Dental caries Todays lecture will be about diet and dental caries; how the food affects dental

caries

Diet is one of the most important factors that contribute to the development of dental caries. And we said that there should be Fermentable carbohydrates + the cariogenic plaque on tooth for the acid 2 form in order 2 demineralize the tooth structure 2 produce dental caries.. There has been a vast amount of experimental work linking fermentable carbohydrates and dental caries. So the link between fermentable carbohydrates in the diet & dental caries comes from experiments either in vitro or in vivo In vivo means: experiments in human inside or cavity.. Also, other than experiments on humans there are other studies on animals, as we mentioned in previous lecture, rats, 4 example: Theres a very known experiment in dental cariology called dishorm study, this study was in the 60s or 70s in the time that fermentable carbohydrates consumption increased,, so in Sweden culb institution they took a group of ppl, divided them into groups and gave them diet containing fermentable carbohydrates w ra8abo l food consumption to see the link between food consumption and dental caries.. But now we have a lot of complaints about the ethics of this study so we cannot repeat it. Unfortunately for the science of cariology we have ethical issues now that forbid the use of humans in this kind of studies, you cant give ppl a lot of sugar to consume. But you have 2 know that we have a lot

of experiments in vivo or oral cavity about link between fermentable carbohydrates and dental caries.. 2 understand the process of how the food or acid formation or the drop of plaque ph affect the demineralization of tooth structure, theres a graphic presentation called STEPHAN CURVE, its a graphical representation of change in plaque pH over time..

8 Plaque pH 6 4

See slide #3: This is the plaque pH, 4; 6; 8. The critical plaque pH for demineralization of enamel is 5.5 we call it the CRITICAL ZONE,, below it demineralization of enamel occur..
For a single sucrose rinse, lasting for seconds, can cause demineralization

that can last between 20 minutes and several hours,, because the pH of saliva or the plaque will drop below what we call critical level for a period of time so this is the amount of drop,, its very important for demineralization of the tooth,, so plaque pH will drop after eating sucrose 4 a long period of time.. If the plaque pH stays below this level (5.5) then demineralization will occur. So the most important time is the time below this level: If the plaque pH lasts for short period then demineralization will not occur. Example: If a person ate sucrose, sure the level of plaque pH would drop because of production of acids,, after that he brushed his teeth then the plaque pH would rise again.. There will be no demineralization or effect on the tooth,,, but if he didnt brush his teeth the plaque pH would remain 4 longer time period here (below 5.5) and demineralization occur!!

Again this is very important point to remember: THE MOST IMPORTANT TIME IN THE CURVE IS THE TIME BELOW CRITICAL pH Usually we characterize different kinds of food according to their ability to drop the plaque pH and keep it under the critical level for long period of time. If it can keep it for a long time there we call it acidogenic.

Following sucrose rinse, the plaque within an active cavity shows a greatest

fall in the pH in the critical level which is 5.5 for enamel, remember this is for enamel, dentine and cementum is different. The critical point for dentine is around 6, it can be demineralized at a higher level of pH so a slight drop in pH level can affect dentine more than enamel. CARIOGENIC FOOD: Foods that have the capacity to lower the pH of plaque below the critical demineralzation level (pH 5.5 to 5.0) are considered acidogenic.

