A Few SoundBites on Diet, Nutrition and Oral Health Carole A. Palmer EdD, RD Tufts University: School of fdental lmedicine i Friedman School of Nutrition Science and Policy
Conflict of Interest Disclosure Advisor Board Member unpaid Mouthwatchers Inc. : an oral health care company that t makes toothbrushes, develops oral health promotion programs, and makes xylitol lollypops
Myth: Teeth are NOT important Diamante Driver
Health Implications of Oral Problems Severe caries in children requires surgery under general anesthesia Severe caries in adults due to radiation/chemo can result in osteoradionecrosis Poor oral hygiene can cause VAP (ventilator-associated pneumonia) Periodontal disease is assoc. with preemies Edentulousness is major risk for choking and malnutrition
Oral health means much more than healthy teeth Oral health is integral to general health 2000 Department of Health and Human Services
Surgeon General s Report Children lose about 632,000 school days Adults lose about 3.6 million workdays/year from oral health pain and suffering. Dental disease can result in profound behavioral consequences: Loss of self-esteem, Social avoidance Loss of self-confidence, diminished i i d ability to function in society From: NIDCR(www.nih.nidcr.gov) 1999 and Surgeon General s Report, 2000.
Dental Caries: one of the most common diseases in 5- to 17-year-olds
Significant Relationship between Periodontal Disease and Heart Disease in Humans* This relationship has long been known in dogs Loesche, Compendium 15 (8) l994
Teeth Should Last a Lifetime Dental problems are preventable!!!
Overlapping dental/medical and nutrition issues Increasing Child and Teen dental caries Childhood obesity Relationships between periodontal and systemic disease
Oral Problems Dental Caries (tooth decay) Periodontal disease (gum disease) Tooth Loss
Nutrition/Oral Health Interrelationships Eating impairment Diet/nutrition problems Oral soft tissue bone problems or Tooth problems
Undernutrition affects the Oral l Cavity Teeth: Pre-eruptive eruptive malnutrition can result in enamel defects Bone & Soft Tissue over the Lifetime Slowed healing/rapid tissue turnover rate Decreased resistance to oral infections Ultimately may result in increased tooth loss
OverNUTRITION can affect the Oral l Cavity Overnutrition (supplements) - developmental defects (vitamin D toxicity) tissue regeneration (vitamin A toxicity) - Fluorosis Child Obesity???
How Diet Effects Teeth: Like politics: all effects are local Demineralization: most common with xerostomia xerostomia Regular & diet sodas both cause demineralization (sugar content not relevant) acid: lemons acid bevs: soda & diet soda vitamin C tablets eating disorders non-colas & iced tea were worst Von Fraunhofer, General Dentistry July-August 2004, pp.308-312
Dental Caries Process Bacterial plaque colonize in protected areas Metabolize simple sugars to acid Acid demineralizes enamel Bacteria and acid invade dentin Bacteria can invade pulp and migrate throughout the body Abscess
What is Cariogenic? All simple sugars can be cariogenic. (glucose, fructose, lactose, maltose, sucrose, honey, high h fructose corn syrup ) Starch can be cariogenic under some circumstances (amylase) Sugars are rarely eaten alone, but rather with other food components and other foods which can affect their cariogenic potential Cariogenic for ME may not be cariogenic for YOU
The AMOUNT of sugars eaten or drunk (drank, drinked??) is NOT the most important factor the relative cariogenicity of a food is NOT correlated with its carbohydrate content (Kandelman, D 1997)
What Determines Cariogenic i Potential of Diet?
