diet and dental health
fermentable carbohydrates are sugars
by Dr Brian Mouatt CBE
and starches. The texture of the food is
also important. The more sticky a food,
Former Chief Dental Officer,
the more it will adhere to the teeth and
Department of Health
the longer it will take to be cleared by
the cleansing action of saliva, thus the
greater opportunity the acid producing
bacteria have to produce the damag-
ing acids.
Diet and dental health:
The prevention of decay relies on the
elimination of one or more of these caus-
another perspective
al components; removal of the plaque,
control of the acid producing bacteria
and limitation of exposure to relevant
What we eat is crucial to health – this the increase. To find the explanation we foodstuffs. In practical terms this means
much is axiomatic; there are many
need to understand a little of how dental
good oral hygiene and a limitation to the
perspectives and much advice is prof-
caries is caused.
number of eating occasions per day.
fered, however it is only the dietitian
Most authorities agree that for
who can bring the professional over-
dental caries to occur three compo-
Dental erosion
view to bear and make sense of it all.
nents are required: dental plaque;
The phenomenon of erosion was
For many years the dental profession
acid producing bacteria; fermentable
hardly talked about ten years ago, but
maintained a rather insular approach
carbohydrates. (2)
now has become a matter of some con-
to health issues, working in an un-inte-
cern. Erosion is seen when the enamel
grated way within the family of health col-
Dental plaque:
of the teeth is dissolved away by some
leagues. Things are better now: the mouth
This is a complex biofilm which sticks
extrinsic acid source (4). Carbonated
has been ‘put back in the body’ and the
to the surface of teeth. It develops
drinks are usually blamed, but other diet
dental team is more ready to address the
quickly and when newly formed can be
sources can be surprisingly acidic. The
preventive aspects of health through the
easily removed by good tooth brushing,
list of implicated factors is a long one.
common risk factors which link oral health
fluoride toothpaste and the use of aids
Strange diets which may include un-
with a wide variety of conditions such
such as dental floss. If neglected it be-
usual quantities of yoghurts, pickles, acid
as Type 2 diabetes, oral cancer, obesity,
comes more difficult to remove and re-
fruit such as lemons and of course large
cardiovascular and respiratory diseases
quires removal by a dental professional
intakes of fizzy drinks all put the enamel
and poor pregnancy outcomes.
such as a dental hygienist. Factors which
at risk. Erosion has been recorded in
All of us are much more knowledge-
affect the formation of plaque include
sportsmen and women who use acidic
able and concerned about health issues
the amount and viscosity of the saliva,
drinks on a frequent basis and even
these days and knowing the questions to
the ‘stickiness’ of foods and the struc-
swimming pool water has been shown
ask and an appreciation of the scope of
ture of the teeth; teeth with irregularities,
to affect the teeth in those who train
modern dentistry can make exchanges
deep fissures and crowding are more
regularly. Sometimes the acid comes
with the dental team much more reward-
prone to attract plaque. ‘Mature’ or old
from an intrinsic source, for example
ing. Most dentists are only too pleased to
plaque becomes calcified and is seen
in patients with a gastro-vesophageal
have referrals and to discuss and explain
as tartar or calculus and is very resistant
reflux, persistent vomiting or regurgita-
what is happening and the options; it is
to removal by normal brushing. Under
tion. Erosion should be considered as
likely they will be flattered by your inter-
the microscope plaque is revealed as
a possible alerting indicator of eating
est.
a matrix of long polysaccharide chains
disorders in some vulnerable patients.
It will come as no surprise that good
interspersed with cells from the mucous

nutrition and oral hygiene are key fac-
membranes of the mouth and bacteria.
Periodontal diseases
tors in the prevention of many dental Of course, to have a healthy mouth,
problems. This is where family routines
Acid producing bacteria:
freedom from decay is not the only
and lifestyle choices come into their
There are many bacteria that live
requirement. The care of the gums and
own. The good news is that relatively
within the mouth, normally without caus-
mucous membranes of the mouth is
simple measures, which are easy to
ing much harm, and however clean, the
equally important. It is no good having
adopt, work effectively.
mouth is never a sterile environment. It
perfect teeth if the support for them is
Let us look at some of the dental
is warm and moist and when trapped
not strong and healthy. It is surprising
problems that can occur and how they
within the matrix of the plaque the
how many people will tolerate bleed-
can be best overcome.
bacteria multiply easily. The bacterial
ing gums and yet elsewhere in the body
strain which is particularly implicated in
bleeding would ring alarm bells. Bleed-
Dental caries
the dental caries process is streptococ-
ing is the first sign that all is not well with
Tooth decay is probably the most
cus mutans. Their important feature is
the periodontal tissues, the ligaments
common disease in the world. Its causes
that they are able to convert ferment-
and bony structures that support the
are well known and it is totally prevent-
able carbohydrates such as sugars and
teeth in the jaws (5). The secret of suc-
able. Despite this, many millions of
starches into acids. It is these acids that
cess is keeping the mouth clean and
people throughout the world still suffer
attack the enamel of the teeth and start
free from plaque. The toxins in plaque
because of it. In advanced Western style
the decay process. (3)
build up and irritate the soft gingival
economies caries rates have declined tissues. These need to be sufficiently ke-
dramatically and now have become Fermentable carbohydrates: ratinised to withstand the wear and tear
an issue mainly for deprived communi- This rather clumsy term is used to of the diet. Regular and efficient tooth
ties (1). In the developing world and describe those foodstuffs that can be brushing is usually enough to achieve
the emerging market economies, the broken down in the mouth by the action this. If bleeding persists the help of the
reverse is true. Here decay rates are on of saliva. In practice, the most important dentist and dental hygienist should be
18 NHDmag.com May ‘08 - issue 34
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