866.928.4445

Subscribe

News

Nov
29

How Does Diet Influence Caries Risk: Part 1

written by CariFree

sugar

When discussing how diet influences dental caries risk, the number one dietary concern that comes to mind is sugar. What does the research say about the challenges we are up against when counseling patients about decreasing their sugar intake? Well, according to this study, the neurobiological response to sweet reward is more robust than that of cocaine.

 

Sugar

“At the neurobiological level, the neural substrates of sugar and sweet reward appear to be more robust than those of cocaine (i.e., more resistant to functional failures), possibly reflecting past selective evolutionary pressures for seeking and taking foods high in sugar and calories.”(Ahmed SH, Guillem K, Vandaele Y. Sugar addiction: pushing the drug-sugar analogy to the limit. Curr Opin Clin Nutr Metab Care. 2013 Jul;16(4):434-9.)

We know sugar is a significant contributor to dental caries, but what is more detrimental to patients? Frequency of intake or the amount of sugar consumed?

 

What about frequency?

Abstract

Food is necessary for the proper growth and development of children. The excessive intake of low-molecular carbohydrates constitutes a serious health issue, which has an unfavourable impact on the dental health status. The aim of this study was to assess the food habits in healthy children aged 6-12 years and the effect on their oral risk profile. The study included 100 children. The assessment of their nutrition was done with the help of a seven-day reproduction of the food intake and a survey used to determine their underlying food habits and preferences. The results revealed unbalanced nutrition of the children and increased intake of simple sugar, which will increase the risk of development of dental caries. The observed high levels of DMFT (number of decayed, missing and filled teeth) in 54% of the children is a logical result of the frequent intake of sugary foods and beverages for a long period of time, as this will increase the acid production by microorganisms in dental plaque, which is one of the leading etiologic factors for the development of caries. It is necessary for dentists to administer control over the carbohydrate intake and the food habits of children, as well as to encourage non-cariogenic diet in order to keep their good oral health.

 

“The results revealed unbalanced nutrition of the children and increased intake of simple sugar, which will increase the risk of development of dental caries. The observed high levels of DMFT (number of decayed, missing and filled teeth) in 54% of the children is a logical result of the frequent intake of sugary foods and beverages for a long period of time.”(Doichinova L, Bakardjiev P, Peneva M. Assessment of food habits in children aged 6-12 years and the risk of caries. Biotechnol Biotechnol Equip. 2015 Jan 2;29(1):200-204.100 6-12yr Diet 7 day/DMFT).

 

sugar2Amount not frequency

Abstract

Dental caries is considered a diet-mediated disease, as sugars are essential in the caries process. However, some gaps in knowledge about the sugars-caries relationship still need addressing. This longitudinal study aimed to explore 1) the shape of the dose-response association between sugars intake and caries in adults, 2) the relative contribution of frequency and amount of sugars intake to caries levels, and 3) whether the association between sugars intake and caries varies by exposure to fluoride toothpaste. We used data from 1,702 dentate adults who participated in at least 2 of 3 surveys in Finland (Health 2000, 2004/05 Follow-up Study of Adults’ Oral Health, and Health 2011). Frequency and amount of sugars intake were measured with a validated food frequency questionnaire. The DMFT index was the repeated outcome measure. Data were analyzed with fractional polynomials and linear mixed effects models. None of the 43 fractional polynomials tested provided a better fit to the data than the simpler linear model. In a mutually adjusted linear mixed effects model, the amount of, but not the frequency of, sugars intake was significantly associated with DMFT throughout the follow-up period. Furthermore, the longitudinal association between amount of sugars intake and DMFT was weaker in adults who used fluoride toothpaste daily than in those using it less often than daily. The findings of this longitudinal study among Finnish adults suggest a linear dose-response relationship between sugars and caries, with amount of intake being more important than frequency of ingestion. Also, daily use of fluoride toothpaste reduced but did not eliminate the association between amount of sugars intake and dental caries.

 

“The findings of this longitudinal study among Finnish adults suggest a linear dose-response relationship between sugars and caries, with amount of intake being more important than frequency of ingestion. Also, daily use of fluoride toothpaste reduced but did not eliminate the association between amount of sugars intake and dental caries.”(Bernabé E, Vehkalahti MM, Sheiham A, Lundqvist A, Suominen AL.The Shape of the Dose-Response Relationship between Sugars and Caries in Adults. J Dent Res. 2015)

Next week we will continue the conversation about diet and dental caries.

 

What about you? Do you think the amount or the frequency of sugar intake contributes more to disease? Let us know in the comments below.

 

3 Responses to “How Does Diet Influence Caries Risk: Part 1”

  1. Joseph Ritz

    I an not convinced of the dose-response conclusion. I am not a researcher but a clinician of 40+ years. The “grazing” eating pattern and frequency of intake of high glycemic/low molecular carbohydrates seems correlated strongly with caries experience. “Better to eat the whole bag of M&M’s at once than to graze on carrots all day” was the comment from one cariologist I heard recently.

  2. Drew Carlin

    I agree with Dr. Ritz. My specialty is pediatrics, and the study in question looked at adults. We know that the caries disease process is different across age groups and dentitions. I am always open to new insights, depending on how the study was designed and whether or not it can be replicated. However, anecdotally, it does seem that “grazing” behaviors lend themselves to higher caries risk. This is consistent with what we know about the plaque biofilm acid challenge and the 20+ minutes that it takes for oral pH to neutralize following a meal.

  3. Richard Schoenbaum, D.D.S.

    With the way sugar is pervasive in processed foods, is this really relevant or valid? We are all active grazers. This seems like another search for a “Silver Bullet” to defeat tooth decay, when it is really a comprehensive utilization of the many products and protocols available today. These would include commonsense behaviors of moderation, good oral hygiene, early detection and repair of tooth defects, and aggressive use of disinfection and remineralization protocols. In short, developing an approach that is based more than one individual element or observation. Allow me to acknowledge that this is extremely difficult to accomplish, both in a private practice, as well as, a public health clinical setting.

Leave a Comment...
Here's your chance to speak. (Email will not be published)

Category: Education