Feature articles

Food and dental health

The Dietitians Association of Australia (DAA) and Dental Health Services Victoria have released a joint position statement on oral health and nutrition. This very comprehensive document is worth reading in full but we have summarised Section 2 here: the rationale for oral health and nutrition. toothy grin and toothbrush.jpg

Oral conditions are the second most expensive to treat (after CVD) in Australia. The combined bill of treating dental caries, gum disease, oral cancer and oral trauma cost a whopping 8.7million dollars in the year 2012-13. Oral diseases disproportionately affect the most vulnerable and have been labelled a disease of social disadvantage.

All sugars and cooked starches in the diet can provide an environment in which bacteria that cause dental caries can thrive and eating or drinking these frequently increase the likelihood of dental caries. Potentially cariogenic (caries-causing) sugars are sucrose, glucose, fructose, lactose, maltose and high fructose corn syrup, but physical form and food context affect their level of cariogenicity. For example, lactose and galactose in milk are considered less cariogenic because they are usually accompanied by calcium, casein phosphopeptides and and other nutrients that help to prevent or repair dental damage. While fresh fruit contains fructose, it does not break down in the mouth.

The three main factors that contribute to risk of dental caries or dental erosion (dissolving of tooth enamel) are:

  1. Frequency of intake (amount is not as important). This is because eating cariogenic foods creates an acid environment that takes around an hour or more  for the saliva to restore a neutral pH and remineralise lost tooth enamel
  2. Form and physical consistency of the food. Foods that are retained on the teeth are more damaging than foods that are cleared more quickly.  In addition, acidic foods and drinks can cause dental erosion.
  3. Sequence and combination of foods. Cariogenic  foods and drinks eaten only at meal times are likely to cause less decay than when eaten as several snacks between meals because snacking increases the frequency of acid attack on the teeth.

On the upside, there are foods, food components and nutrients considered protective to oral health:

  1. Fluoride can help developing teeth (in children) become more resistant to acid attack. Most obtain fluoride from tap water that has been fluoridated. Topical application of fluoride helps to prevent the breakdown of enamel and to remineralise and reverse early decay.
  2. Dairy milk products have been shown to be protective in helping prevent decay and calcium and phosphorous in saliva can help remineralise tooth enamel. Cheese in particular is excellent to eat after a sweet food to decrease dental damage (the traditional cheese platter after a meal makes good sense).
  3. Xylitol has antibacterial properties and chewing sugar free gum promotes salivation which helps remove food from teeth, increases the pH in saliva and helps promote remineralisation of tooth enamel.
  4. Fresh fruits and vegetables require a lot of chewing which helps boost saliva flow. Vitamin C and fibre help keep gums healthy while phytates and phosphates have been shown to help retard decay.
  5. Artificial sweeteners when used to replace sugar can reduce cariogenic potential of foods – cooked starches may still remain in some foods.  Many foods or drinks with artificial sweeteners are very acidic thus increase the risk of dental erosion.

Key oral health advice – a summary

  • Brush teeth morning and night for 2 minutes. Spit out toothpaste but don’t wash it off as the fluoride provides further protection after brushing.
  • For children 18 months to 6 years, use low fluoride toothpaste (500ppm). Standard toothpaste (fluoride 1000-1500ppm) can be used from six years of age#.
  • The first oral health assessment should take place at 2 years of age*.
  • Chewing sugar-free gum can help reduce the risk of decay, especially after a meal or sugary drink.
  • Don’t smoke (smoking increases the risk of periodontal disease and mouth cancer)
  • A healthy diet as recommended by the Dietary Guidelines: limit sugar foods (especially between meals); choose healthy snacks between meals such as fruits, vegetables, milk and cheese; encourage small amounts of cheese after a meal.
  • Drink plenty of fluoridated tap water (where available).
  • Avoid sweet, acidic or carbonated drinks, especially between meals
  • Milk and water are preferred drinks for children.
  • Mouthguards are recommended for sports that carry a risk for orofacial injury

# NB In New Zealand regular toothpaste (1000ppm) is recommended from 6 months to 6 years, and then a higher fluoride toothpaste (1500ppm) after that for high risk children and adolescents.

*NB In New Zealand the first oral health assessment is recommended by 12 months

NEXT: Sugar and cardio-metabolic health 

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