“You are what you eat”- is a well-known adage that all of us
would have heard a thousand times, but the least heard adage is “your smile is
also what you eat”! Like in general health, the food that we eat and the liquid that we drink plays
a major role in good dental health. The oral cavity (the teeth and the gums), like other parts of
the body, also require nourishment – energy and nutrients for health and
maintenance. The food we eat affects our teeth. At the
same time, the health or lack of health of our teeth and gums affects what we
can eat. Good dental health begins early in life and must be practiced
throughout life.
Healthy
Diet leads to Healthy teeth and gums
A well-balanced diet which includes
water provides energy, nutrients (carbohydrate, protein,
fat, vitamins) and minerals, essential for healthy teeth and gums as well as
for rest of the body. When one gets all the nutrients that meet the daily
needs, then he/she gets good nutrition and good
nutrition is the fundamental requirement for positive health and functional
efficiency. Good nutrition is possible throughout the life cycle only through
healthy diet – a balanced diet. Balanced diet is
made of foods selected from all food groups such as cereals, pulses, nuts,
fruits and vegetables, milk and milk products, oil, meat, poultry and fish.
Composition of balanced diet that is
the requirement of the food items from each of these food groups varies with
age, gender and health, physiological status and physical activity level of the
individual.
Development and integrity of oral
tissues and structures
Good nutrition is
essential to the initial growth and development of oral tissues. Tooth
development begins shortly after conception, usually between the sixth and
eighth weeks of gestation and continues throughout pregnancy. The most important long-term factor affecting the
health of teeth and gums is nutrition, from the womb onward.
Malnutrition during
periods of tooth development can have irreversible effects on the developing
oral structures. Nutritional deficiencies can impair tissue regeneration and
healing and can increase susceptibility to oral infections. Vitamin C
deficiency will result in bleeding gums, Calcium deficiency would affect bones
supporting the teeth, B-complex deficiencies will affect overall oral health
with cracks in the lips and sores on the tongue or inner mouth, Vitamin A deficiency would
affect the cell integrity and Nutrients are interdependent – they cannot work
in isolation.
Nutrients for Oral health:
Nutrients which maintain the bones and
the muscles of the body are also accountable for maintaining the gums and
teeth. These includes calcium
and phosphorus, protein, magnesium, fluoride, zinc, copper, iron, selenium and
vitamins D, A, C, K and folate. Other
nutrients that influence normal bone metabolism are energy, fat, carbohydrates
and fibre intake, and the electrolytes, sodium and potassium and the remaining
32 odd nutrients!! The
nutrients essential for general health do not function in isolation and all work
together to keep one’s body strong and healthy lifelong.
Process
of Tooth decay / Dental Caries:
Dental caries commonly occurs on the
chewing surface or the inter-dental surfaces in posterior teeth. The chewing
surfaces of these teeth are wide with pits and fissures for easy retention of
food debris and microbes.
The bacteria present in oral cavity form an invisible layer of plaque. The
plaque is mainly composed of bacteria, salivary proteins, few cells and some
bacterial products. When the food remnants, especially carbohydrates, come in
contact with the bacteria in the plaque, fermentation begins, resulting in
dissolution of tooth surface and dental caries.
Untreated dental caries can result
in pain and subsequent tooth loss, which may lead to malnutrition or abnormal
digestion, since these conditions often prevent a person from chewing and
eating adequate amounts of food as well as eating some hard, high-fibre foods.
Additionally, many diseases such as Type 1 and Type 2 diabetes, and
cardiovascular disease, may exacerbate these conditions leading to poor oral
health.
Factors causing
tooth decay:
The food we eat and the beverages we
drink can have a direct influence on the incidence and progression of tooth
decay, depending upon:
- The form and consistency of
food.
- Duration of exposure of teeth
to food.
- Frequency : How often these are
used –
o sugary / acidic foods / beverages
- The combination of foods and
the order (sequence) of eating.
- Medical conditions such
as gastrointestinal reflux and eating disorders, which can increase
risk of cavities and weaken teeth.
Food
form determines the duration of exposure or retention time of a food in the
mouth, which in turn affects how long the acid-producing activity will
last. Liquids are rapidly cleared from
the mouth and have low adherence (or retentiveness) capabilities. Solid foods such as crackers, chips, dry
cereals, and cookies can stick between the teeth (referred to as the
interproximal spaces) and have high adherence or retention capability which
results in prolonged sugar exposure in the mouth.
Consistency
also effects adherence. Chewy foods
stimulate saliva production and have a lower adherence potential than solid,
sticky foods such as pretzels, bagels, or bananas.
Sugar
is the part of the triad that leads to tooth decay, the other two factors being
acid forming bacteria harbouring the mouth and the susceptible tooth. Every
time a person eats sweet food, mouth bacteria have an unlimited food supply and
begin to produce acid that attacks the teeth for 20 minutes or
more. Saliva eventually neutralizes these acids and repairs tooth
enamel.
The
amount of sugar present in the mouth plays a critical role in the process, so
also the time. Longer the period sugar stays in the mouth, more damage to the
teeth will occur. Day-long
sipping of sugar-containing drinks exposes one’s teeth to constant sugar and,
in turn, constant decay-causing acids.
