel by acids of non bacterial origin
356
How is the BEWE carried out ?
mouth divided into sextants
all surfaces measured
no 8s
cumulative scores given - only record highest score for the sextant
357
What is a BEWE score 1 ?
initial surface texture loss
shiny enamel surface
loss of mamelons
incisal translucency
358
What is BEWE score 0 ?
no erosive tooth wear
359
What is a BEWE score 2 ?
distinct defect
| hard tisseu loss is lessthan 50% of surface area
360
What is a BEWE score 3 ?
Hard tissue loss is more than 50% of surface area
dentine is exposed- hypersensitivity
possible pathological
361
What is the highest BEWE score ?
3
362
Is erosive tooth wear reversible ?
no
363
What happens in pathological wear ?
pulpal exposure
364
What are the consequences of pathological wear ?
```
loss of function
pain
aesthetics
destructuion
psychological
costly
```
365
What is the aetiology of erosion ?
intrinsci
| extrinsic
366
What is the intrinsic aetiology of erosion ?
GERD
frequent vomiting
Hcl
367
What are the extrinsic aetiology of erosion ?
medicine
| dietary acids
368
What are some examples of dietary acids ?
```
acetic
ascorbic
citrus
carbonic
phosphoric
```
369
What re some acidic foods and drinks ?
```
carboanted
alcohol
fresh fruit juices
fruit
tomato and chilli foods
```
370
How do hydrogen ions erode enamel ?
hydrogen ions are dissociated in water
combine with phosphate/carbonate ions
release all ions from that part of the crystal
371
What is the appearance of eroded enamel ?
honeycomb
372
How does Hcl work in erosion ?
hydrogen ions directly dissolve mineral surface
| no effect from chloride ions
373
How does citric acid dissolve ?
hydrogen ions directly dissolve
| citrate anion interacts with calcium removing it from crystal surface
374
Which acid has a higher erosive potential ?
citric
375
What determines the erosive potential ?
```
pH
titratable acidity
buffering capacity
mineral content
calcium chelation
```
376
What is the titratable acidity ?
total amount of acid in solution as pH changes
377
What is buffering capacity ?
maintain pH at neutral
| offset the effects of the acid
378
How does quantity influence erosive potential ?
increased acidic drinks and fruit intake - higher erosio prevalence
379
How does frequency affect erosive potential ?
dietary acids more than 4 times a day- tooth wear
fruit between meals- higher risk of erosion
drinks with meals- reduced prevalence by 50%
380
How do habits affect erosive potential ?
spending longer eating druit/acidic drinks means more tooth weast
longer time drinking- less time for the acid to buffer away
swishing and sipping
381
How does temperature affect erosive potential ?
higher temperature increaes erosive potnetial
382
What are some groups at risk of erosion ?
```
sports people
eating disorders
alcoholics
drug addicts
dieters
wine tasters
pregnant women
```
383
What do you need to ask patients when you suspect erosiove tooth wear ?
how often are you having dietary acids ?
how many between meals
how long
are these hot ?
384
What is essential for management of dental erosion ?
good records
early diagnosos
control aetiological factors
ongoing monitoring
385
Which aspects of MH can effect erosion ?
salivary gland hypofucntion
radiotherapy
gastric disturbances
oral hygeine habits
386
What is dietary advice to be given for erosion pateitns ?
drink water/milk with meals
consume quickly/straw
chilled beverages
387
What should be used after an acid attack ?
remineralising agent- fluoride
| neutralising agent - sugar free
388
What are some protective factors for erosion ?
dairy milk - lactose is least cariogenic
| cheese
389
Why are dairy milk and cheese used as protective factors ?
```
calcium
phosphate
casein
all anti cariogenic
increases concnetration to locally reduce conc gradient
```
390
What does cheese do in erosive protection ?
increases saliva flow
391
What is the effect of tooth loss on chewing ?
bite strength
| closing force
392
What types of foods do edentuolous people avoid ?
raw fruit and veg
| food with pips
393
Which nutrients are lower in edentulous ?
```
protein
iron
vitamin B1
vitamin B2
vitamin C
```
394
What leads to a low intake of dietary fibre in edentulous ?
```
tooth loss
reduced tooth function
selective food avoidance
low intake of fruit and veg
low intake of fibre
```
395
What do edentulous tend to substitute fibre with ?
saturated fat
396
What does a low BMI in older people ?
low functional status
low protein intake
low energy intake
397
What does being edentuolous put you at risk of ?
undernutrition
398
What does prosthetic rehabilitation due to chewing function ?
prosthetic rehabilitation improve chewing fucntion
399
What does prosthetic rehabilitation not do ?
give people the drive to change theri nutrition now they can eat
400
What is needed to improve nutritional status of denture wearing patients ?
dietary advice
401
What can dietary advice lead to in denture patients ?
sustained reduction in saturated fat
| increased fibre intake
402
What needs to be done to improve nutritional status of denture patients ?
dietary adive
| optimised denture
403
How could you increase fruit and veg fro edentuolous ?
smoothies
mushy peas
grate
soup
404
How can you increase fibre in edentulous aptients ?
wetabix
porridege
lentil soup
dhal
405
What are the interacting factors in the disease process of periodontitis ?
exaggerated host response
patient risk factros
microbial dysbiosis
406
What are some risk factors for periodontal disease ?
