Nutrition and diet Flashcards
How can nutrition affect tooth development ?
affect in utero tooth development
affect posteruptive tooth development
affect caries and periodontal disease
What are the macronutrients ?
fat
carbohydrate
protein
What is the purpose of the macronutrients ?
provide energy
What are the micronutrients ?
vitamins minerals and trace elemnts
What can energy be measured in ?
kJ or kcal
How many kcal per fat gram ?
9 kcal per gram of fat
How many kcal per carbohydrate ?
4 kcal
How many kcal per protein gram ?
4 kcal
How many kcal per gram of alcohol ?
7 kcal
How many kJ in one kcal ?
i kcal-4.18 kJ
What is EAR ?
estimated average requirment
total dietary intake prediced to maintain energy
What happens to excess energy ?
stored as fat
What is EAR required for ?
temperature maintenance
breathing
heartbeat
brain function
What does EAR maintain ?
BMR
basic metabolic rate
When is BMR altered ?
body builders
pregnant
What is a healthy BMI ?
18.5 and 24.9
What is EAR based on ?
body size and composition
gender
age
activity level
What 2 things link EAR in an equation ?
EAR= BMR x PAL
What is the EAR of adult men ?
2772 kcL
What is the EAR of 1 year old girls ?
646 kcal
What is the EAR of 1 year boys ?
718
What is the EAR of adult women ?
2079 kcal
What are fats composed of ?
glycerol and fatty acids
What are types of fatty acids ?
saturated and monounsaturated and polyunsaturated
What are saturated fatty acids ?
no double bonds
only single carbon carbon bond
Where can you find saturated fatty acids ?
animal and dairy fats
Where can you find MUFA ?
seeds and nuts
Where can you find PUFA ?
oils
What are the functions of dietary fats ?
make lipid bilayer energy release precursors of prostaglandins precursor of cholesterol absorption of ADEK
What are essential fatty acids ?
not made in the body
must come from diet
What is cholesterol needed for ?
fat absorption via chylomicrons
What are the essential fatty acids ?
alpha lionlenic
linoleic
Where can you find lionleic and linolenic fatty acids ?
plant oils
What are omega 3 fatty acids ?
3 carbon double bonds before the methyl end of the chain
Give an example of an omega 3 fatty acid ?
lionoleic fatty acid
What odes alpha linolenic acid do ?
converts into EPA and DHA
What is EPA ?
EICOSAPENTANOIC ACID
What is DHA ?
docosahexanoic acid
What is the purpose of DHA and EPA ?
form prostaglandins
decrease cardiovascular risk
prevent periodontal disease
reduce platelet aggregation and hence thromboembolic episodes
What is a cis fatty acid ?
hydrogen atoms orinetated in one direaction
What is a trans fatty acid ?
hydrogen atoms orientated in different direction
What do hydrogenated oils contain ?
trans fatty acids
cheaper than animal fats
What is trans fat intake strongly associated with ?
colon cancer
cardiovascualr disease
What does accumulation of cholesterol rich lipid lead to an increase in ?
increase cardiovascular disease risk
Which is the bad type of cholesterol ?
LDL
What can saturated fat increase ?
LDL
What do trans fatty acids to ?
increase LDL
decrease HDL
What does dietary cholesterol increase ?
increases LDL
How can we substitute saturated fat ?
with PUFA- secreases cholesterol
What do plant stanols and sterols do ?
prevent cholesterol absorption
lower LDL cholesterol
What is a commercial plant stanol ?
benecol
What can also lower cholesterol ?
oat fibre
soya protein
How do oat fibres reduce cholesterol absorption ?
beta glucans in oat fibres bind to cholesterol and sequester it
What is obesity associated with ?
cancer
What is high animal fat intake associated with ?
bowel
pancreas
prostate
cancer
How much of the total dietary intake should come from fat ?
less than 35%
less than 5% from saturated fat
What are the types of carbohydrates ?
starch
sugars
fibre
oligosaccharides
What is starch ?
amylose and amylopectin
bread, pasta. potatoes
What are the types of sugars ?
monosaccharidea
disaccharides
What are sugar alcohols ?
xylitol
sugar substitutes and sweetners
How much kcal do sugars produce ?
4 kcal per gra
What is excess energy from sugar stored as ?
glycogen and fat
What are sugars used for in the body ?
glycoproteins - albulin
GAGs- hyaluronic acid
proteoglycans
What can high sugar intake lead to ?
obesity
cardiovascular disease
diabetes
What are oligosaccharides ?
2 or more sugar molecules bonded
What is fibre?
non glycaemic carbohydrates
What are the classifications of fibre ?
