The present knowledge of dental nutrition leads to the placing of emphasis on calcium, phosphorus and vitamins A, D and C as specific

requirements for all ages. It is undoubtedly correct to assume that a well balanced diet in respect to other essential food substances is necessary in the normal growth and development of the teeth. Diet during Pregnancy and Lactation. The mother needs an adequate diet planned in harmony with the principles already discussed. Proteins and fats should be used in smaller amounts while mineral foods and vitamins should be provided in greater proportions than normally required. Calcium and phosphorus are needed for the proper development of the infant's bones and teeth. Toward the end of pregnancy when the need for these substances by the growing fetus is at the maxi-mum, they should be provided even more freely. The simplest and most satisfactory way to obtain calcium and phosphorus is to use one quart of milk daily, supplemented with a moderate amount of cereals and liberal amounts of fruits and vegetables. During this period she should not experience an abnormal gain in weight.

That vitamins A, D, and C are necessary in the development of sound teeth has been demonstrated in experimental work. Sufficient vitamin A will be provided with a quart of milk in the diet. The mother should be out-of-doors in the sunshine as much as possible so that the sun may make vitamin D in her own skin. -If she could live in the tropics the vitamin D supplied in this way might be adequate, but in temperate zones she should obtain some from other sources. Foods are comparatively poor sources, except when irradiated. Irradiated foods and fish liver oils should therefore be used if necessary. Her diet should contain generous amounts of raw fruits and vegetables, because these contain vita-min C, which has been shown to be necessary for the prevention of scurvy, the earliest manifestations of which are seen in blood vessel changes around the teeth. The need for minerals and vitamins during lactation is greater than during pregnancy, so the mother must continue a similar program of diet as long as she nurses the baby. We favor mothers nursing their babies when-ever possible, because the calcium and phosphorus in human milk is in a form more easily absorbed than that found in cow's milk or prepared formulas. Infancy. The newborn baby is always given milk. As stated above, it should have mother's milk if possible. If for any reason this is not available, then formulas containing cow's milk are used. These are planned to furnish calcium and phosphorus in proper proportions. All vitamins are important to the baby. Vitamin A is provided in the milk. Vitamin D, found in sources already mentioned, must be provided. The baby may make some of its own vitamin D if it is allowed plenty of sunshine. Special attention must be given to insure an adequate supply of vitamin C as cooked foods are added to the diet. Often a few drops of orange juice or tomato juice, which are very good sources of vitamin C, are given to the baby before it is two weeks old. There are many vacuum packed preparations of sieved fruits and vegetables on the

market suitable for infant feeding. These retain vitamin C, which is destroyed by heat only in the presence of oxygen. After weaning, the infant should be given one quart of milk daily. While additional cereals, fruits, and vegetables are put into the diet during the second year, care must be taken to see that the necessary food substances are provided which will build the tissues being formed at that time. Milk provides the calcium and some of the phosphorus needed in building bones and teeth. It also supplies vitamin A. Raw fruit juices will insure adequate vitamin C; and generally, vitamin D can be supplied in adequate amounts by using irradiated foods and cod liver oil or similar preparations. Milk from cows fed a diet well supplied with vitamins A and D will probably supply these vitamins in suitable amounts. Not only are minerals and vitamins needed for the formation of the deciduous teeth which appear in this period, but also for the early development of the permanent teeth which are forming deeper in the jaws at the same time. Childhood. The greatest loss of teeth from decay occurs between the ages of two and four years. This may be due in part to poor prenatal and infant nutrition. At this age the child is ready to take a fairly generous mixed diet. Too often they are fed according to their size rather than according to their needs. Childhood is a period of rapid growth and tooth development. Calcium, phosphorus and vitamins must be liberally supplied in the diet. Children need, crave, and should have a high carbohydrate diet. This should be provided largely with generous amounts of fruits and vegetables rather than with concentrated sweets, so that in addition to the necessary carbohydrates they will be given the valuable minerals and vitamins. Some raw fruits, fruit juices, or raw vegetables should be included daily to provide vitamin C. Extra vitamin D may be supplied in the form of irradiated foods or fish liver oils. Adolescence. Children also lose many teeth from decay between the ages of 12 and 15 years. During this period food requirements reach a maximum. Too often unwise food restrictions are self-imposed to achieve an artificial ideal in weight or form. Teeth may share in the damage to health generally by such a course. Tea and coffee are often substituted for milk in the diet because of the erroneous idea that milk is meant only for small children. Fruits and vegetables are often replaced by more refined and tempting articles of food. If glandular changes bear any relation to dental nutrition this is probably the period when an adequate diet should be most carefully followed. Adult Life. After the growing years, practically every one of the principles mentioned above must continue to apply if good dental nutrition is to continue. This is particularly true with the young adult as tooth decay is very prevalent during the ages of 22 and 25 years. There is a difference of opinion as to whether the adult needs to continue to take an extra supply of vitamin D. Theoretically, if an adequate