```
tobacco
environmental
oral hygiene
medication
microbial
obesity
genetics
```
407
What is the main overriding factor in aetiology of periodontal disease ?
plaque
408
What does nutrition do in periodontitis ?
poor nutriton impairs the host defence
409
Which sugar affects plaque volume ?
sucrose leads to higher volumes of plque
410
Why does sucrose impact on plaque ?
sucrose leads to glucan formation
411
What does malnutrition due to immune systems ?
impairs innate immunity- phagocyte production,
| impairs adaptive immunity- cell mediated, antibody
412
Why does malnutrition affect oral disease ?
more glucocortoicoids
| impaired host defence of saliva
413
What are some diseases that are a result of poor nutrition ?
poor nutrition leads to necrotising periodontal diseases
ANUG- seen with poor OH and stress
Cancrum oris
414
What is cancrum oris ?
gangrenous disease
| rapid necotising destruction of soft and hard tisseu
415
What are some risk factors for necrotising diseases ?
malnutrition
poor OH
compromised immune system
HIV
416
What have calcium and vitamin D deficiencies lead to in animals ?
resorption of bone
| exacerbates bone loss
417
What is vitamin D needed for ?
cell development
bone development
neuromuscualr functioning
inflammation control
418
What is a major source of vitamin D ?
from the conversion of 7-dehyrocholesterol to D3
419
What are the sources of vitamin D ?
oily fish
egg yolks
cheese
fortified foods
420
What is folic acid needed for ?
needed for cells with high turonver - gingiva
| low serum folate independently associated with periodontla disease
421
What is vitamin C ?
ascorbic acid
| antioxidant
422
What does severe vitamin C deficiency lead to ?
scurvy
| swollen bleeding gums and tooth loss
423
What is vitamin C needed for ?
collagen synthesis
PDL
bone matrix
blood vessel wallls
424
What is the immune fucntion of vitamin C ?
phagocytosis and wound healing
425
What is the link between vitamin C and periodontitis ?
weak association with vitamin C and periodontitis
426
What are low B12 levels associated with ?
worsening of periodontal status and tooth loss
427
What are ROS and when are they produced ?
ROS are released from PMNs in response to antigens
| leads to phagocytosis and oxidative burst
428
What can a prolonged period of ROS lead to ?
tissue damage
429
What is oxidative stress ?
balance between ROS and antioxidants
| in pathogenesis of diseases
430
Which diseases does oxidative stress feature in ?
type 2 diabetes
cardiovascualr sisease
rheumatoid arthritis
431
Which type of diet provides oxidants ?
refined sugars
carbs
saturated fats
432
What does a disbalance in ROS lead to ?
local tissue damage
| affects epithelial cells, connectove tiises, bone and neutrophils- in periodontitis
433
What do antioxidants do ?
prevent oxidation of other molecules
influence periodontal onset, progressiona dn wound healing
buffer agaisnt ROS tissue damage
434
Which tissues are damaged by ROS in peridontitis ?
gingival tissue
PDL
alveolar bone
435
What do ROS do ?
lipid peroxidation
protein degradation
DNA mutations
bone resorption
436
Give some examples of antioxidants ?
glucathione
coper
IRon
vitamin AEC
437
Give some antioxidant rich foods ?
```
sweet potato
apricots
almonds
sunflower
sesame
chicken
```
438
Which antiocidants are compromised in periodontitis ?
those in the GCF and serum
439
What is the main function pf vitamin E ?
stabilise membrane structure by terminating free radical chain reaction
440
Where can you find vitamin E ?
non citrus
nuts
seeds
441
What did the nigata study say ?
higher itnake of dietary antioxidants- les teeth infected by PD
strongest for vitamin E
442
What is obesity associated with ?
increased risk of periodontitis
443
What do adipocytes do in obesity ?
release pro-inflamamtory adipokines like TNF aloha and IL6
up regualte acute phase proteins
promote periodontitis
444
What ar the omega 3 fatty aids ?
