Norman Tinanoff DDS, MS Department of Pediatric Dentistry Dental School, University of Maryland
Carol A. Palmer EdD, RD Department of General Dentistry Tufts University School of Dental Medicine
Key Words: dental caries, preschool children, diet, recommendations, nutrition, education Correspondenceto: Norman Tinanoff Department of Pediatric Dentistry 666 W. Baltimore St., Room 3 E 10 Dental School, University of Maryland Baltimore, MD 21201 410 706 7970 firstname.lastname@example.org
ABSTRACT Objectives: The purpose of this review, commissioned by the Administration for Children and
Families, the Health Resources and Services Administration, the Health Care Financing Administration,and the Department of Agriculture’s Food and Nutrition Service, was to update the evidence of the dietary factors that affect dental caries, and subsequently formulate dietary recommendations for preschool children based on principles of cariology. Methods: Literature on the dental caries process, dietary factors affecting dental caries initiation and progression, nutrition education and counselingwere reviewed and synthesized. Dietary guidelines for children at various ages were then constructed based on the review. Results: Dental caries in preschool children is due to a combination of factors, including colonization of teeth with cariogenic bacteria, type of foods and frequency of exposure of these foods to the cariogenic bacteria, and susceptible teeth. Caries risk is greatest ifsugars are consumed at high frequency and are in a form that is retained in the mouth for long periods. Sucrose is the most cariogenic sugar because it can form glucan that enables firm bacterial adhesion to teeth and limits diffusion of acid and buffers in the plaque. There is emerging interest in the effects of tooth development and its role in the future dental caries risk of the child. Conclusions:Nutrition education and counseling for the purposes of reducing caries in children is aimed at teaching parents the importance of reducing high frequency exposures to obvious and hidden sugars. Guidelines include: avoiding frequent consumption of juice or other sugar containing drinks in bottle or sippy cup; discouraging the behavior of a child sleeping with a bottle; promoting non-cariogenicfoods for snacks; fostering eating patterns consistent with Food Guide Pyramid; limiting cariogenic foods to mealtimes; rapidly clearing cariogenic foods from the child’s oral cavity either by tooth brushing or by consumption of protective foods; and restricting sugar containing snacks that are slowly eaten (e.g., candy, cough drops, lollipops, suckers). Along with nutritional factors, acomprehensive approach to preventing dental caries in preschool children must include improved general dietary habits, good oral hygiene, appropriate use of fluorides, and access to preventive and restorative dental care.
The Dental Caries Process The assertion that diet plays a central role in the development of dental caries is unquestionable. Observations in humans, in animals and in vitro haveclearly shown that frequent and prolonged oral exposure to certain carbohydrates are fundamental to caries activity. The mechanism by which diet affects dental caries is rather simple. The bacteria attached to teeth, the so-called dental plaque, utilize mono and di-saccharides (e.g., glucose, fructose, sucrose) in their glycolytic pathways to produce energy, and acid is a byproduct of thismetabolism. Consequently, the acidity of dental plaque may fall to a point where the demineralization of the tooth ensues. The rate of demineralization is dependent upon the absolute pH decrease, as well as the length of time that the pH is below a level that fosters dissolution of enamel. The “critical pH” value for demineralization varies among individuals, but is in the approximate range of 5.2 to 5.5...