Acidogenesis is a necessary condition for the development of caries, but it is not the only condition. Because as we said before caries is multi-factorial many factors affect their development Whether an acidogenic food is cariogenic or not will depend greatly on a number of factors specific to the individual who eats it, for example: this food is acidogenic, its able to produce a drop in the pH of dental plaque, but whether it can cause caries or not depends on the patient, as we said before if the flow rate and buffering capacity of saliva is high then caries will not develop. So this food is not necessary cariogenic, it maybe acidogenic. So it depends on the individuals saliva , oral hygiene, individual immune factors and fluoride availability well talk about fluoride later on and its effect on tooth structure The outcome will also depend on the quantity and frequency of food eaten. As we will see later, the different kinds of food differ in their cariogenesis according to: TYPE OF FOOD & THE FREQUENCY OF CONSUMPTION OF THE FOOD. Thus it is very hard to say whether an acidogenic food is cariogenic or not for a particular patient, for much depends on those individual factors that are quiet distinct from the nature of the food itself. However, a non-acidogenic food must also be a non-cariogenic food. So,,, we said if a food is acidogenic it may be also called cariogenic but not necessarily, it depend on the individuals variation BUT if the food is not acidogenic it will not be cariogenic. Now the cariogenic potential of a food: the foods ability to foster caries in human under conditions conducive to caries formation. CONSUMPTION OF SUGAR: The most important food that well talk about today is sugar because its the most commonly associated to the development of caries. When we say sugar we mean table sugar; the one we use in tea, coffee and wt ever!!! Sucrose is disaccharide we have 2 kinds of sugar: # monosaccharide wh is composed of one sugar.. #disaccharide wh is more complex and composed of 2 sugars- now as we sucrose is disaccharide that is added to variety of processed food we find in the supermarket.

Consumption of sugar in all forms has been calculated for different countries and some differences were found, they usually use it as a Kg / person / year and sometimes they relate it to dental caries or something like that other studies. For example: for the U.S. it was 54.5 kg/person /year, Jordan is 45, Iraq is 55 and UK is about 38. This is just estimation about how much person consume sugar in a year. Sucrose enhances the colonization and growth of MS Mutans Streptococci- in dental plaque more than other monosaccharides and disaccharides.

BUT WHY SUCROSE IS VERY IMPORTANT???

So,, why the acidogenecity of sucrose is high? Because of: Sucrose enhances the colonization and growth of MS wh is the bacteria that help in development of caries.

MS ferment sucrose rapidly producing acids, convert sucrose to extracellular polysaccharides that facilitate the adherence of the bacteria to teeth - they are very sticky- and reduce plaque permeability that in turn decrease the rate at which saliva can neutralize or dilute acids formed on the tooth surface. High-fructose corn syrup: They started to use it maybe in the 70s I dont exactly know!!! High Fructose Corn Syrup (HFCS) is now used in place of sucrose in processed foods and soft drinks for economic reasons; because its cheaper. So we use (HFCS) in the processed food that is available in the markets instead of sucrose because its cheaper and more available. It consists of 50% fructose and 50% glucose, and these sugars (HFCS) dont cause any production of extracellular polysaccharides in the oral cavity. The Cariogenicity of these sugars is less than that of sucrose because: They composed of 50% fructose and 50% glucose and they contain less sugar than sucrose.

In addition to the considerable shift from sucrose to HFCS and other syrup in processed food, two other changes have taken place in sugar consumption patterns:

The proportion of energy intake from carbohydrate food has changed from that obtained from starches (bread, potato, and whole grain cereals) to those obtained from sugars (now the food or the energy in the food depends on the sugar mainly not the starch and this may be the linkage to the high prevalence of caries nowadays than in the past, although sucrose is replaced by (HFCS) but theres still high presence of dental caries related to this food consumption) The main use of sugar has changed from discretionary (sugar bowl on the table) to consumption by way of processed food (hidden sugar). People in the past were depending on pure sugar now we have whats called hidden sugar; sugar can be in any food you cant imagine some food that have sugar, even processed meat they sometimes put sugar in it! This is hidden sugar found in the processed food available in markets.

Cariogenicity of different sugars Although its well known that Sucrose is more cariogenic than other sugars. The difference between sucrose and different sugars in term of cariogenicity is less pronounced than originally believed, this was found by experiment. However, sucrose is still more cariogenic potential than other sugars.
The production of extracellular polysaccharides depends on sucrose and that

