Oral health is related to diet in many ways, for example, nutrition influences craniofacial development, oral cancer and oral infectious diseases. There is a need to understand the relationships between nutrition and oral health and apply this knowledge to improve personal care.
Good nutrition is essential to the initial growth and development of oral tissues. Malnutrition during periods of tooth development can have irreversible effects on the developing oral structures. In humans, enamel hypoplasia can result. Nutritional deficiencies can impair tissue regeneration and healing and can increase susceptibility to oral infections.
The elderly are particularly susceptible to malnutrition. Sensory function decreases leading to impaired taste and smell. Changes in the gastrointestinal system can affect the ability to digest, absorb and utilize food properly. Functional problems, such as arthritis or vision difficulties can affect the ability to prepare and eat food. Psychosocial problems such as loneliness, depression, lack of money and poor access to food can all undermine good eating habits. Nutrition is an important contributor to oral status in the elderly. Low calcium intake throughout life has been shown to contribute to osteoporosis. In turn, osteoporosis is thought to be an important contributing factor to the resorption of alveolar bone, which ultimately results in tooth loss.
The nutritional concepts that apply to preventing infection and enhancing wound healing apply to the prevention and management of periodontal disease. These include the need for adequate protein, calories, vitamin C, iron and zinc. Even with a healthy periodontium, there is continual need for nutrients to maintain the tissues. The relationship between malnutrition and infection is a close one, with infection aggravating malnutrition and malnutrition abetting infection. Along with the increased metabolic needs of infection, additional demands by the tissue cells attempting to maintain and repair damaged areas; result in a greater requirement for all nutrients.
The relationship between consumption of sugars and dental caries has been well established. People with very low sugar intakes tend to have low caries. The amount of sugars consumed may not be the primary dietary factor associated with caries development. Other food factors that may hinder or enhance caries development include: The frequency of eating, the physical form of the carbohydrate (liquid vs.solid); Retentiveness of a food on the tooth surface; The sequence in which foods are consumed (e.g., cheese eaten before a sweet food limits the pH drop), and The presence of minerals in a food. Frequent between-meal snacking on sugar or processed starch- containing foods increases plaque formation and extends the length of time that bacterial acid production can occur.
One snack between meals is probably not harmful since there will be time for remineralization; however, snacking many times throughout the day keeps the plaque pH low and extends the time for enamel demineralization to occur. Bacterial fermentation of simple sugars can continue as long as the sugars are in contact with dental plaque on enamel surfaces. Foods retained on tooth surfaces for prolonged periods of time extends acid production. Thus, solid foods are more likely to contribute to tooth decay than sugar sweetened liquids that are rapidly cleared from the mouth. On the other hand, slowly sipping soft drinks and other sweetened beverages between meals increase the risk of caries. The sequence in which foods are eaten also affects plaque pH levels. Sugared coffee consumed at the end of a meal will cause the plaque pH to remain low for a longer time than when an unsweetened food is eaten following intake of sugared coffee.
Some components of foods are protective against dental caries. Protein, fat, phosphorus and calcium inhibit caries. Natural cheeses have been shown to be cariostatic. The protective effect of cheeses is attributed to their texture, which stimulates salivary flow, and their protein, calcium and phosphate content, which neutralizes plaque acids. If peanuts are eaten before or after sugar containing foods, the plaque pH is less depressed. Fats appear to be caries protective. Some fatty acids in low concentrations inhibit growth of mutans streptococcus. Fats may also accelerate oral clearance of food particles. Some proteins found in plants, appear to interfere with microbial colonization and may affect salivary function. Other factors contributing to the caries decline are fluoride intake, improved plaque control, the use of dental sealants and more frequent visits to the dentist.
One of the most severe forms of caries occurs in babies who are allowed to feed on bottles of sugar containing liquids for prolonged periods. These may include, milk, juice and other sweetened beverages. As a result, progressive dental caries on the buccal and lingual surfaces of newly erupted primary maxillary teeth of infants and toddlers may occur. Primary risk factors for early childhood caries include allowing a child to sleep with a bottle containing something other than water, allowing an infant to breast feed at- will and extending the use of the nursing bottle beyond one year of age. Furthermore, children who develop maxillary anterior caries are at increased risk of developing posterior caries in the future.
