Dietary advice for caries

Question 1

What is the salivary pellicle?

Answer 1

thin glycoprotein layer that forms on the tooth surface after brushing, precipitated from saliva

acts as buffer

Question 2

What happens to the salivary pellicle after a few hours?

Answer 2

specific bacteria begin to colonise

coccal bacteria dominate

over time, they develop into cocci, rods and filaments

Question 3

What specific sites does plaque tend to accumulate?

Answer 3

pits and fissures of molars and premolars

approximal surfaces

margins of restorations

Question 4

What allows bacteria to stick together and the tooth to then form plaque?

Answer 4

sticky extracellular polysaccharide

Question 5

If the plaque is thickened, what does this then prevent?

Answer 5

saliva from neutralising acid

contributes to enamel demineralisation and increases caries risk

Question 6

How does enamel appear in the early lesion?

Answer 6

frosty, chalky surface

Question 7

What is the difference between intrinsic and extrinsic sugars?

Answer 7

intrinsic - natural in plant food

extrinsic - sugars added to food

Question 8

What are some commonly prescribed liquid medications?

Answer 8

lactulose

ensure

amoxicillin

fortisip

morphine sulfate

gaviscon

oramorph

paracetamol

• these medications may contain sugars

Question 9

What are some high-risk caries groups?

Answer 9

early childhood

medically, physically, and chronically ill patients

socially deprived individuals

language and cultural barriers

Question 10

What are some causes of reduced salivary flow?

Answer 10

xerostomia

polypharmacy

sjogren’s syndrome

radiation therapy

atrophy of salivary glands

Question 11

What does the toolkit advise about diet?

Answer 11

confectionary should be consumed only at mealtimes

only milk or water should be given to children in a feeder cup

reduce soft drinks - only at meal times, use a straw

avoid honey or jam

no sugar-sweetened drinks at bedtime - only water

Question 12

How should sugar intake be modified?

Answer 12

reduced to 4x a day

restrict sugary foods to meal times only

non-sugar sweeteners

consume non-cariogenic snacks

Question 13

What are some sources of non-milk extrinsic sugars?

Answer 13

confectionary

cakes, biscuits etc

table sugar

breakfast cereals

fresh fruit juices

dried fruit

soft drinks

hidden sugars in processed foods and savoury foods

Question 14

What are the general key messages from the toolkit?

Answer 14

toothbrush with fluoride

diet and healthy eating advice

sugar-free medicines

improving periodontal health

smoking cessation

alcohol misuse prevention

erosion prevention

behavioural changes

Question 15

What is used to develop management strategies?

Answer 15

oral health toolkit (DBOH)

NICE guidelines for dental recall

Faculty of general dental practitioners selection criteria for dental radiography

Question 16

What are some high risk indicators?

Answer 16

siblings with caries

carious lesion in primary dentition

early childhood caries

toddler with night-time bottle

Question 17

How often should fluoride varnish be applied?

Answer 17

4 months

Question 18

What are some recommended fluoride varnishes?

Answer 18

duraphat

molotte

Question 19

Why are beaker cups recommended?

Answer 19

to reduce prolonged exposure to sugary liquids

as bottles tend to cause pooling effect where liquid is trapped around teeth - increasing risk of caries

Question 20

What does Stephan curve show?

Answer 20

how plaque acids, formed from bacterial metabolism of sugars, cause pH drop in mouth

leading to enamel demineralisation

it takes 40 mins for mouth’s pH to return to normal - during this period, enamel is vulnerable to demineralisation