smooth surface caries can only develop with plaque that adheres by means of extracellular polysaccharides (plaque formation) because as we pit and fissure caries enhance the accumulation of plaque while smooth surface caries need something to stick on it. They stick by extracellular polysaccharides produced by MS. Theres a very important point: some people dont have a lot of plaque still develop dental caries. And here is the last sentence the amount of plaque formed is not necessarily related to Cariogenicity since high caries development in the absence of significant plaque has been reported. Some people dont have drop under the critical level of plaque but still develop caries because development of caries is multi-factorial (amount of bacteria, immunity of the person, maybe the fluoride supplement of this person is different from others) So, we have to think about caries as multi-factorial and it depends on individual variation. This is very important later on when you go to clinic

and treat patients; you have to take in consideration the need of every patient. And we have sth new in the world we call it caries web pattern or something pattern Im not sure for every individual, we study the forms that make this individual at higher caries risk than any other individual. Effect of Eating Pattern and Physical Forms of Food Snacking means eating between meals, as we said previously in stephans curve the most important thing is the period of time that the plaque pH stays below the critical level.. For example: if the patient ate chocolate then the pH will drop, after half an hour he ate a piece of cake and the pH will drop again; there is no time for the saliva to try to neutralize the pH. So snacking is very important because of frequent exposure 2 the acid like for example drinking soft drinks this is what we call eating between meals, the frequency of consumption of sugar or fermentable carbohydrates increase we dont give the saliva the time to dilute the pH.

Frequent between-meal snaking on sugars or processed starch containing sugars increases plaque formation and extends the length of time that bacterial acid production can occur. The time here is very important. time for enamel and dentin demineralization to occur. Because the plaque pH is low, more acidic environment so theres demineralization of enamel..

Frequent snaking between meals keeps the plaque pH low and extends the

High sucrose foods deliver high levels of sugar to the oral bacteria

immediately after foods are consumed, whereas high starch food (such as soft bread and potato chips) deliver increasing concentrations of sugar over a longer period of time. They can decrease the pH for longer period of time.

The sequences in which foods are eaten affect how much the plaque pH falls. For example: Sugared coffee consumed at the end of a meal will cause the plaque pH to remain low for a longer time than when unsweetened food is eaten following intake of sugared coffee.

 If peanuts are eaten before or after sugar-containing food, the plaque pH is

less depressed.

Some components of food are protective against dental caries, we call them protective food.

Protein, fat, phosphorous and calcium inhibit caries in rats.

Aged natural cheese has been shown to be cariostatic. Eating cheese after a meal neutralize the pH or decrease the drop of the pH

When cheese is eaten following sucrose rinse, the plaque pH remains higher than when no cheese follows the sucrose rinse.

The protective effect of cheese is attributed to their texture that simulate salivary flow and their protein, calcium and phosphate content that neutralize plaque acids. So the cheese may be linked 2 those factors. Lipids also seem to accelerate oral clearance of food particles. Some fatty acids in low concentrations inhibit growth of MS. Fluoride well talk about it in different lecture found in drinking water, foods, and dentifrices tooth paste increase a tooths resistance to caries and enhance remineralization of carious lesion. Milk wh is not sweetened, despite being one of the most sources of sugar lactose, is anticariogenic. Why????
The sugar in milk is lactose, which is the least cariogenic sugar and

milk is also known to contain protective factors due to the presence of calcium, phosphate, casein and lipids. The End

Aham she Bahanekom belsalame b3d emte7an l oral histo elle tle3na mno mtabasheen asde salmeenw good luck fee l2emte7anat elle jay :D Very big I love u 2 my best friend ever 3nood,,, w akeed la aswa2 dof3a b teb l2snan specially Humam thx 4 making it easy 2 me while Im writing the lecture ,my best friend in dentistry layla 3azzaaaa, sana2 bet2ool aih??!!! :P, suzan best roommate ever bs a3teene chips, ghadooooshe 2ole flashe :D, sale7 ana 2 w enta 0, rabee3 :D, zaina, heba, tarek, michel, tashtooooooosh, 3reen & loly 7ad l3abe :D,nadeen, lara,aya, aseel, mona, ma7darbashi, fares and 3assan, do7a ,rawzan, sa7ar, aynoor :D,,, last and not least A7MAD :D THX 2 OUR C.R: MO3TAZZZZZ FADIA HAMAM