diet and dental health
sought. Other problems such as ulceration need care as well. country. The division between medicine and dentistry is an ar-
Small ulcers can be painful but usually resolve within ten days tificial one which is perpetuated by the rather technical way in
or so. Any ulcer lasting more than six weeks needs to be inves- which dentistry has developed. There is a great need for oral
tigated professionally. Oral cancer, often linked with smoking health to be made part of general health.
and alcohol abuse is a life threatening condition (6). This is where the work of dietitians can be so valuable. What
then are the messages to pass on to those at risk? Dietitians
Nutrition and some facts and fallacies about oral health are ideally placed to give oral health advice and should work
Nutrition is the bedrock upon which good oral health can with the dental team to do so. Most dentists would be pleased
be built. It is important from the outset, beginning with preg- to be asked and it might be the start of a beautiful friendship!
nancy and the early years. Moderation in all things with a
varied yet balanced diet is as good for the teeth and bones Top Tips for Teeth
as it is for general health. Dentists are very much in favour of - Use a fluoride toothpaste and brush morning and night
breast-feeding because the muscles of the oral cavity and every day.
tongue, which are complex, need the stimulus of sucking in - Limit snacking (of any foods). Three meals a day with two
order to develop well, influencing the growth of the jaws and snacks in between is sensible.
the teeth developing inside them. Bottle-feeding does not - If you have sweet sticky foods, eat them all at once
provide these muscles with a sufficient challenge, due often to - avoid ‘grazing’ over extended periods. For example have
poor design. a whole chocolate bar in one go rather than constantly
If a well-balanced diet is followed, combined with good dipping into a bag of sweets.
cleaning habits, then from a dental point of view the main - At night have nothing except water after having brushed
dangers come from frequent snacking between meals and the teeth.
the over-consumption of fizzy drinks. This is a far cry from the - Visit the dentist regularly for checks and discuss any prob-
advice of twenty years ago when the mantra was puritan in lems and the options open to solve them.
approach, with an emphasis on the avoidance of all sugar.
Science has simplified the issues for us. Until recently there
References
has been one faction of the dental profession who said that
1 Hobdell M et al :oral diseases and socioeconomic status; Brit Dent J 2003, 194:91-96
2 Dietary Sugars and Human disease, Committee on the Medical Aspects of Food
the quantity of sugars and starches ingested was the most Policy Report 37 p 16-17, HMSO 1989
important factor in determining the prevalence of dental car-
3 Krass B: Caries Risk; Quintessence, Chicago; 1985
ies, and another who claimed that frequency of intake was
4 Shaw l Dental erosion; current thinking Word of Mouth, BDHF Dental health and
Practice 1999/2000, London 2000
the critical factor. This quarrel among dentists has now been
5 Moore S: Periodontal health of London women in early pregnancy, Brit Dent J,
resolved. The arguments are neatly summarised in a review 2001, 191:570-573
article by Curzon (2006) (7) who states:
6 Helping Smokers Stop; NHS Health Development Agency 2004
“A hundred years of literature and innumerable studies have
7 Curzon M, Sugars, starches and dental caries- frequency versus quantity; Dent
Digest vol7: 1 1-4 Advisa Medica 2006
failed to show a statistically significant relationship of sugar
consumption, as quantity, to dental caries. Studies on the
frequency of sugar use, however, have indicated that there
is a correlation, albeit not a very strong one. The experimen-
tal evidence is much stronger and shows that the frequent
use of refined carbohydrates (more than three times a day)
including sugars but in the absence of fluoride is related to
the development of dental caries. However the frequency of
challenge before enamel demineralisation occurs increases to
more than seven times a day when fluoride toothpaste is used
regularly twice daily.”
The two ‘Fs’ - Fluoride and Frequency
Remembering the two ‘Fs’ rule is key to the prevention of
dental decay in all ages and is at its most effective in young
people. As we have seen, dental caries starts with acidic at-
tack on the enamel. In order to demineralise the hard tooth
surface the acids must remain in contact for a significant time.
The saliva is nature’s mouthwash and can neutralise the acids
and contribute to the repair of any damage. In the healthy
mouth there is a constant equilibrium between this acid attack
and the repair process. Unfortunately if the bacteria are sup-
plied with sugars and starches too frequently, the saliva does
not have time to neutralise the acids. However help is at hand;
the presence of fluoride strengthens the enamel, making it
more resistant and at the same time reducing the capacity of
bacteria to produce acid.
From these facts we can deduce a simple rule of thumb for
caries prevention:
Fluoride: brush with fluoride toothpaste twice a day
Frequency: Have three meals a day and limit snacking in be-
tween to two occasions.
Practical Advice
It is a regrettable accident of history that dentistry in the
past did not truly integrate into primary health care in this
NHDmag.com May ‘08 - issue 34 19
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