GOOD NUTRITION FOR A GOOD SMILE

“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.