NSP
resistant starch
resistant oligosaccharide
What is NSP ?
cellulose
pectine
mucilages
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
What is insoluble NSP ?
adds to stool mass
increases satiety- good for weight loss
What is resistant starch ?
starch not digested because enclosed in cells
green bananas
What is resistant oligosaccharide ?
encourage growth of bifodobacterium and lactobacillus so can increase caries risk
What are maltodextrins and glucose syrups ?
made from starch hydrolysis
can be found in soya infant formula
increase cariogenic risk
What is the recommended intake of free sugars ?
5% of all dietary intake
How much sugar intake in children 11+ ?
30 g sugar
What are the functions of dietary proteins ?
muscle and tissue maintenance
hormones and enzymes
What are animal sources of proteins ?
meat dairy and fish
What are the vegetable protein sources ?
pulses
nutes
What is the nitrogen balance ?
the balance determines requirements for proteins
amount of nitrogen we intake should equal amount excreted
What is a positive nitrogen balance ?
amount excreted in less than amount taken in
growth and pregnancy
What is a negative nitrogen balance ?
amount excreted is more than amount uptaken
in starvation
How much nitrogen is in 6.25g of protein ?
1 g of N
How much protein do people require ?
0.75 kg to 1.g kg per kg of weight
bascially 1 g for every kilo
How much of total dietary intake is protein ?
12%
What are the 3 types of protein deficiency syndromes ?
marasmus
kwashiorkor
NOMA
What is marasmus ?
protein-energy malnutrition
severe muscle wasting
decreased insulin:glucagon
muscle proteins used in liver to make albumin - prevents oedema
What is kwashikor ?
protein deficiecny
high insulin: glucagon
reduced amino acids for albumin synthesis causes oedema
What is NOMA ?
malnorushment
ulceration and stomatitis
of upper gum. maxilla and cheeks
What is beta carotene ?
a yellow pigment antioxidant that is converted to vitamin A
found in yellow vegetables
What are sources of vitamin A ?
cheese eggs milk eggs yoghurt leafy vegetables
What are the fucntions of the vitamin A ?
sight- retinol production T cell differentiation Maintenance of healthy skin regulates gene expression anti oxidant
What is the recommended intake for vitamin A ?
750 micrograms for men
650 micrograms for women
What are signs of vit A deficiency ?
eczema
night blindness
infertility
What are oral healthy symptoms in deficiency ?
increased keratin formation- blocks saliva ducts leading to xerostomia
enamel hypoplasia
delayed tooth eruption
What are sources of thiamine ?
meat
bread
What is thiamine (B1) used for ?
metabolic pathways to convert carbohydrates to ATP
What are signs of thiamine deficiency ?
weight loss
anorexia
muscle weakness
beri beri disease
What are sources of riboflavin (B2) ?
animal products
What is the function of B2 ?
metabolism of fats
conezymes
conversion of carbs to ATP
What are signs of deficiecny of riboflavin ?
anaemia
cataracts
skin disorders
What are oral symptoms of thiamine deficnecny ?
thiamine deficinecy cna cause vomiting effecting enamel
What are oral symptoms of riboflavin deficiency ?
ulceration
angular cheilitis
mucosal inflammation
What are sources of folate ?
green veg
nuts
beans and dairy
What is the fucntion of folic acid ?
neural tube closuure
What can happen with folic acid deficiency ?
failure of neural tube to close
leads to anencephaly
What are sources of B12 ?
animal products
What are the fucntions of B12 ?
coenzyme
DNA and RNA synthesis
What does folic acid and B12 deficinecy lead to ?
megaloblastic anaemia
What are the oral symptoms of B12 and folate deficinecy ?
lack of keratinisation
pale mucosa
angular cheilitis
What are sources of vitamin C ?
oranges
red peppers
brocolli
supplements
What are functions of vitamin C ?
collagen synthesis
cartialge and bone
wound healing and scar formation
antioxidant
What are symptoms of vitamin C deficiency ?
painful joints
osteoporosis
scurvy
dry skin and hair
What are the oral symptoms of vitamin C deficiency ?
swollen , erethematous gingiva
PDL breakdown as it made of collagen
antioxidant- reduce ROS in inflammation
What are the fat soluble vitamins ?
A D E K
What are sources of vitamin K ?
green leafy veg nuts seeds meat dairy
What are the fucntions of vitamin K ?
needed in acitivation of vitamin K dependent clotting factors
2,7, 9 and 10
Which medication should you not prescribe to someone with folic acid deficiency ?
sulfonamides
trimethoprim
What can vitamin K deficiency lead to ?
haemorhage
excessive bleeding
easy bruising
What are oral symptoms of vitamin K deficiency ?
osteocalcin regulates mineralisation and is vit K dependent
What are the sources of nicotinic acid (B3) ?
meat
fish
wheat
fortified cereals
What are the functions of vitamin B3 ?
protein and fat metabolism
inhibit LDL production
precursor of enzymes- NAD
What are signs of nicotinic acid deficinency ?
