October 12, 2009
By Christina Fitzgerald, M.S., R.D., L.D.N., Contributing Editor
We consume food for a variety of reasons: energy, comfort, social interaction and more. What is often overlooked is the effect food choices have on teeth and gums. According to Surgeon General David Satchers 2000 report, Oral Health in America, dental caries are seven times more common than hay fever. Eating patterns and choices among children and teens are important factors associated with the onset of these caries. Unfortunately, 20% to 25% of American children have approximately 80% of caries.
Nutrition for dental health
Tooth development begins at two to three months of gestation and is greatly impacted by the maternal nutritional status, which must supply pre-eruptive teeth with nutrients. Protein and calorie malnutrition, and deficiencies in vitamin A, vitamin D, calcium, phosphorus, fluoride and iron, all effect future caries. Protein and calorie malnutrition may cause delayed tooth eruption and decreased tooth size. Deficiency in vitamin D, calcium and phosphorus may cause hypo-mineralization, compromised tooth integrity and delayed eruption patterns. Iron deficiency may cause salivary gland dysfunction.
Plaque, a bacterial film, is constantly forming on teeth. When we eat or drink foods containing sugars or starches, the combination of these and the bacteria in the plaque produces acids that attack the tooth enamel. Plaque keeps this acid on the enamel. Over time, the enamel breaks down and forms a cavity.
There are several categories of foods in regard to dental health:
Cariogenic foods contain fermentable carbohydrates (any carbohydrate susceptible to salivary amylase) that decrease salivary pH and promote dental caries. These can be found in healthy food groups, including the grains, fruit and dairy, as well as products with added sugars. Several factors affect how cariogenic foods may be: the frequency of fermentable-carb consumption; food form (solid vs. liquid); sequence of eating; combinations of foods; and nutrient composition.
Cariostatic foods do not contribute to decay. These include proteins, most vegetables, fats and sugarless gum. Non-carbohydrate sweeteners (saccharin, cyclamate and aspartame) are cariostatic.
Anticariogenic foods prevent plaque from recognizing an acidogenic food when it is consumed first. Xylitol cannot be metabolized by bacteria and is thought to have two mechanisms that protect the enamel: antimicrobial activity against Streptococcus mutans, and salivary stimulation from chewing xylitol-containing gum that increases the clearance of fermentable carbs from the tooth surface. The recommended dose is two pieces of xylitol-containing gum after consuming fermentable carbohydrates. There is some evidence xylitol can also produce a remineralizing effect. Other anticariogenic foods include cheeses, such as aged Cheddar, Monterey Jack and Swiss, due to their calcium, phosphate, casein and lipids.
In addition to these, an ingredient derived from casein, known as casein phosphopeptides-amorphous calcium phosphate, or CPP-ACP, helps to strengthen teeth by delivering calcium and phosphate in a soluble form to help remineralize the enamel. One study (Pediatric Dentistry 2005;27:61-67) suggests that adding CPP-ACP to acidic beverages might aid dental health.
The FDA allows sugar-free foods containing the sugar alcohols xylitol, sorbitol, mannitol, maltitol, isomalt, lactitol, hydrogenated starch hydrolysates, hydrogenated glucose syrups, erythritol to make a does not promote dental caries claim. The European Food Safety Authority has approved a reduces the risk of caries in children claim for xylitol-containing gum
Factors affecting cariogenicity
The form, solid vs. liquid, greatly affects a food's cariogenicity, since it often determines enamel exposure time. Liquids rapidly leave the mouth, so there is low adherence to the teeth; solid foods often stick between the teeth, extending adherence.
Nutrient composition also affects cariogenicity due to the foods ability to produce acid. Some studies suggest that consuming cariostatic or anticariogenic foods along with foods with fermentable carbohydrates may help buffer the acid and lower a meals cariogenicity.
A decline in pH-promoting caries formation is initiated within 5 to 15 minutes after fermentable-carbohydrate consumption and can last up to 30 minutes. Consuming frequent meals and snacks with fermentable carbohydrates is more cariogenic than consuming three meals a day. It is also less cariogenic to consume a large fruit salad at one meal and to brush teeth afterward than to consume several servings of fruit throughout the day.
Christina Fitzgerald, M.S., R.D., L.D.N., specializes in pre- and postpartum, as well as pediatric, nutrition. She is the owner of the private nutrition practice, Nourished Nutrition and Wellness, based in Chicago, and can be reached at [email protected].
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