Factors Increasing Risk Factors Decreasing Risk Eaten or sipped often Consumed infrequently Eaten or sipped for prolonged periods Highly retentive in mouth Consumed fast Liquid or fast removal from mouth No rinsing or brushing after Oral hygiene after Xerostomia No xerostomia
Potentially t ti Cariogenic i i Foods d Highly Cariogenic Low Cariogenicity dried fruits candy, hard candy cake, cookies, pie crackers chips Moderately Cariogenic fruit juice sweetened, canned fruit soft drinks breads raw vegetables raw fruits milk Non-cariogenic meat, fish, poultry fats and oils Cariostatic cheeses nuts xylitol
Which is More Cariogenic? hard candy OR soda
Which h is More Cariogenic i? one hard candy consumed slowly OR one soda consumed slowly once a week every day
Snacking cartoon
Adults Root Caries & Periodontal Disease Multiple meds = xerostomia Smoking cessation Hard candies and breath lozenges
Caries Protective Foods
Xylitol Gum Xylitol interferes with StrepMutans: inhibits their ability to produce acids. Interferes with their ability to colonize and stick to oral tissues. chewing action stimulates salivary flow Sugar-Free Gum Stimulates salivary flow
Considered Caries-Safe Meal 3 meals Pattern No more than 3 snacks Sweets as dessert not between No constant sipping Van loveren,duggal, Caries Research: vol 38 (suppl 1),2004
What we DON T know caries- safe diet for individuals (Some say 3 meals/2 snacks) extent of protection of other food components (Ca, P, cocoa, etc.) protective mechanisms of cariostatic foods: e.g. salivary stimulation, remin., etc.
Life Cycle Issues
Early Childhood Caries Immature dentition Plaque-filled mouth Low L saliva Long bottle contact
The Sippy & Juice Issue Consumed constantly, Considered nutritious Contributes to ECC Contributes t t to childhood d obesity
Diet Patterns and ECC S-ECC children: more total food/ beverage items daily (p=0.0029), ate/drank more frequently (p= 0.005), 005) more cariogenic foods more often (p<0.0001) more: juice, particularly between meals (p<0.007), non-juice j cariogenic liquids (p<0.01), solid retentive foods (p<0.0005). more bedtime snacks (p=0.002). Palmer, Tanner, et. al. JDent.Res 2010
How Periodontal Disease occurs Also called gingivitis, pyorrhea Plaque bacteria infect gums Gums recede Bacteria infect jaw bone Jaw bone recedes
Elders: Dentate Status Tooth loss affects dietary quality and nutrient t intake Tooth loss risk of low body mass index and weight loss, among vulnerable populations I l ti b t Inverse correlation between vitamin C levels and occlusal pairs
Active Research Child Obesity assoc. with early tooth eruption = early risk for dental caries and increased risk of malocclusions. (Must, Obesity, 2012 ) Vitamin D insufficiency (serum 25[OH]D <75 nmol/l) is associated with maternal periodontal disease during pregnancy (Boggess, JPeriodontol. 2011) Low calcium intake is related to increased risk of tooth loss in men (Adegbove, Jnutr, 2010) Green tea is associated with decreased odds of tooth loss ( Koyanna, Prev.Med, 2010)
Active Research Green and Black tea: may have anti-plaque bacterial effect (via catechins) 1 Calcium & Vit. D: may clinical attachment loss and tooth loss 2 Dentate Status affects Nutritional Status 3 Antioxidant intake may modulate both periodontal disease and systemic disease (such as CVD, cancer, stroke) 4 1. Czajka-Jakuboswka et al. Chemistry in Britain, 2002 2.. Krall, Dent. Clin. Of NA ## Sahyoun,Krall, JADiet A, 2003 3. Krall, Annals of Perio, 2001, Nishida J, J Periodontol. 2000 4. Ritchie et al. Critical Rev. Oral Biol Med 13 (3): 291-300, 2002.
Summary: Common Myths Debunked Tooth loss is inevitable Only sucrose causes tooth decay How much sugar you eat is the most important factor Diet is not important t in periodontal disease
Research Needs Making cariogenic foods less cariogenic Learning oral effects of nutrients and phytochemicals to prevent periodontal disease and mitigate oral infections
Ancient History
Shameless h l Promotion P!!
Dental Caries: Preventable Fluoride Anti-microbial rinses Systemic nutrition
Nutrition & Perio Disease Significant associations between tooth loss and bone loss Vitamin C: collagen and antioxidant Those eating < 60 mg vit. C/day had 1 1/2x chance of having gingivitis than those with 180 mg/day low Calcium & Vit..D:may increase clinical attachment loss and tooth loss