pellagra- thick scaly rash
What are oral symptoms of nicotnic acid deficinecy ?
atrophic glossitis
atrophy of filliform anf fungifomr papillae
angular stomatitis
What are sources of vitamin D ?
oily fish
red meat
sunlight
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
What are the signs of vitamin D deficiency ?
rickets
weak immune system- innate immunity
What are the oral symptoms needs of vitamin D ?
allows calcium absorption
hydroxyapatite formation
What are sources of calcium ?
dairy
green veg
tofu
What are the functions of calcium ?
muscle contraction
blood clotting
nerve signalling
bone and tooth formation
What are the signs of calcium deficiency ?
muscle cramps
brittle fingernails
osteoporosis
insufficinet blood clotting
What are sources of magnesium ?
dark chocolate
avocado
legumes
What are the functions of magnesium ?
co factor for muscle contraction
glycaemic control
ionic transport
What are the symptoms of magnesium deficiency ?
muscle cramps
nausea
seizures
decreased apatite
What are the oral symptoms of magnesium deficiency ?
anti inflammatory- lack of can lead to gingival inflammation
can lead to reduced calcium absorption
What are the sources of iron ?
liver
beans
fortified cerelas
dark green veg
What is the function of iron ?
haemoglobin formation
What are the symptoms of iron deficiency ?
tiredness
paleness
shortness of breath
dizziness
What are the oral symptoms of iron deficiency ?
pale tongue
angular cheilitis
What are sources of zinc ?
oysters
red meat
phyates can bind to zinc and prevent absorption- soak beans
What are the functions of zinc ?
cell division
cell growth
wound healing
T cell development
What are the signs of zinc deficiency ?
immune problems
loss of smell and taste
lethargy
acne
What is the oral significance of zinc ?
found in saliva to inhibit plaque growth
inhibits bacterial metabolism
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
What are dietary reference values given for ?
carbohydrates- free sugars and fibre
protein -
fat- saturated and trans
What are DRVs based on ?
popualtions not individulas
What is the RNI ?
reference nutrient intake
amount of nutrient enough to satisfy 97.5% of population
Where is RNI on a normal distribution graph ?
near the end
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
What is RNI used for ?
reference amount for population groups
What is EAR used for ?
energy
What is LRNI used for ?
nutritional inadequacy
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
How much should fat constitute of total energy intake ?
35%
less than 10% saturated
less than 2% trans fat
How much should free sugars constitute total energy intake ?
5%
How much should protein constitute total energy intake ?
12-15%
How much sugar should 11+ have ?
no more than 30g
How much sugar should 7-10 years ?
no more than 24g
How much sugar should 4-6 years have ?
no more than 19g
What is the eatwell guide ?
guide to proportion of each nutrient needed daily
What does eatwell guide recommend for fruit and veg ?
5 a day
What are the portions of fish required from the eatwell guide ?
2 portions a weel
1 should be oily
What are portions of red meat needed according to EP ?
limit to less than 70g
How much fluid should be taken according to EP ?
6/8 glasses a day
Which starchy foods are needed in EP ?
bread rice potatoes pasta wholegrain provide fibre, protein, B vtamins and vitamin E
What is the recommendend milk and dairy intake ?
moderately
choose low fat varieties
What are the protein requirements according to EP ?
eat moderate amounts
choose low fat- remove skin from chicken
eggs and fish in this group
What is enamel hypoplasia ?
structural defect in enamel
enamel is present and well mineralised but deficient in amount
What are the manifestations of enamel hypoplasia ?
alteration of shape
pits and grooves
What is enamel hypomineralisation ?
defects in which enamel matrix is present
reduced mineral content
enamel opacities and chips
What are some of the manifestations of hypomineralisation ?
enamel chips
white and brown marks softer
What is one cause of developmental enamel defects ?
nutritional deficiency
What is the problem with enamel defects ?
can get stained
carious risk
What is manifestations of enamel hypoplasia ?
pits and grooves
What are some of the nutrient deficiencies that can lead to enamel hypoplasia ?
vitamin A vitamin D hypocalcaemia PEM LBW
What are the causes of LBW ?
placental insufficinecy
maternal undernutrition
What are the conclusions in the guatemalen rats study ?
providing a protein supplement does not reduce the caries incidence.
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
What does protein deficiency cause ?
salivary gland atrophy
xerostomia leads to rampant caries
What does vitamin D dependent caries lead to ?
low calcium
low phosphate
hypoplasia
What does hypophosphataemia lead to ?
normal calcium
low phosphate
no hypoplasia
What does hypoparathyroidism lead to ?
low calcium
high phosphate
hypoplasia
Why is hypocalcaemia common in undernourished children ?
diarrhoea induced
What is vitamin A deficiency linked to ?
