Dietary advice - Dr Al-Ani

Question 1

What are the important factors in caries control

Answer 1

• Plaque control
• Use of fluoride
• Dietary modification

Question 2

What factors may place a patient at high risk for caries

Answer 2

• High sugar intake
• Inadequate brushing habits
• No fluoride exposure
• Irregular dental attendee
• Medically compromised
• Xerostomia

Question 3

What investigations should be caried out for a patient with xerostomia

Answer 3

• Diet analysis
• Investigation on fluoride intake
• Medical history
• Oral hygiene practices
• Bitewing radiographs

Question 4

What dietary factors are associated with caries

Answer 4

• Amount of fermentable carbohydrate eaten
• Sugar concentration of food
• Physical form of carbohydrate
• Oral retentiveness
• Frequency of eating meals and snacks
• Length of interval between eating
• Sequence of food consumption

Question 5

What is the Vipeholm study

Answer 5

• The consumption of sugary foods is
  associated with a higher caries incidence
• Increasing the frequency of sugar intake
  also increases caries incidence
• Lowering sugar intake reduces caries
  incidence
• Consumption of sticky sugar-containing
  between meal products can be associated
  with high caries risk

Question 6

What sugars are investigated in the Turku study

Answer 6

Sucrose
Xylitol

Question 7

What did the Turku study show

Answer 7

The results show a profound
difference in caries rate
between the two groups
The findings clearly indicate a
therapeutic, caries inhibitory
effect of xylitol

Question 8

What is the Stephan Curve

Answer 8

The Stephan Curve is a graph that shows what happens after the
consumption of sugar in relation to dental caries

Question 9

How much pf our total energy consuption should consist of free sugars according to WHO

Answer 9

No more than 10%
50g per day

Question 10

What are some carbohydrates can cause caries

Answer 10

• Sucrose
• Fructose
• Glucose
• Maltose

Question 11

What are some foods with a very high hidden sigar content

Answer 11

baked beans
breakfast cereals
tomato ketchup
plain biscuits

Question 12

What should dietary advice be

Answer 12

Acceptable, Practical
and Affordable

Question 13

What advice could you give to someone to reduce the risk of caries

Answer 13

• Reduce snacks containing sugar; replace it with healthy snacks
• Avoid adding sugar (consider using sugar substitutes); look for ‘hidden
  sugars’ on food labels
• Best time to do have fruit drinks when saliva flow is highest at meal-times
• Save sweets to as special time of the week, eg Saturday morning
• Eat sweet all in one rather than spreading them out
• Only drink plain milk or plain water between meals
• Don’t eat or drink after brushing at night
• Increase the amount of fresh fruit and vegetable
• Avoid food within 20 minutes of bedtime

Question 14

How long does damage to teeth occur after eating sugary food

Answer 14

Up to one hour after intake

Question 15

What does the prevention and management of dental caries on children programme state

Answer 15

• Give dietary advice at least
  once a year
• Advise or remind the
  child/parent/carer about how a
  healthy diet can help prevent
  caries
• Limit consumption of sugar
  containing food and drink
• Snack on healthier foods which
  are low in sugar, such as fresh
  fruit, carrots, peppers,
  breadsticks, oatcakes and
  occasionally a small amount of
  lower fat cheese
• Do not place sugary
  drinks, fruit juices,
  sweetened milk or soy
  formula milk in feeding
  bottles or pacifiers
• Do not eat or drink, apart
  from tap water, after
  brushing at night
• Be aware of hidden sugars
  in food and of the acid
  content of drinks

Question 16

What causes dental erosion

Answer 16

Chronic exposure of dental hard tissues to acidic substances which can be extrinsic or intrinsic

Question 17

What causes extrinsic erosion

Answer 17

Extrinsic erosion is caused by acid
originating outside the body (for example
in drinks). Generally the acid strength
will be pH 2.5 or weaker

Question 18

What causes intrinsic erosion

Answer 18

Intrinsic erosion is due to stomach acid
reaching the teeth, with a pH of 1. This
acid is typically 100 times stronger than
in extrinsic erosion, and so much more
destructive

Question 19

What is titratable acidity

Answer 19

Reflects the number of hydrogen ions available for erosive attack, rather than pH

Question 20

Which has a more erosive potential
-Coke
-Grapefruit juice

Answer 20

Grapefruit juice as it’s TA (titratable acidity is much hight (9) than coke (2)

Question 21

What is the worst acid for teeth

Answer 21

Citric acid

Question 22

How can simulation salivary flow after meals be beneficial

Answer 22

Saliva acts as buffer and removes harmful acids after eating

Question 23

What should you finish a meal with

Answer 23

Milk or cheese

Question 24

What teeth are exceptions to the erosion in order of eruption

Answer 24

Lower primary incisors
* the position of the submandibular ducts
that open adjacent to these teeth
* the position of the tongue in suckling,
which covers the lower incisors

Question 25

What is the patern of teeth erosion

Answer 25

Teeth become carious in the order in which they erupt

Question 26

What should the advice be to parents about night time feeding

Answer 26

Only water should be given during the night after 12 months of age

Question 27

What additional factors make the upper primary incisors more predisposed to caries?

Answer 27

* High bow-shaped upper lip in infants which does not cover the upper incisors and results in an increased evaporation of any saliva on these teeth * Gravity, which keeps submandibular saliva pooled around the lower incisors and less likely to reach the upper incisors * Any liquid with sugar that is allowed to bathe the teeth on a frequent basis will cause caries. This is especially so at night when the protective function of saliva reduces as less saliva is produced * Even breast milk, formula milk or cows' milk with their lowered natural sugars can still be cariogenic on this basis * In some situations maxillary incisors may erupt with hypoplastic or hypomineralized defects, thus making the teeth less resistant to the development of dental caries