Search

Background and Overview: Dental erosion occurs after exposure to intrinsic or extrinsic acids. Exposure to intrinsic gastrointestinal acids is associated with anorexia nervosa, bulimia nervosa, rumination syndrome, or gastroesophageal reflux. Extrinsic dietary acids from foods or beverages also can cause erosion, particularly when exposure is prolonged by holding or swishing behaviors., Conclusions: Clinicians should screen patients exhibiting dental erosion for anorexia nervosa, bulimia nervosa, rumination syndrome, and gastroesophageal reflux disease. Clinicians should screen patients without a medical explanation for their erosion for exposure to acidic foods and beverages, particularly for habits that prolong exposure., Practical Implications: Identification of intrinsic and extrinsic acid exposures and recommendations to minimize exposures are important to prevent erosion and maintain oral health., (Copyright © 2018 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background and Overview: The World Health Organization has recommended a reduction in free sugars intake throughout one's life span to decrease the burden of noncommunicable diseases, including caries and obesity. The author defines sugars' nomenclature, describes sugars' roles in food, and identifies current sugars intake., Conclusions: The oral health care practitioner can identify added sugars intake and provide guidance to patients to decrease their intake of added sugars while improving nutrient intake and reducing caries risk., Practical Implications: Intake of added sugars increases the burden of chronic diseases in the United States. The oral health care practitioner is in a position to provide dietary guidance to patients to reduce both oral and systemic diseases., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: The results of several studies conducted in the United States show no association between intake of 100 percent fruit juice and early childhood caries (ECC). The authors examined this association according to poverty and race/ethnicity among U.S. preschool children., Methods: The authors analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) for 2,290 children aged 2 through 5 years. They used logistic models for caries (yes or no) to assess the association between caries and intake of 100 percent fruit juice, defined as consumption (yes or no), ounces (categories) consumed in the previous 24 hours or usual intake (by means of a statistical method from the National Cancer Institute)., Results: The association between caries and consumption of 100 percent fruit juice (yes or no) was not statistically significant in an unadjusted logistic model (odds ratio [OR], 0.76; 95 percent confidence interval [CI], 0.57-1.01), and it remained nonsignificant after covariate adjustment (OR, 0.89; 95 percent CI, 0.63-1.24). Similarly, models in which we evaluated categorical consumption of 100 percent juice (that is, 0 oz; > 0 and ≤ 6 oz; and > 6 oz), unadjusted and adjusted by covariates, did not indicate an association with ECC., Conclusions: Our study findings are consistent with those of other studies that show consumption of 100 percent fruit juice is not associated with ECC.

Background: Dietary intake of sugar-sweetened beverages (SSBs) has increased during the past 30 years, and SSB intake is associated with caries., Conclusions: SSBs vary in the quantity and nature of sugars they contain; however, all of the sugars are fermentable by oral bacteria and potentially cariogenic., Practical Implications: Oral health care practitioners should assess patients' SSB intakes by asking questions regarding the quantity, frequency and duration of SSB intake. In response to individual behaviors, practitioners should tailor recommendations when providing anticipatory guidance to help patients decrease their exposure to SSBs for caries prevention. In light of the association between SSB intake and caries risk, as well as the increased consumption of SSBs, all dental practices should assess patients' SSBs intake.

Background: The U.S. Department of Agriculture developed Dietary Guidelines for Americans, 2010, by taking into consideration evidence-based nutritional science, changes in the food supply and environmental influences., Conclusions: The 2010 guidelines emphasize the importance of maintaining caloric balance to support a healthy weight and selecting nutrient-dense foods and beverages to ensure adequate nutrient intakes. Americans' compliance with previous dietary guidelines has been poor, and the 2010 guidelines acknowledge the need for collaboration among individuals, the community, government and industry to ensure consumers' access to and acceptance of appropriate foods., Clinical Implications: As part of the greater community, the oral health practitioner will find that familiarity with the 2010 guidelines will enable him or her to assist patients in making better food choices for oral and systemic health.