Dental
nutrition also involves a certain sense of timing. To prevent cavities and
maintain good oral health,
the diet – what
one eats and how often one eats, are important factors. More frequent meals
mean more risk for the tooth! Saliva production is slowed down if one
eats constantly, so there will not be enough in the mouth to neutralize the
bacteria and prevent the damage.
Eating sequence and combination of
foods also affect the caries potential of the substrate. Bananas, which are
cariogenic because of their fermentable carbohydrate content and adherence
capability, have less potential to contribute to decay when eaten with cereal
and milk than when eaten alone as a snack.
Milk, as a liquid, reduces the adherence capability of the fruit.
Factors
preventing tooth decay:
·
Saliva
·
Water
·
Sequence
of eating
Saliva decreases mouth acidity and
washes away food particles. Saliva eventually
neutralizes the acids and repairs tooth enamel. The food eaten should stimulate the
gums, increase saliva flow and reduce the build-up of cavity-causing bacteria. Crunchy
and chewy foods, such as carrots, celery, cucumber, popcorn, and nuts, cause
saliva to flow. Foods that require a lot of chewing stimulate saliva flow, and
saliva protects the teeth by cleaning them, neutralizing acid, and inhibiting
harmful bacteria. Saliva flow slows during sleep;
going to bed without brushing the teeth is especially harmful.
Good dental nutrition also calls for
healthy water intake. Saliva
production depends on hydration. Saliva production goes down if
one does not drink enough water. A chronically dry mouth also contributes
to decay. Good dental nutrition demands the plentiful intake of healthy water.
Starches
(cereals, potatoes etc.) and
sweets should be combined when possible. This will stimulate saliva
production. Dessert should
therefore be eaten prior to a meal, never sometime afterwards. Cheese or milk
at the end of the meal decreases the carcinogenicity (caries causing effect) of
the meal.
Tips to preserve oral health
·
Eating a balanced diet high in fiber (high
fiber foods – whole cereals, whole grams, fruits and vegetables) that is low in
free sugars and fat protects oral and
general health. The high fiber content in the foods will counteract the
fermentation by bacteria and help to stop the decay.
·
Having a glass of water after eating and rinsing mouth with water for 30 seconds
after eating food/beverages. Drinking a lot of water keeps the mouth moist, and helps ward off tooth decay and
periodontal diseases by washing away food and neutralizing plaque.
·
Limiting
the consumption of sugar-containing drinks, including soft drinks, lemonade,
and coffee / tea with added sugar. The best beverage choices include water
(especially fluoridated water), milk, and unsweetened tea.
·
Spacing eating occasions at least 2 hours
apart and limiting snack time to 15-30 minutes.
·
Controlling sugar levels in
the diet is a key factor in caries prevention. Limiting the frequency of
consumption of foods and/or drinks containing free sugars should be limited to
a maximum of four times per day. Sugarless
or sugar-free food sometimes simply means that no sugar was added to the foods
during processing. However, this does not mean that the foods do not contain
other natural sweeteners, such as honey, molasses, evaporated cane sugar,
fructose, barley malt, or rice syrup. These natural sweeteners contain the same
number of calories as sugar and can be just as harmful to teeth (look for the
sugar content on the packaging label).
·
Combining
desserts and sweets with other food items, or even better, be
eaten as part of a full meal or just
before the meal.
·
Eating
acidic foods, such as citrus fruits, tomatoes, and lemons, as part of a larger
meal to minimize the acid from them.
·
Avoiding
day-long sipping of sugar-containing drinks.
·
Choosing crunchy and chewy foods, such as
carrots, celery, cucumber, popcorn, and nuts, which cause saliva to flow.
·
Choosing
whole grams, whole wheat products and vegetables with skin and seeds as these
foods need thorough mastication.
·
Chewing
sugar-free gum is another option that will increase saliva in the mouth and remove
food particles that cause tooth decay.
·
Chewing unsweetened Fennel seeds (Saunf) can also be considered as it
helps in production of saliva as well as acts as a mouth freshener.
Summary
Optimal
nutrition plays a key role in the development and maintenance of a healthy
mouth, especially the teeth and gums. Use of
good oral hygiene practices to prevent dental caries focuses on fluoridation,
adequate oral hygiene, frequency of eating and drinking, and a varied diet, as
opposed to sugar intake alone. Good
nutrition is essential for good dental health as well as good
general health.
Know the terminology
Cariogenic foods are
those that contain fermentable carbohydrates (sugars), which when in contact
with microorganisms in the mouth, can cause a drop in salivary pH to 5.5 or
less and stimulate the caries process.
Cariostatic foods do
not contribute to decay. Examples of cariostatic foods are protein foods such
as eggs, fish, meat, and poultry; most vegetables; fats; and sugarless
gums. Sugarless gum may help to reduce
decay potential because it uses non carbohydrate sweeteners.
Anticariogenic foods
are those that, when eaten before an acidogenic food, prevent plaque from
recognizing the acidogenic food, examples being Cheese and Xylitol containing
chewing gum. The form and consistency of a food have a significant effect on
its cariogenic potential and pH-reducing or buffering capacity.