EHA
| DHA
445
What is linoleic acid ?
essential fatty acid
| in cell membranes
446
What is the pathway for linoleic acid ?
linoleic acid
arachidonic acid
leukotrienes and eicosanoids
447
What is the impact of EHA ?
stops arachidonic acid conversion into eicosanoids
promoted leukotriene B5 over B4 - less inflammatory
448
What can breast feeding do ?
reduce child mortality
| prevent 37% of deaths in
449
What does the WHO recommend breast feeding for ?
exclusively for 6 months
450
What do studies say about formula fed children and caries ?
formula fed children had higher caries
451
What does evidence suggest about breastfeeding and its protective effect ?
breast feeding has a greater protective effect agaisnt dental caries that bottle feeding
452
What is the link between children being breastfed for 12 months and caries ?
fewer dental caries if fed for 12 months
453
What is the link between children being breast fed for more than 12 months and caries ?
fed more than 12 months then increased caries
454
What increases the risk even more with breast fed children ?
nocturnally fed
455
Why are babies breast fed after 12 months ?
birth control - prolonged return of meneses
reduces risk of diarrhoea
protects agaisnt respiratory infection
reduced risk of shigellosis
456
What are the benefits of nocturnal breastfeeding ?
improves milk supply
contraceptive effect
reduced SIDS risk
ensure adequate intake as stomach volume is small
important for babies with faltering weight
promotes sleep- serotonin
457
What are the benefits of baby led breastfeeding ?
increases milk flow and helps with nutritional adequacy
boost oxytocin
regulate body temperature and blood glucose
458
When should cow mil be given ?
not in the first 12 months
| defintiely not in first 6 months- too high risk of allergy
459
What is hypoallergenic infant formula ?
for babies that are lactose intolerant, cow milk protein allergy or cow protein intolerant
460
What does hypoallergenic infant formula contain ?
fully hydrolysed cow protein
can also be partially hydrolysed cow protein
maltodextrins
sucrose/fructose to camoflague taste- exceeds daily intake of sugar
461
When is hypoallergenic infant formula used ?
under medical supervision
462
What is low/lactose free formula ?
does not contain caesin or lactose
| contains glucose syrups and sucrose so is cariogenic
463
What is nutrient enriched post discharge formula ?
for pre term infants post discharge
464
What is soya formula ?
use for vegan infants
higher in micronutreitns
contain glucose and syrups
not recomended because of phytooestrogens
465
What is follow on formula ?
for infants 6 months plus
contains more proteins, micronutrients than infant formula
have a source of high iron- not needed
can contain maltodextrins and oligosaccharides
466
Are follow on formulas suitable ?
no - they are not a repalcement for breast milk form 6 months onwards
467
Why shouldnt cows milk be given before 12 months ?
low in iron
468
Why shouldnt skimmed milk be given bedfore 5 months ?
loss of fat and fat soluble vitamins - ADEK
469
What is bottle feeding and sugars associated with ?
increased dental caries
470
Why do parents add sugar to infant feeds ?
treat constipation
aid digestion
help baby sleep and reduce pain
471
When should different tastes and textures be induced ?
from 6-7 months
472
Whens hould infants be eating family foods ?
from 1 year
473
When are micronutrient supplements for ACD be given ?
from the time complementary foods are given
| if they are not having infant formula
474
What should be the drinks in infants ?
milk and juice
475
When should a cup be introduced ?
from 6 months
476
When should bottle drinking be discouraged ?
from 1 year
477
What is the dietay proportions for children ?
50% of energy from fat- reduce this to 35%
5 fruot and veg
starch carbohydrate in all meals
478
What increases ECC risk ?
sugared drinks and sweet snacks
479
What are hidden sugars ?
```
invert sugars
glucose syrup
corn starch
maltodextrin
hugh frucrose corn syrup
fruit juice and cocnentrate
```
480
What are some actions to reduce free sugar intake ?
policies
taxing foods in high sugars
advertising/marketing restrictions on food and drinks
reformulation of food products to reduce free sugars
481
What are the main aims in trying to reduce free sugar intake ?
decrease frequnecy
decrease amount consumed
remove in between meals snacks
do not consume within bedtime
482
How do you plan dietary intervention ?
screening- those who need to change
assessment- are they ready to change ?
desired changes- neogtiate some changes
monitor progress
483
What are the 3 Ps ?
practical
personal
positive
484
What are SMART goals ?
```
specific
measurable
acheivable
realistic
timely
```
485
How should goal/agenda setting be ?
```
collaborative
patient led
flexible
individually tailored
faciliated and not driven
```
486
What are the stages of change model ?
pre contemplation
contemplation
planning
action maintenance
487
What do you need to talk about change ?
change talk
| rapport
488
How do you assess the readiness to change ?
they have importance and confience
489
How do you assess importance and confidence ?
scaling questions
490
What are the aspects of change talk ?
rolling with resistance
scaling questions
reflections
open/closed questions
491
What should you do when using scaling questions ?
ask why they gave a 6 and not a 1
492
Which stage are people at if they are rolling with resistance ?
contemplation
493
What should you do with rolling with resistance ?
acknowledge that change might not be possible now and that the relationship should be open in future
494
What is important to remeber with monitroring ?
bring up and check nect time
495
What does SMART stand for ?
```
specific
measurable
acheivable
realsitic
timed
```