amount of sunshine is al-ways available after the growing period, the adult may make enough vitamin D to supply the body's needs, except as stated above, during the gestation and nursing periods. Adults, too frequently stop drinking milk. It is extremely difficult to supply an adequate amount of calcium and phosphorus in the diet without at least one pint of milk per day, and since no possible harm can come from the taking of more milk, a safe general rule would be to use one quart of milk daily from the cradle to the grave. Those who prefer not to use sweet milk may supply the same minerals very satisfactorily by using sour milk or cheese. Briefly summing up our knowledge of dental nutrition, we would recommend that the elements necessary in producing strong sound teeth be provided long before the child is born, and that a liberal supply of the same elements be planned for throughout life. Ample mineral foods must always be included in the diet. Special attention is necessary to insure sufficient calcium and phosphorus. Adequate vitamins must always be supplied, especially A, D, and C, to insure the most favorable states for the growth and maintenance of sound sturdy teeth.

9.1 Are dental diseases a growing problem?

Maintaining dental health Micro Application

In developed countries, dental diseases account for 5% - 10% of total health care costs, exceeding the cost of treating cardiovascular disease, cancer, and osteoporosis. Dental diseases include among other things:

caries which are cavities resulting from the action of bacteria on sugary foods, dental erosion which is the loss of hard tooth tissue (enamel anddentine) caused by acid attack, periodontal disease which refers to bacterial infections of the gums.

Despite the marked overall decline in dental caries over the past 30 years (perhaps due to exposure to an adequate amount of fluoride) the prevalence of dental caries remains unacceptably high in many developed countries. In most developing countries, the prevalence rate of dental caries is relatively low and more than 90% ofcaries are untreated. However, there has been a recent increase in the prevalence of the disease. This increase is thought to be linked to changing diets, and particularly to an increase in sugar consumption without exposure to sufficient amounts of fluoride. Overall prevalence of dental caries in children remains high. Dental erosion, which is related to diet, is a relatively new dental problem in many countries throughout the world. In some populations it is estimated that approximately 50% of children are affected. Denatal diseases have an impact on self-esteem, eating ability and nutrition. 9.2 How can diet affect dental diseases? Bacterial fermentation of dietary sugars in the mouth is responsible the loss of minerals from the teeth that can lead to the formation of caries. While the development of caries requires the presence of both sugars and bacteria, it is also influenced by the susceptibility of the tooth, the type of bacteria, and the quantity and quality of the saliva. Deficiencies of vitamins D and A have been shown to affect the natural development of the teeth, which can make them more susceptible to decay. Under nutrition, coupled with a high intake of sugars, may exacerbate the risk of caries. Whilst severe vitamin C deficiency can result in inflammation of the gums, the most important factor in preventing periodontal disease is good oral hygiene. Undernutrition increases the severity of oral infections, such as gum disease. Dental erosion can be caused by dietary acids such as those found in fruit drinks, soft drinks (including sports drinks), vinegar, citrus fruits and berries. Studies have shown that tooth enamel is softened within one hour of exposure to cola, but that this softening may be reversed by exposure to milk or cheese. 9.3 Dietary sugars and dental caries

Insulin regulates blood sugar levels Micro Application

Sugars are the most important dietary factor in the development of dental caries. Worldwide studies on human populations show an association between sugar consumption and level of dental caries. Isolated communities that consume a small amount of sugar have a very low level of this disease. Groups of people with a high exposure to sugars have a higher level. A strong correlation exists between both the amount and frequency of sugar consumption and the development of caries, even in countries that use preventative measures such as water fluoridation. In addition to solid foods, consumption of sugary drinks also increases the risk of developing dental cavities. Studies have shown that starches are generally a much lower risk factor in developing dental cariesthan sugars. However, when starches are cooked or combined with sugars, the risk is greater. As part of a normal mixed diet there is little evidence that fruit causes caries . Animal studies have shown that when fruit is consumed in very high frequencies (e.g. 17 times a day) it may induce caries. The link between dietary sugars and dental caries is supported by a large body of evidence. However, the limitations of the different types of studies should be considered when interpreting results:

