Role Of Sugars And Nutrition In Dental Caries

Introduction

A dynamic relation exists between sugars and oral health. Diet affects the integrity of the teeth; quantity, pH, and composition of the saliva; . Sugars and other fermentable carbohydrates, after being hydrolyzed by salivary amylase, provide substrate for the actions of oral bacteria, which in turn lower salivary pH. The resultant action is the beginning of tooth demineralization.

Many factors in addition to sugars affect the caries process, including

the form of food or fluidthe duration of exposure nutrient composition sequence of eating salivary flow presence of buffers and oral hygiene.

According to the American Dietetic Association(2):

1- “nutrition is an integral component of oral health.

2- diet and nutrition are major multifactorial environmental factors in the etiology and pathogenesis of craniofacial diseases.

Relation between diet and caries(Miller’s chemoparasitic theory)(3)

Dental caries was first described in Miller’s chemoparasitic theory in 1890 . Caries is caused by the dissolution of the teeth by acid produced by the metabolism of dietary carbohydrates by oral bacteria. The primary bacteria involved in caries formation are mutans streptococci and lactobacilli. In the 1960s the caries theory was depicted as circles for dental caries: the tooth, the diet, and dental plaque (Figure 1) (4)

Since then, many modifying factors have been recognized, resulting in a more complex model that includes saliva, the immune system, time, socioeconomic status, level of education, lifestyle behaviors, and the use of fluorides. Sugars and dental caries The caries process can be described as loss of mineral (demineralization) when the pH drops below the critical pH value of 5.5; the critical value for enamel dissolution is 5, and an average pH of 5.5 is the generally accepted value. Redisposition of mineral (remineralization) occurs when the pH rises. The presence of fluoride reduces the critical pH by 0.5 pH units, thus exerting its protective effect.

Diet and nutrition may interfere with the balance of tooth demineralization and remineralization in several ways. The diet provides sugars and other fermentable carbohydrates, which are metabolized to acids by plaque bacteria (Figure 2). The resultant low pH favors the growth of the bacteria (mutans streptococci). In contrast, a diet lower in added sugars and fermentable carbohydrates and high in calcium-rich cheese may favor remineralization.

The anticariogenic effect of cheese:

Mechanisms proposed to explain the anticariogeniceffects of cheeses are as follows: 1-increased salivary flow and the subsequent buffering

effect, which can neutralize plaque acids;

2-inhibition of plaque bacteria and the effect of that

inhibition on reducing the amount of bacteria, thereby reducing acid

production; 3-intake of increased alkaline substances, calcium,

inorganic phosphate, and casein, which decrease demineralization and enhance remineralization (6)

What do we mean by sugar?

When we say “sugar”, we usually mean granulated Table sugar. However there are so many kinds of sugars these days, we need to be very clear the word “sugar” includes these things ending in “ose”:

1. Sucrose (Table sugar) a simple sugar made from cane sugar or beets. 2. Fructose, a simple sugar in fruits, plants and honey. 3. Maltose, a complex sugar in barley and malt syrups. 4. Lactose, a complex sugar in milk. 5. Dextrose, a refined simple sugar from corn, sugar cane or beets. 6. Glucose, a simple sugar in fruits, vegetables

The influence of fluoride on the sugars–caries relationship(7)1-reduces and inhibits demineralization.2- remineralisation of enamel .3-affects plaque :by inhibiting bacterial

metabolism of sugar thus reducing acid production.

Factors that affecting the food cariogenicity (8)

1-types of carbohydrate2-physical form of food retention and oral

clearance time 3-factor in the diet that protect against dental

caries 4-intake frequency5-nature of diet

1-types of carbohydrateCLASSIFICATION OF SUGARS FOR DENTAL HEALTH PURPOSES

sugars

Monosaccharide: naturally

found in fruit ,vegetable

and honey

Glucose Fructose

Disaccharide :

Sucrose

found in sugar cane and

sugar beets

Lactose

found in milk

Maltose

delivered from hydrolysis of starch

Polysaccharide

starch

Potatoes peas

and rice

dextrin glycogen

2-physical form of food retention and oral clearance time

Forms of sugars and starch in the dietSugars are a form of fermentable

carbohydrate. Fermentable carbohydrates are carbohydrates (sugars and starch) that begin digestion in the oral cavity via salivary amylase.

diet in 2 forms: those found naturally in foods (e.g., fruit, honey, and those that are added to foods during processing to alter the flavor, taste, or texture of the food (9)

food retention

Prolonged oral retention of cariogenic components of food may lead to extended periods of acid production and demineralization and to shortened periods of remineralization. Retentiveness of foods is not the same as stickiness. A caramel or jellybean may be sticky, but its retentive properties are fairly low and they are cleared from the oral cavity faster than are retentive foods such as cookies or chips .

anticariogenic sugars

1-PolyphenolsPolyphenols such as tannins in cocoa, coffee, tea,

and many fruit juices may reduce the cariogenic potential of foods.

 2-Sugar alcohol–based productsSugar-free gums can stimulate saliva, increasing

the clearance of sugars and other fermentable carbohydrates from the teeth and the oral cavity and increasing buffer capacity. Tooth-friendly polyols include sorbitol, xylitol, mannitol, erythritol, and isomalt.

2-People with increased frequency of eating because of a medical problem, e.g., gastrointestinal disease, eating disorders, uncontrolled diabetes.

3-Those with an increased carbohydrate intake due to a medical problem e.g., Crohn’s disease, chronic renal failure, or other chronic illness, malnutrition

4-Those with reduced salivary secretion. Sjogren’s syndrome, irradiation in the region of the salivary glands.