PEM
linked to defects
What is the rat vitamin A deficiency experiment ?
vitamin A deficient rates given a highly cariogenic diet had higher caries
What does vitamin A deficinecy lead to ?
salivary gland hypotrophy
poor quality saliva
What happened to dogs on a vitamin D deficient diet ?
poorly aligned teeth
delayed eruption
delayed development
enamel and dentine defects
What can be concluded from the may mellanby experiment ?
all teeth with hypoplasia has caries
vitamin D is a factor responsible for caries
What happened when children were given a vitamin D supplement ?
reduced inititiation and spread of caries
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
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
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
What is the PHE advice for vitamin D ?
adults and children over the age of 1 should hvae 10 mcg
equivalent of 5 sardines
What can lead to high caries rates in developing countries ?
poor diet
high sugars
What does under nutrition lead to ?
lack of PE results in developmental defects
making tooth caries prone
salivary gland atrophy
delays eruption
What does dental fluorosis lead to ?
opacities
mottling
hypomineralisation
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
What are the manifestations of fluorosis ?
hypomineralised
alteresd optical properties
opaque
What does the dean research tell us ?
continued use of water- 1 ppm - 10%
continued use of water at 1.7 ppm- 40%
What does excess fluoride lead to ?
enamel mottling
hypomineralisation
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
What are the methods of fluoride absorption ?
90% of fluoride is absorbed mainly in stoamch as HF (uncharged)- rapid absoroption
What happens to fluoride in the body ?
99% goes to calcified tissues like bones and teeth
How is fluoride excreted ?
10% urine and faeces
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
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
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
What happens in fluorosis ?
dental fluorosis mottling of enamel, opacities
skeletal fluorosis- brittle bones and teeth
How does fluoride act ?
topically- aids remineralisation
also inhibits anaerobic glycolysis and sunsequent acd production by oral bacteria
What are the methods for arresting primary caries ?
eliminate dietary abd microbial factors
enhance protecitve factros- fluoride, selaant and salivary stimulation
What is acute fluoride toxicity ?
acute fluoride sudden poiaoning
sudden ingestion of a lethal dose
nausea, vomiting, diarrhoea and abdominal pain
What is a safe fluoridated dose ?
8-16 mg F/kg
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
What is the optimum safe dose for fluoride ?
0.05-0.07 mg/Kg body weight
What are the methods for fluoride therapy ?
public water fluoridation
school water fluoridation
fluoridises, salt and mil
topical mouth rinse, varnish and toothpaste
What did H trendley deans graph result in ?
J shaped curve
What did H trendly conclude ?
water fluoridation at 1 ppm wa best balance between caries prevention and fluorosis risk
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
Why is fluoride beneficial for adults too ?
caries is progressice- fluoride cant protect exposed roots
Have studies linked cancer and fluoride ?
no association between water fluoridation and mortality frm any cancer
What can happen if water fluoridation is decreased ?
increased caries rate- higher than those of water unfluoridated areas
What are the benefits of fluoridated salts ?
decreases caries
gives consumer choice
better if milk/water fluoridation not available
What can happen to fluoride in milk ?
F binds to calcium and protein- reduces the topical effect- not free
What do trials show about F milk ?
it has preventative effects
especially if given whilst teeth are developing
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
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
What is the reduction in dental caries rates due to water fluridation ?
20-50 %
Why is water fluoridation more effective ?
hits everyone
What are the advantages and disadvantages of public water supply ?
advantages- hits everyone
disadvantages- no chocie
What are the advantages and disadvantages of milk fluoridation ?
advantage- children- high ECC risk
disadvantage- not everyone taking milk
What are advantages of salt and disadvantages of salt fluoridation ?
advantage- gives choice
disadvanteg- hypertesnion if excess
What are the classifications of carbohydrates ?
sugars (monsaccharides and disaccharides)
polyols
oligosaccharides (malto and non digestivle)
polysacchrides
What are types of polysaccharides ?
starch
non starch polysaccharides
Where are digestible carbohydrates absorbed and digested ?
in the small intestine
What happens to non-digestible polysaccharides ?
resistant to hydrolysis in small intestine
reach large intestine
partially fermented by commensal bacteria in colon
What is dietary fibre ?
constituents of non digetible carbohydrates
associated with plant cell walls
What is the classification of sugars ?
total sugars split into
free sugars
intrinsic sugars
milk sugars
What are intrisnsic sugars ?
in whole fruits, veg and grains
What are milk sugars ?
naturally present in milk and milk products
What are free sugars ?
free sugars,added sugars and sugars in honey, syrups, fruit and juices and fruit juice concentrates
monsaccharides and disaccharides
What do you need to be careful about with fruit ?
blending can change composition
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
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
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
What percentage of 5 year old children have decay experience ?
31%- this is obvious decay as well
mean number of teeth efffected-0.7
How many dentate adults have decay ?
