The Role of Diet in Oral Health Education

The Bidirectional Relationship between Oral Health and Diet

A bidirectional relationship exists between oral health and diet and nutrition. Diet and nutrition affect the health of the tissues in the mouth; and the health of the mouth affects nutrients consumed. Specifically, compromised integrity of the oral cavity can influence an individual's ability to eat. Epidemiological studies show that while they can identify associations between nutritional factors and oral health outcomes, demonstrating causation is more challenging. Clinical studies generally control for more factors but following participants for a meaningful length of time can be difficult.

Dental Caries and Diet

Dental caries is a complex disease process that is biofilm-mediated, sugar-driven, multifactorial, and dynamic. Carbohydrate consumption is a significant nutritional factor in caries development. Sugars, especially free sugars, are the main drivers of caries. Sucrose is the most cariogenic sugar, and its consumption leads to changes in dental plaque composition and pH levels, increasing the risk of tooth demineralization. The World Health Organization (WHO) recommends that free sugars be less than 10% of total energy intake, with a further reduction to less than 5% suggested. The frequency of sugar intake also plays a role in caries risk, although determining the relative contribution of sugar amount and frequency is complex.

Early Childhood Caries (ECC) and Diet

ECC, formerly known as "baby bottle tooth decay," is mainly caused by prolonged exposure of enamel to sweetened liquids. To prevent ECC, guidelines from the Academy of Nutrition and Dietetics and the American Academy of Pediatrics limit fruit juice consumption in babies and toddlers.

Dairy Products and Oral Health

The calcium in dairy products may offset some of the cariogenic properties of lactose and reduce the risk of caries. Studies suggest that milk consumption does not increase caries risk and may even have a protective effect.

Chewing Gum and Oral Health

Some chewing gums can be beneficial for oral health by reducing the acidogenic potential, inhibiting the growth of Streptococcus mutans, or increasing salivary flow. However, the ADA does not have a policy on the use of xylitol for caries prevention, and the evidence of its benefit as an adjunctive therapy is of low quality.

Vitamin D and Oral Health

Observational studies suggest that higher prenatal intakes of vitamin D and prenatal serum vitamin D levels may be associated with reduced caries risk in children and infants. Historical reports and cross-sectional studies also indicate an association between dental caries and lower serum levels of vitamin D in children.

Periodontal Disease and Diet

Periodontal disease is caused by specific microorganisms in dental plaque and an excessive host response. The effect of nutrition status on the body's immune response may modify factors affecting periodontal disease management, but the multifactorial nature of the disease and nutritional status makes it difficult to determine such effects. Studies on the associations between carbohydrates, proteins, and lipids and periodontal disease have found insufficient evidence.

Tooth Erosion and Diet

Diet plays a significant role in tooth erosion. The frequency, patterns, and time of contact with acidic food or beverage influence erosive tooth wear. The pH and buffering capacity of foods and beverages collectively determine their erosive potential. Yogurt, despite its low pH, is not erosive due to its high calcium content.

Calcium and Oral Health

Calcium is essential for maintaining the health of teeth and bones. Dietary calcium is absorbed from the intestine and can be obtained from human or animal milk, dairy products, or calcium-fortified foods. The 2015-2020 Dietary Guidelines for Americans recommend specific amounts of calcium intake for different age groups. Plant-based milk alternatives are available but may not be suitable for infants.

Other Oral Health Conditions and Diet

For other oral health conditions such as oral and oropharyngeal cancer, no direct relation between diet has been identified, but the consumption of fruits and vegetables may be protective. Preliminary data suggest that zinc deficiency is more common in those with recurrent aphthous stomatitis (RAS) and zinc supplementation may improve RAS resolution. Xerostomia/dry mouth may also be affected by diet.

ADA Policy on Diet and Nutrition

The American Dental Association has policies and positions on the role of diet and nutrition in oral health. Various studies and guidelines provide valuable insights into this relationship.

Summary

In conclusion, diet plays an indispensable role in oral health education. The foods and beverages we consume have a direct impact on our teeth, gums, and overall oral well-being. Understanding the connection between diet and oral health is crucial for making informed choices. From the development of dental caries and periodontal disease to tooth erosion and other conditions, nutrition is a key factor. By being aware of the effects of sugar, calcium, vitamins, and various food groups, we can take steps to improve our oral health through a balanced and nutritious diet. This knowledge empowers us to make better decisions for a healthy smile and a better quality of life.