Objectives: The authors describe associations between dental fluorosis and fluoride intakes, with an emphasis on intake from fluoride in infant formula., Methods: The authors administered periodic questionnaires to parents to assess children's early fluoride intake sources from beverages, selected foods, dentifrice and supplements. They later assessed relationships between fluorosis of the permanent maxillary incisors and fluoride intake from beverages and other sources, both for individual time points and cumulatively using area-under-the-curve (AUC) estimates. The authors determined effects associated with fluoride in reconstituted powdered infant formulas, along with risks associated with intake of fluoride from dentifrice and other sources., Results: Considering only fluoride intake from ages 3 to 9 months, the authors found that participants with fluorosis (97 percent of which was mild) had significantly greater cumulative fluoride intake (AUC) from reconstituted powdered infant formula and other beverages with added water than did those without fluorosis. Considering only intake from ages 16 to 36 months, participants with fluorosis had significantly higher fluoride intake from water by itself and dentifrice than did those without fluorosis. In a model combining both the 3- to 9-months and 16- to 36-months age groups, the significant variables were fluoride intake from reconstituted powder concentrate formula (by participants at ages 3-9 months), other beverages with added water (also by participants at ages 3-9 months) and dentifrice (by participants at ages 16-36 months)., Conclusions: Greater fluoride intakes from reconstituted powdered formulas (when participants were aged 3-9 months) and other water-added beverages (when participants were aged 3-9 months) increased fluorosis risk, as did higher dentifrice intake by participants when aged 16 to 36 months., Clinical Implications: Results suggest that prevalence of mild dental fluorosis could be reduced by avoiding ingestion of large quantities of fluoride from reconstituted powdered concentrate infant formula and fluoridated dentifrice.

Background: Exposure to acidic foods and beverages is thought to increase the risk of developing dental erosion. The authors hypothesized that the erosion potential of sour candies was greater than the erosion potential of original-flavor versions of the candies., Methods: The authors measured the pH and titratable acidity of candies dissolved in artificial saliva or water. They then measured the lesion depths of enamel surfaces exposed to candy slurries for 25 hours. Statistical analyses included two-sample t tests and Wilcoxon rank-sum tests to identify differences between original-flavor and sour candies, as well as correlations to identify relationships between lesion depths, pH and titratable acidity., Results: The study results show that lesion depths generally were greater after exposure of enamel to sour candies than they were after exposure of enamel to original-flavor candies, as well as for candies dissolved in water compared with those dissolved in artificial saliva. Lesion depths were negatively associated with the initial slurry pH and positively associated with titratable acidity., Conclusions: Both original-flavor and sour versions of candies are potentially erosive, with sour candies being of greater concern. Although saliva might protect against the erosive effects of original-flavor candies, it is much less likely to protect against the erosive effects of sour candies., Clinical Implications: People at risk of developing candy-associated erosion, particularly those with a high intake of candy, pocketing behaviors or decreased salivary flow, should receive preventive guidance regarding candy-consuming habits.

Background: A dietary habit assessment should be an integral component of oral health care. The author outlines strategies that oral health care professionals can use to assess dietary habits associated with caries risk and to develop dietary recommendations., Conclusion: A caries risk assessment tool can be used to identify dietary habits that may contribute to caries risk., Practical Implications: The caries risk assessment tool can provide structure for evaluating patients' dietary habits and food choices and helping oral care health professionals provide preventive dietary recommendations.