30%
hard to manage
What percentage of 55-66 year olds have root caries ?
11%
What percentage of 75-84 year olds have root caries ?
20%
ageing population
polypharmacy- xerostomia and increased caries
What are problems of root caries ?
hard to manage
hard to control diet
endentulous end up
affects all teeth usually
What are the SACN free sugar recommendations ?
no more than 5% of daily dietary intake
What are the WHO guidelines for free sugar intake ?
do not exceed 10% intake
What is the problem with diluting juice ?
says no added sugar
not actually sugar free
high frequency of attacks
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
What is the recommended dietary reference value for carbohydrate intake ?
50% of total dietary intake
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
What is helpful for parents and sugar intake ?
sugar cubes
How much sugar should 11 year olds have ?
no more than 30g
7 cubes
6-7 teaspoons
How much sugar ahould 7-10 year olds have ?
no more than 24g
6 cubes
5-6 teaspoons
How much sugar should 4-6 year olds have ?
5 cubes
4-5 teaspoons
How much sugar is one sugar cube ?
4g
What is significant about honey ?
protects agaisnt dental caries
propolis bee glue contains flavanoids and esters that decrease enamel dissolution
How can we transition from a high sugar to low sugar cereals ?
sprinke on top
What are RCTs ?
preferred- gold standard
doesnt work for dental caries
wouldnt be ethical- giving a high sugar diet
What are non randomised intervention studies ?
open to bias
What is the strongest data after RCT ?
cohort studies
What are cohort studies ?
look at the effect of specific risk factors
What are population ecological studies ?
use per capita sugars data- people in popualtion
What are cross sectional studies ?
measure one point in time only
What are case studies ?
weak evidence and only suggestive
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
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
What is a cross sectional study ?
snapshot of time
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
What is the relationship between sugar avaialability and DMFT ?
more sugar availabiltiy and higher DMFT
What is tristan de cuhna ?
island
low free sugar diet
transport links icnreased- decay increased as sugar access increases
What is the relationship between sugar availability and caries ?
reduced sugar availability
reduced caries
ww2 and iraq
What can happen with the transition from primary to secondary school ?
increased access to sugar
What happened in iraq ?
reduced sugar intake after UN sanctions
reduced DMFT after sanctions
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
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
Can dental caries still occur in children when free sugar intake is less than 10% ?
yes
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
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
What have cohort studies shown about caries and freqency and amount of sugar ?
amount is more important
Which type of studies can measure if frequency or amount is more important ?
measure frequency and amount
What is the cariogenicity of mono and disaccharides ?
exception of lactose
cariogenicity of mon/di saccharides is similar
What is the cariogenicity of lactose ?
lactose is less carigenic than other mono.disaccharides
What do some animal studies say about sucrose ?
more cariogenic
What does turku say about fructose and sucrose ?
pre cavity lesions more with sucrose than fructose
What is the role of sucrose ?
substrate for extracellualr glucan synthesis
sucrose has high energy bond
What is the evidence about glucan and strep mutans ?
glucans enhance strep mutans in plaque by increasing plaque porosity- acid accumulation at enamel surface
How much does fluoride reduce careis by ?
50%
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
Why are low levels of caries in childhood significant ?
dental caries is progressive and effects of sugars on dentition are lifelong
What type of evidence is lacking to show a relationship between frequency of sugar and caries ?
epidemiological evidence is lacking
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
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%
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%
What are the limitations of plaque pH studies ?
indirect measure of dental caries as they only measure acidogenicity
What are the limitations of animal experiments ?
differneces in tooth morphology and salivary composition
caution when extrapolating findings to humans
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
What happens in cross sectional studies ?
look at data from a specific population at a specific time
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
What happens in cohort studies ?
do not provide such strong data as RCT
dont control for compounding factors like fluoride
What are highly processed starchy foods ?
sweetened breakfast cereals biscuits cakes processed corn and potato snacks sweetened popcorn
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
What has lab incubation concluded about processed starchy foods ?
crisps. pretzels, breadksticks and crackers - hydrolysed to glucose - metabolised to lactic acid
What do enamel slab experiments show about processed starchy foods ?
cause 1/4 of the demineralisation seen with sugars
What happens when total starch intake is unaltered/increases and sugar decreases ?
caries declines
What happened in japan and norway ?
sugar decreased
starch increased
dental caries decreased
What do children with HFI compared with controls have ?
low caries
low intake of sucrose and fructose
normal/higher intake of starch
What does WHO say about starch rich staple foods and caries relationship ?
evidence that starch rich food showed no relationship with caries
What did the iowa fluoride study say ?
significant associations between consumption of highly processed starch foods and development of caries
What are the conclusiosns regarding cooked staple starchy foods ?
low cariogenicity in man
What happens if starchy food are eaten frequently, heat treated and ground ?
can cause caries- less than sugars
What are conclusions about cariogenicity about cooked starch foods ?
adding sugar increases cariogenicity
baked starch- same levels of cariogenivity as sucrose
What are recommendations to patients on starch ?
consume starchy staples
avoid highly processed starchy foods
What do plaque pH studies show about fruit consumption ?
fruit consumption decreaes pH but not to below critical
What do epidemiological studies show about fruit consumption ?
associted wih low levels fo caries
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
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
What is lactose content in human milk ?