Caries develop over time and therefore the dietary factors, several years previous to the appearance of caries, should be considered. Animals have different teeth than humans and therefore the results of animal studies are not always transferable to human cases. Studies sometimes measure the amount of acid produced from a food when bacteria in the mouth ferment it, in order to estimate the risk of caries, but such studies do not consider protective properties, such as effects on the flow of saliva

9.4 Dietary factors which protect against dental caries

See also our GreenFacts' Fluoride Digest

Fluoride is the most effective preventative measure against the development of dental caries. The addition of fluoride to drinking water reduces dental cariesin children by between 20% and 40%, but does not eliminate the risk of dental caries altogether. Thus, restricting consumption of sugars still has a role to play in the prevention of caries, even in situations where there is widespread use of fluoride. Excess ingestion of fluoride during enamel formation can lead to dental fluorosis, particularly in countries that have high levels of fluoride naturally present in water supplies. Certain other dietary components have been shown to have protective properties against dental caries:

Cows milk (cheese) contains calcium, phosphorus, and casein which are believed to inhibit caries. Wholegrain foods require more chewing thereby stimulating the flow of saliva and protecting against caries. Peanuts, hard cheeses, and chewing gum also stimulate salivary flow and protect against caries. Black tea extract increases fluoride concentration in tooth plaque thereby reducing the risk of developing caries linked to a diet rich in sugars.

Studies have associated breastfeeding with lower levels of dental caries in early childhood. This is likely to be due to the fact that breastfed infants consume less sugar than infants fed formula milk to which free sugars are often added. .5 How could dental diseases be prevented? The main diet-related recommendations for reducing the risk of dental diseases are:

Ensure that the intake of free sugars contributes on average less than 10% to the daily energy intake. Indeed, the occurrence of dental caries is lower in

countries where the average daily consumption of sugars is below 40-55g per person which represents 6-10% of the daily energy intake.

Restrict the frequency of consumption of foods and drinks that contain free sugars to a maximum of 4 times per day. Assure adequate exposure to fluoride to protect against caries Avoid nutrient deficiencies that can contribute to dental diseases.

DENTAL NUTRITION Nutrition and Dental Health

by J. Anderson and L. Brown 1

Quick Facts... See your dentist regularly. A well balanced diet is important for the body and subsequently the mouth's health, vitamin C is important for tissue health and calcium is important for bone health. Brush and floss teeth at least once a day -- after each meal or snack is best. In areas with low fluoride in the water, use a toothpaste or mouthwash containing fluoride. Limit foods high in simple carbohydrates or very sticky; snack wisely. Good dental health begins early in life. To prevent "nursing bottle syndrome," never allow a child to fall asleep with a bottle.

Good nutrition is essential for good physical health. Nutrition also plays a key role in the development and maintenance of a healthy mouth, especially the teeth and gums. The food we eat affects our teeth. At the same time, the health or lack of health of our teeth and gums affects what we can eat. Good dental health begins early in life and must be practiced throughout life. Tooth development begins shortly after conception, usually between the sixth and eighth weeks of gestation and continues throughout pregnancy. It seems to take severe nutritional deficiencies in the mother to cause obvious changes in tooth formation in the child. However, slight deficiencies may cause changes in tooth structure that will leave a tooth at greater risk for decay later in life. A good

diet during pregnancy is always important. However, nutrient excesses as well as nutrient deficiencies, may play a role in congenital anomalies of the mouth. Therefore, take supplements during pregnancy only on the advice of a doctor or dietitian. Up To Top
Fluoride Intake
Good nutrition is equally important during infancy, childhood and adolescence. During these growth periods, primary and permanent teeth are being mineralized. This occurs before they erupt into the mouth. Fluoride intake from birth has been shown to reduce dental caries (tooth decay) by as much as 60 percent. During tooth development, fluoride is incorporated into the tooth structure making the tooth strong and decay resistant.

Many community water supplies are fluoridated at the rate of 1 ppm (1 part per million). This rate has proven safe and effective at reducing dental caries. The normal daily intake from fluoridated water is about 1 milligram per day. When teeth are forming, an intake of more than 2 parts per million may cause fluorosis, a condition in which tooth enamel becomes toughened, mottled and discolored. However, teeth remain strong and resistant to decay. If you live in an area where drinking water has little or no fluoride, prescription fluoride drops or tablets may be prescribed by your doctor. An alternative to supplements is the daily use of fluoridated toothpaste and mouthwash. If you don't know the fluoride level of your water, contact your local water department. Up To Top
The Decay Process

Brushing after meals and snacks is one of the best ways to remove sugars and food particles from tooth surfaces. The decay process begins when the bacteria that are always present in the mouth break down components of saliva. These components adhere to tooth enamel. This is the start of dental plaque.