Eating disorders, especially bulimia, are often first diagnosed in the dental office. Patients, usually young females, present with severe erosion of teeth, especially lingual surfaces. The oral tissues are often red, sore and painful. The esophagus may be inflamed, and salivary glands are often swollen. Bulimia is characterized by recurrent episodes of binge eating (consumption of large amounts of food at a time) followed by self- induced regurgitation (purging). Patients may also use laxatives and/or diuretics to induce malabsorption and fluid loss. The acid from stomach regurgitation irritates the esophagus and the oral soft tissues. The regurgitated acid in combination with xerostomia, result in rapid and extensive destruction of tooth enamel. Patients often first deny having an eating disorder.
In children, unrecognized dental pain can contribute to failure to thrive. Oral pain can cause a child to avoid eating and chewing and can lead to weight loss. In young children, who cannot articulate their problems, the cause of this anorexia may go undetected for prolonged periods. Problems in the oral cavity can be major contributors to poor eating habits and subsequent malnutrition in the elderly. Edentulous individuals consumed less fiber and carotene, fewer vegetables, and more cholesterol, saturated fat and calories. Dentures can also affect taste and swallowing ability, especially if they are maxillary dentures. The denture covers those taste buds found on the upper palate. And when the upper palate is covered, it becomes difficult to detect the location of food in the mouth. Dry Mouth (Xerostomia) is common in the older population. Xerostomia makes eating more difficult and increases the cariogenic potential of the diet. It has also been associated with burning mouth syndrome and inadequate diet.
The patient who has had oral surgery needs an adequate diet to support adequate post-surgical response. The risk of nutritional deficiency increases with the length of the eating impairment. Surgery itself can result in anorexia, inability to chew, and increased metabolic re-quirements. After surgery, a patient may need a liquid diet for 1 or 2 days but should be graduated as soon as possible to a soft diet of high nutritional quality until normal eating ability is restored. In some cases, nutritionally complete liquid supplements may be appropriate and should be prescribed. Multivitamin/ mineral supplements may be needed as well.
The diabetic dental patient is at greater risk for developing oral infections and periodontal disease than the non- diabetic. Dietary management of Diabetes Mellitus has moved from the high fat, low carbohydrate diets of past decades to the more liberal use of complex carbohydrates and the reductions in fat recommended today. Since the use of cariogenic fermentable carbohydrates should be infrequent, a diabetic diet should be low in cariogenicity.
Immuno-compromised patients, such as those with cancer or AIDS, often have increased requirements for nutrients. Cancer often causes severe anorexia, taste changes and early satiety. The pain and discomfort of oral infections, such as the herpes simplex and oral candidiasis found in AIDS patients and after chemotherapy, can also impair the desire and ability to eat. Radiation therapy compounds eating difficulty by causing painful oral mucositis and severe xerostomia. The nutrition care plan should focus on providing high caloric intake in frequent small meals. Liquid supplements may be used if optimal nutriture cannot be achieved via food alone. In more serious cases, patients may need enteral (tube) feedings or more advanced nutritional support. A high calorie diet will likely be high in sugars as well as total calories. Rather, cleaning after each eating period and use of fluoride mouth rinses before bed is important.
Typically the orthodontist often advise their patients to eat soft food during treatment to avoid pressure sensitivity, but very few give clear cut instructions or provide diet charts. In absence of these, patients generally switch over to convenient, easy to eat food without any special attention to the nutrient values of the consumed food.
To optimize patient physiologic response to orthodontic treatment, it may be beneficial for the orthodontist to provide nutritional guidance to patients in choosing soft food diets. Providing a dietary chart with various alternative soft food choices, which provide the recommended nutritional values, will help the patient in selecting the healthy diet. The recommendation of a low fat diet would be helpful.
There are many ways in which diet and orthodontic processes interact. Diet can affect periodontal health, oral microbe composition and quantity, wound healing, protein synthesis, immune system function, growth, and intelligence quotient. Orthodontic treatment may affect these processes by altering the diet consistency, quality, or quantity.
Drinking plenty of water keeps mouth moist and protects teeth from cavities.
Calcium, phosphorus, and vitamins A, C and D are essential for healthy teeth.
Deficiency of these nutrients affects tooth development in various ways.
|Nutrient Deficiency||Effect on tooth development|
|Calcium, phophorus, vitamin D||Hard structure of tooth less mineralized|
|Vitamin A||Reduced enamel formation|
|Flouride||Increased demineralization of tooth in acidic environment|
|Excess flouride||Leads to Fluorosis|