7g per 100g
What is lactose content in cows milk ?
5g per 100g
Is milk classified as cariogenic ?
could be
lactose is least cariogneic of the sugars
calcium and phosphprous help against enamel dissolution
Which breastfed children have an increased risk of caries ?
breastfed for more than 12 months
frequentyl fed and nocurnally fed
What are the types of artificial sweetners ?
intense and bulk
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
What are some examples of bulk sweeteners ?
xylitol
sorbitol
mannitol
What are intense sweeteners ?
range of structures like dipeptides
much more sweeter than sugar
What are some examples of intense sweeteners ?
acesulfame potassium
thaumatin
aspartame
stevia
What are plaque pH studies ?
in vitro
plaque in test tube and look at pH drop
What are animal studies ?
comapre sugar and sweetneers and look at incidence of caries
rodents have a different tooth anatomy
What are intervention studies ?
clincial trials
What are enamel slabs ?
bovine enamel
attached to tooth and observed
What type of sweeteners are sorbitol and mannitol ?
bulk
How sweet are sorbitol and mannitol ?
sorbitol- 0.5 times as sweet
mannitol- 0.7 times a sweet
What do incubation studies show about sorbitol and mannitol ?
sweeteners are fermented much slower than sugar
What do plaque pH studies show about sorbitol and mannitol ?
slight decrease
What do animal studues dhow about sorbitol and mannitol ?
happens but at a lesser extent than curose
What do clinical trials show about sorbitol and mannitol ?
non cariogenic
What is the risk of using chewing gum in studies and comapring it with no gum ?
gum stimulates salivar production
Are there any long term effects of sorbitol and mannitol ?
no
likely to increase caries in normal people
What type of sweetener is xyltoll ?
bulk
How sweet is xylitol ?
as sweet as sucrose
Is xylitol cariogenic ?
no- it is non cariogenic
What did the turku study show about xylitol ?
total sub of sucorse with xylitol- 85% less caries development
What does xylitol do ?
increases salivary flow
What is sucralose ?
splenda
bulk
chlorinated derivative of sucrose
What is aspartame ?
canderel
intense- 200x sweeter
non cariogenic
used in frozen foods
What is the problem with aspartame ?
contains phenylalanine
cant be used by PKU patients
What happens in PKU ?
mutations in phenylalanine hydroxylase
cant convert phenyalalanine to tyrosine
leads to irreversable brain damage
What is saccharin ?
intense
500 x times as sweet as sucrose
inhibits bacterial growth/metabolism by enzyme inhibition
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
What is stevia ?
intense from the leaves of the plant active comounds are stevoil glycosides heat stable/pH stable non fermentable
What are the types of tooth wear ?
attrition
erosion
abrasion
What is erosion ?
chemical dissolution of enamel by acids of non bacterial origin
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
What is a BEWE score 1 ?
initial surface texture loss
shiny enamel surface
loss of mamelons
incisal translucency
What is BEWE score 0 ?
no erosive tooth wear
What is a BEWE score 2 ?
distinct defect
hard tisseu loss is lessthan 50% of surface area
What is a BEWE score 3 ?
Hard tissue loss is more than 50% of surface area
dentine is exposed- hypersensitivity
possible pathological
What is the highest BEWE score ?
3
Is erosive tooth wear reversible ?
no
What happens in pathological wear ?
pulpal exposure
What are the consequences of pathological wear ?
loss of function pain aesthetics destructuion psychological costly
What is the aetiology of erosion ?
intrinsci
extrinsic
What is the intrinsic aetiology of erosion ?
GERD
frequent vomiting
Hcl
What are the extrinsic aetiology of erosion ?
medicine
dietary acids
What are some examples of dietary acids ?
acetic ascorbic citrus carbonic phosphoric
What re some acidic foods and drinks ?
carboanted alcohol fresh fruit juices fruit tomato and chilli foods
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
What is the appearance of eroded enamel ?
honeycomb
How does Hcl work in erosion ?
hydrogen ions directly dissolve mineral surface
no effect from chloride ions
How does citric acid dissolve ?
hydrogen ions directly dissolve
citrate anion interacts with calcium removing it from crystal surface
Which acid has a higher erosive potential ?
citric
What determines the erosive potential ?
pH titratable acidity buffering capacity mineral content calcium chelation
What is the titratable acidity ?
total amount of acid in solution as pH changes
What is buffering capacity ?
maintain pH at neutral
offset the effects of the acid
How does quantity influence erosive potential ?
increased acidic drinks and fruit intake - higher erosio prevalence
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%
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
How does temperature affect erosive potential ?
higher temperature increaes erosive potnetial
What are some groups at risk of erosion ?
sports people eating disorders alcoholics drug addicts dieters wine tasters pregnant women
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 ?