Dental plaque is a clear, gelatinous material that allows bacteria to remain on the teeth. If dental plaque is not removed frequently (at least once a day) by proper brushing and flossing, the plaque becomes tightly attached to the tooth and only mechanical cleaning can remove it. This is why frequent visits to a dentist and regular, thorough cleaning by a dental hygienist is very important. Inside this dental plaque, the bacteria ferment dietary carbohydrates for a food source. This fermentation produces lactic and other acids. These acids demineralize the tooth enamel. As the tooth demineralizes, bacteria move into the tooth, decay begins and a cavity is formed. Untreated dental caries are painful and can result in tooth loss. Pain or loss of teeth may cause malnutrition. These conditions often prevent a person from chewing and eating adequate amounts, as well as eating some hard, high-fiber foods. Bacteria need carbohydrates for food. By cutting back on simple carbohydrates, the rate of dental caries can be reduced. Sucrose (table sugar) is the carbohydrate bacteria prefer. However, other simple carbohydrates, such as fructose, lactose and glucose, are easy to ferment and also support bacteria growth. Up To Top Simple sugars are found in many foods and have many names. Some of these are table sugar, corn syrup, honey, molasses and dextrose. By reading labels on food products, you can limit foods high in simple sugars and thus reduce the chance of dental caries. Bacteria also can ferment complex carbohydrates (starches), but the process takes longer. However, many complex carbohydrates are sticky and become lodged between teeth and gums. This allows the bacteria time to ferment the carbohydrate. Meats and foods high in fiber, such as fresh fruits and vegetables, help clean the teeth of food particles and sugars during the chewing process. These foods promote saliva flow, which helps rinse the teeth of food particles. Saliva also neutralizes the acid. Although fresh fruits and vegetables do contain carbohydrates that

can be fermented by bacteria, the fiber content counteracts the effect and helps clean the teeth, therefore protecting against dental caries. When we eat, we provide food for mouth bacteria. Eating three meals a day is important for adequate energy and nutrient intake, but snacking between meals presents special dental health problems. The snacks most people enjoy tend to be high in simple sugars (examples might be dried fruits such as raisins, sweet rolls, candy bars, pop or caramel corn). Snacking does not need to be completely omitted. In many situations, snacking is important for good physical health. This is especially true for young and growing children who need the calories and nutrients from snacks for proper growth. Choose snacks that do not harm teeth. Such snacks also tend to be more nutritious. Good snacks include cheese, yogurt, meats, plain nuts (not recommended for children younger than school age), peanut butter, fresh fruits and vegetables, unsweetened breads or cereals, and popcorn. Decay Potential of Certain Foods High Potential for Decay Dried fruits Hard and soft candy Cake, cookies, pie Crackers Chips Moderate Potential For Decay Fruit juice Sweetened, canned fruit Soft drinks Breads Low Potential for Decay Raw vegetables

Raw fruits Milk No Potential for Decay Meat, fish, poultry Fats, oils Ability to Stop Decay Cheeses Xylitol Nuts
Diet and Behavior Dilemma, Clinical Preventive Dentistry Leadership Conference, Dr. Palmer. 2/04

Acidic content of foods: Approximate pH of Foods and Food products Up To Top

Nursing Bottle Syndrome

One preventable dental problem that affects young children is "nursing bottle syndrome." It is characterized by rapid decay of the primary upper teeth and some of the lower back molars. The lower front teeth are seldom affected. This condition develops when a child is given a bottle that contains a carbohydrate liquid or a sweet pacifier at bed or nap time. While the child is awake and sucking, saliva flow helps wash sugars away from teeth. As the child falls asleep sucking and saliva flow decreases, the sugars in the liquid pool around the teeth and provide an excellent feeding ground for bacteria. Painful decay results from this practice. If left untreated, infections and abscesses are possible. Premature loss of upper teeth may lead to the child developing poor "tongue-thrust." This could cause poor alignment of permanent teeth and future orthodontic and speech problems. All of these problems can be avoided by never allowing a child to fall asleep with a bottle.

Up To Top
References
1. Nutrition: Principles and Application in Health

Promotion. Carol West Suitor and Merrily Forbes Hunter, J.B. Lippincott Co., 1980. 2. Nutrition: Concepts and Controversies. Eva May Nunnelley Hamilton and Eleanor Noss Whitney, West Publishing Co., 1979.
3. Diet, Nutrition and Dentistry. Patricia M. Randolph

and Carol I. Dennison, C.V. Mosby Co., 1981.