Background: The authors conducted a study to test the hypothesis that high consumption of soft drinks, relative to milk and 100 percent fruit juice, is a risk factor for dental caries in low-income African-American children in Detroit., Methods: Trained dentists and interviewers examined a representative sample of 369 children, aged 3 to 5 years, in 2002-2003 and again two years later. The authors used the 2000 Block Kids Food Frequency Questionnaire (NutritionQuest, Berkeley, Calif.) to collect dietary information. They assessed caries by using the International Caries Detection and Assessment System., Results: Soft drinks, 100 percent fruit juice and milk represented the sugared beverages consumed by the cohort. A cluster analysis of the relative proportion of each drink at baseline and follow-up revealed four consumption patterns. Using zero-inflated negative binomial models, the authors found that children who changed from being low consumers of soft drinks at baseline to high consumers after two years had a 1.75 times higher mean number of new decayed, missing and filled tooth surfaces compared with low consumers of soft drinks at both time points., Conclusion: Children who consumed more soft drinks, relative to milk and 100 percent fruit juice, as they grew older were at a greater risk of developing dental caries., Clinical Implications: Health promotion programs and health care providers should emphasize to patients and caregivers the caries risk associated with consumption of soft drinks.

Background: Methamphetamine users are reported to have marginal dietary habits and high caries rates. The authors compared retrospective dietary patterns, oral hygiene behaviors and current oral health status of methamphetamine users and nonusers in a pilot study., Methods: Eighteen adults with a history of methamphetamine use (methamphetamine users) and 18 age- and sex-matched control subjects (nonusers) completed retrospective questionnaires concerning meal patterns, food group intakes, beverage habits, oral hygiene behaviors, smoking behaviors and drug use. The authors performed oral examinations to identify the number of remaining teeth, the number of teeth with obvious decay and presence of visible plaque., Results: Methamphetamine users were more likely to snack without eating defined meals (P = .026), consume regular soda pop (that is, carbonated beverage with sugar) (P = .018), never brush their teeth (P < .001) and smoke (P < .001) than were nonusers. Users had more visible plaque (P < .001), fewer molars (P = .001) and more decay on anterior teeth (P < .001), premolars (P < .001) and molars (P < .001) than did nonusers., Conclusions: The results of this pilot study are consistent with anecdotal reports; methamphetamine users have more gross caries than do nonusers. Marginal dietary and oral hygiene behaviors associated with methamphetamine use likely increase caries risk., Clinical Implications: Patients at risk or suspected of using methamphetamine require detailed oral hygiene instruction and extensive dietary counseling.

Background: Calcium in acidic beverages can decrease a person's risk of experiencing dental erosion. The authors compared the pHs and titratable acidities of commercially available calcium-fortified and unfortified 100 percent juices, and enamel and root surface lesion depths after they were exposed to different juices., Methods: The authors measured the pH and titratable acidity of calcium-fortified and unfortified 100 percent juices. They exposed enamel and root surfaces to different 100 percent juices for 25 hours and measured lesion depths. They used the Spearman rank correlation test and the two-sample t test to identify associations between the juices' properties and lesion depths and to compare lesion depths between fortified and unfortified juices., Results: The authors found that fortifying apple, orange and grapefruit juices with calcium prevented enamel erosion and decreased root surface erosion (P < .01). They also found that fortifying white grape juice with calcium decreased enamel erosion (P < .001) but not root surface erosion. They observed that mean lesion depths were greater in root surfaces than in enamel surfaces after exposure to unfortified orange juice and all fortified juices (P < .001)., Conclusions: Calcium concentrations in commercially available, calcium-fortified 100 percent juices are sufficient to decrease and prevent erosion associated with extended exposure to a beverage., Clinical Implications: People at risk of experiencing erosion could decrease their erosion risk by consuming calcium-fortified juices.

Background: Relationships among sugars and dental caries in contemporary societies are unclear. The authors describe young children's intakes of nonmilk extrinsic (NME) and intrinsic/milk sugars and relate those intakes to dental caries., Methods: The authors conducted cross-sectional analyses of dietary data collected from the Iowa Fluoride Study using three-day diaries for subjects at ages 1, 2, 3, 4 and 5 years and for subjects aged 1 through 5 years according to dental caries experience at 4.5 to 6.9 years of age. They categorized foods and beverages as containing NME or intrinsic/milk sugars., Results: Subjects' total, NME, food NME and intrinsic/milk sugars intakes at ages studied did not differ between subjects with and without caries experience. Beverage NME sugars intakes at age 3 years predicted caries (P < .05) in logistic regression models adjusted for age at dental examination and for fluoride intake., Conclusions: Dental caries is a complex, multifactorial disease process dependent on the presence of oral bacteria, a fermentable carbohydrate substrate and host enamel. A simple NME-intrinsic/milk sugars categorization appears insufficient to capture the complex dietary component of the caries process., Clinical Implications: Cariogenicity is more likely a function of the food and/or beverage vehicle delivering the sugar and the nature of exposure-that is, frequency and length of eating events-than of the sugar's categorization.