What is essential for management of dental erosion ?
good records
early diagnosos
control aetiological factors
ongoing monitoring
Which aspects of MH can effect erosion ?
salivary gland hypofucntion
radiotherapy
gastric disturbances
oral hygeine habits
What is dietary advice to be given for erosion pateitns ?
drink water/milk with meals
consume quickly/straw
chilled beverages
What should be used after an acid attack ?
remineralising agent- fluoride
neutralising agent - sugar free
What are some protective factors for erosion ?
dairy milk - lactose is least cariogenic
cheese
Why are dairy milk and cheese used as protective factors ?
calcium phosphate casein all anti cariogenic increases concnetration to locally reduce conc gradient
What does cheese do in erosive protection ?
increases saliva flow
What is the effect of tooth loss on chewing ?
bite strength
closing force
What types of foods do edentuolous people avoid ?
raw fruit and veg
food with pips
Which nutrients are lower in edentulous ?
protein iron vitamin B1 vitamin B2 vitamin C
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
What do edentulous tend to substitute fibre with ?
saturated fat
What does a low BMI in older people ?
low functional status
low protein intake
low energy intake
What does being edentuolous put you at risk of ?
undernutrition
What does prosthetic rehabilitation due to chewing function ?
prosthetic rehabilitation improve chewing fucntion
What does prosthetic rehabilitation not do ?
give people the drive to change theri nutrition now they can eat
What is needed to improve nutritional status of denture wearing patients ?
dietary advice
What can dietary advice lead to in denture patients ?
sustained reduction in saturated fat
increased fibre intake
What needs to be done to improve nutritional status of denture patients ?
dietary adive
optimised denture
How could you increase fruit and veg fro edentuolous ?
smoothies
mushy peas
grate
soup
How can you increase fibre in edentulous aptients ?
wetabix
porridege
lentil soup
dhal
What are the interacting factors in the disease process of periodontitis ?
exaggerated host response
patient risk factros
microbial dysbiosis
What are some risk factors for periodontal disease ?
tobacco environmental oral hygiene medication microbial obesity genetics
What is the main overriding factor in aetiology of periodontal disease ?
plaque
What does nutrition do in periodontitis ?
poor nutriton impairs the host defence
Which sugar affects plaque volume ?
sucrose leads to higher volumes of plque
Why does sucrose impact on plaque ?
sucrose leads to glucan formation
What does malnutrition due to immune systems ?
impairs innate immunity- phagocyte production,
impairs adaptive immunity- cell mediated, antibody
Why does malnutrition affect oral disease ?
more glucocortoicoids
impaired host defence of saliva
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
What is cancrum oris ?
gangrenous disease
rapid necotising destruction of soft and hard tisseu
What are some risk factors for necrotising diseases ?
malnutrition
poor OH
compromised immune system
HIV
What have calcium and vitamin D deficiencies lead to in animals ?
resorption of bone
exacerbates bone loss
What is vitamin D needed for ?
cell development
bone development
neuromuscualr functioning
inflammation control
What is a major source of vitamin D ?
from the conversion of 7-dehyrocholesterol to D3
What are the sources of vitamin D ?
oily fish
egg yolks
cheese
fortified foods
What is folic acid needed for ?
needed for cells with high turonver - gingiva
low serum folate independently associated with periodontla disease
What is vitamin C ?
ascorbic acid
antioxidant
What does severe vitamin C deficiency lead to ?
scurvy
swollen bleeding gums and tooth loss
What is vitamin C needed for ?
collagen synthesis
PDL
bone matrix
blood vessel wallls
What is the immune fucntion of vitamin C ?
phagocytosis and wound healing
What is the link between vitamin C and periodontitis ?
weak association with vitamin C and periodontitis
What are low B12 levels associated with ?
worsening of periodontal status and tooth loss
What are ROS and when are they produced ?
ROS are released from PMNs in response to antigens
leads to phagocytosis and oxidative burst
What can a prolonged period of ROS lead to ?
tissue damage
What is oxidative stress ?
balance between ROS and antioxidants
in pathogenesis of diseases
Which diseases does oxidative stress feature in ?
type 2 diabetes
cardiovascualr sisease
rheumatoid arthritis
Which type of diet provides oxidants ?
refined sugars
carbs
saturated fats
What does a disbalance in ROS lead to ?
local tissue damage
affects epithelial cells, connectove tiises, bone and neutrophils- in periodontitis
What do antioxidants do ?
prevent oxidation of other molecules
influence periodontal onset, progressiona dn wound healing
buffer agaisnt ROS tissue damage
Which tissues are damaged by ROS in peridontitis ?
gingival tissue
PDL
alveolar bone
What do ROS do ?
lipid peroxidation
protein degradation
DNA mutations
bone resorption
Give some examples of antioxidants ?
glucathione
coper
IRon
vitamin AEC
Give some antioxidant rich foods ?
sweet potato apricots almonds sunflower sesame chicken
Which antiocidants are compromised in periodontitis ?
those in the GCF and serum
What is the main function pf vitamin E ?
stabilise membrane structure by terminating free radical chain reaction
Where can you find vitamin E ?
non citrus
nuts
seeds
What did the nigata study say ?
higher itnake of dietary antioxidants- les teeth infected by PD
strongest for vitamin E
What is obesity associated with ?
increased risk of periodontitis
What do adipocytes do in obesity ?
release pro-inflamamtory adipokines like TNF aloha and IL6
up regualte acute phase proteins
promote periodontitis
What ar the omega 3 fatty aids ?
EHA
DHA
What is linoleic acid ?
essential fatty acid
in cell membranes
What is the pathway for linoleic acid ?
linoleic acid
arachidonic acid
leukotrienes and eicosanoids
What is the impact of EHA ?
stops arachidonic acid conversion into eicosanoids
promoted leukotriene B5 over B4 - less inflammatory
What can breast feeding do ?
reduce child mortality
prevent 37% of deaths in
What does the WHO recommend breast feeding for ?
exclusively for 6 months
What do studies say about formula fed children and caries ?
formula fed children had higher caries
What does evidence suggest about breastfeeding and its protective effect ?
breast feeding has a greater protective effect agaisnt dental caries that bottle feeding
What is the link between children being breastfed for 12 months and caries ?
fewer dental caries if fed for 12 months
What is the link between children being breast fed for more than 12 months and caries ?
fed more than 12 months then increased caries
What increases the risk even more with breast fed children ?
nocturnally fed
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
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
What are the benefits of baby led breastfeeding ?
increases milk flow and helps with nutritional adequacy
boost oxytocin
regulate body temperature and blood glucose
When should cow mil be given ?
not in the first 12 months
defintiely not in first 6 months- too high risk of allergy
What is hypoallergenic infant formula ?
for babies that are lactose intolerant, cow milk protein allergy or cow protein intolerant
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
When is hypoallergenic infant formula used ?
under medical supervision
What is low/lactose free formula ?
does not contain caesin or lactose
contains glucose syrups and sucrose so is cariogenic
What is nutrient enriched post discharge formula ?
for pre term infants post discharge
What is soya formula ?
use for vegan infants
higher in micronutreitns
contain glucose and syrups
not recomended because of phytooestrogens
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
Are follow on formulas suitable ?
no - they are not a repalcement for breast milk form 6 months onwards
Why shouldnt cows milk be given before 12 months ?
low in iron
Why shouldnt skimmed milk be given bedfore 5 months ?
loss of fat and fat soluble vitamins - ADEK
What is bottle feeding and sugars associated with ?
increased dental caries
Why do parents add sugar to infant feeds ?
treat constipation
aid digestion
help baby sleep and reduce pain
When should different tastes and textures be induced ?
from 6-7 months
Whens hould infants be eating family foods ?
from 1 year
When are micronutrient supplements for ACD be given ?
from the time complementary foods are given
if they are not having infant formula
What should be the drinks in infants ?
milk and juice
When should a cup be introduced ?
from 6 months
When should bottle drinking be discouraged ?
from 1 year
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
What increases ECC risk ?
sugared drinks and sweet snacks
What are hidden sugars ?
invert sugars glucose syrup corn starch maltodextrin hugh frucrose corn syrup fruit juice and cocnentrate
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
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
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
What are the 3 Ps ?
practical
personal
positive
What are SMART goals ?
specific measurable acheivable realistic timely
How should goal/agenda setting be ?
collaborative patient led flexible individually tailored faciliated and not driven
What are the stages of change model ?
pre contemplation
contemplation
planning
action maintenance
What do you need to talk about change ?
change talk
rapport
How do you assess the readiness to change ?
they have importance and confience
How do you assess importance and confidence ?
scaling questions
What are the aspects of change talk ?
rolling with resistance
scaling questions
reflections
open/closed questions
What should you do when using scaling questions ?
ask why they gave a 6 and not a 1
Which stage are people at if they are rolling with resistance ?
contemplation
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
What is important to remeber with monitroring ?
bring up and check nect time
What does SMART stand for ?
specific measurable acheivable realsitic timed