Background: Diet- and nutrition-related diseases influence oral health. The U.S. government recently revisited the dietary guidelines for health promotion and chronic disease prevention. The purpose of this article is to review the new recommendations., Conclusions: The Dietary Reference Intakes are designed to identify nutrient intakes required to maintain health in people of a given age and sex. The Dietary Guidelines for Americans are designed to promote healthy dietary and activity habits. MyPyramid is designed to identify individual dietary patterns to ensure adequate nutrient intakes within energy needs., Clinical Implications: Familiarization with the new dietary guidelines will enable dental practitioners to develop diet-related oral health recommendations that are consistent with disease prevention.

Background: As a result of the introduction of multiple fluoride vehicles and other preventive agents, caries prevalence rates in young children have been declining over the past two decades in the United States. However, changing dietary patterns in young children may offset some of the oral health benefits of fluoridation. The objective of this study was to examine the relationship between caries in primary teeth and healthful eating practices in young children., Methods: The authors used data from the third National Health and Nutrition Examination Survey to investigate the relationship between healthful eating practices (such as breast-feeding, eating breakfast and consuming five servings of fruits and vegetables a day) and dental caries (untreated tooth decay and overall caries experience) in the primary dentition among children aged 2 through 5 years., Results: The odds of experiencing caries in primary teeth were significantly greater in nonpoor children who did not eat breakfast daily or ate fewer than five servings of fruit and vegetables per day (odds ratio, or OR = 3.77; 95 percent confidence interval, or CI, 1.80 to 7.89 and OR = 3.21; 95 percent CI, 1.74 to 5.95, respectively). No association was found between breast-feeding and caries in primary teeth., Conclusion: Young children with poor eating habits are more likely to experience caries. Overall, the findings support the notion that dental health education should encourage parents, primary caregivers and policy-makers to promote healthful eating practices, such as eating breakfast daily, for young children., Practice Implications: Dental professionals are well-positioned to inform parents and caregivers regarding age-appropriate healthful eating practices for young children entrusted in their care.

Background: Limited food choices and inadequate nutrient intake are linked to poor oral health. The authors describe relationships between dietary variety, nutrient intake and oral health measures in community-dwelling, rural Iowans aged 79 years and older., Methods: Dental examinations were conducted by trained and calibrated examiners, and trained interviewers completed standardized interviews in subjects' homes. Subjects (n = 220) then completed three-day dietary records. Adequate nutrient intakes were defined using the Dietary Reference Intakes of the Food and Nutrition Board of the National Academy of Sciences., Results: Mean daily nutrient intakes were significantly lower in subjects who had fewer natural or functional teeth and ill-fitting mandibular dentures than in subjects who had more teeth or did not have these problems. Adequacy of intakes was lower in subjects who had fewer natural or functional teeth and ill-fitting mandibular dentures. Mean daily nutrient intakes did not differ between subjects with well-fitting dentures (either complete or partial) and subjects with natural teeth. Neither mean daily intake nor adequacy of intake was associated with subjects' perceptions of oral health problems, chewing difficulties or temperature sensitivity., Conclusions: The presence of natural teeth and well-fitting dentures were associated with higher and more varied nutrient intakes and greater dietary quality in the oldest old Iowans sampled. Clinical Implications. Maintenance of natural dentition or provision and maintenance of adequate mandibular prostheses are important for nutrient intakes to support systemic health.