William Moskowitz, DDS, FAGD, LLC
Matthew Penner, DDS
Dimensions in Dentistry

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Implant Dentist Aberdeen, NJ - William Moskowitz, DDS - Periodontal Gum Disease

Report by The Food and Drug Administration

In 1986 the Food and Drug Administration (FDA) published the Report of the Sugars Task Force. An FDA task force had devoted three years to reviewing worldwide research concerning the relationship of sugars and health. As for dental caries, the FDA task force made the following observations:

1. The etiology of dental caries is multi-factorial. Oral microbial flora, host factors (such as resistance to dental decay and hardness of tooth surface) and dietary factors (influencing the residence time of fermentable carbohydrates and plaque acidity) are the major factors involved in the development of carious lesions.

2. The consumption of all fermentable carbohydrates facilitates the development of plaque, dental caries and periodontal disease.

3. Many foods can modify cariogenic potential, and there is no apparent simple relationship between the sugar content of foods and cariogenic potential.

4. The incidence of dental caries in the United States is declining and modern preventive dental methods (including fluoridation, topical fluoride treatments, dental sealants and programs to improve oral hygiene) have contributed to and are expected to continue to augment this decline.

5. Available scientific literature and the results of clinical trials do not establish a quantitative relationship between sugar consumption and the incidence of dental caries because of the many factors that influence plaque formation and enamel dissolution.


Baby Bottle Tooth Decay

"Baby bottle tooth decay," which contributes substantially to the national caries incidence, is caused by frequent and prolonged exposure of teeth to liquids containing sugars, including milk, formula, fruit juice and other sweetened drinks. An infant's dental health is threatened when a bottle, containing any such liquid, is used as a pacifier. Prolonged exposure of teeth to liquids containing sugars gives rise to a characteristic pattern of severe caries, particularly on the maxillary incisors, where there is low salivary flow during sleep.

To prevent "baby bottle tooth decay," parents should be counseled to avoid using a bottle as a pacifier (unless it contains only water) and to wipe their infants teeth and gums clean daily.

Caries-promoting properties of starches.

Researchers now recognize that starches, like sugars, are caries-promoting because they provide sugars for bacterial metabolism. When starches are heated during food processing, a significant percentage of them are changed into sugars, particularly maltose and glucose. Furthermore, in the mouth, amylase causes cooked starches to split into glucose and maltose. Only small amounts of these sugars are required by plaque bacteria to produce acid. One may believe that it is dentally safe to consume starch-containing foods, although, in reality, they give rise to sugars. Since cooked starches dissolve slowly in the mouth, until they clear, they act as oral sugar reservoirs. Recent cariogenicity research indicates that since starches retard sugar clearance, foods which combine starches and sugars generally appear to be relatively more acidogenic than foods which contain sugars alone.

Oral retention and food clearance.

The speed at which food clears from the mouth is associated closely with its caries-promoting potential. Prolonged oral retention of food leads to extended acid formation, frequently for several hours. Thus, carbohydrate foods that clear more slowly are expected to be more caries-promoting. Physical characteristics that affect salivation and food clearance include coarseness, solubility, texture, and adhesiveness.

Patients should be made aware that "sticky" and "chewy" are subjective perceptions which generally do not correlate with a food's speed of oral clearance. Contrary to popular belief, research shows that some foods commonly perceived as "sticky," such as caramels, clear from the mouth faster than other foods not generally thought of as "sticky," including crackers, breakfast cereals, potato chips, dried fruit, and bread.

Saliva

Recent findings have increased our knowledge about the complex relationship between foods, saliva and caries. "Tasty" foods stimulate greater salivary production. Sugar-containing foods tend to stimulate more salivary flow than do starch-containing foods. A food's stimulation of salivary flow increases its speed of oral clearance. The high levels of calcium and phosphate in saliva inhibit demineralization and enhance remineralization. Bicarbonate buffers in saliva help to neutralize plaque acid. Importantly, salivary enzymes transform starches into soluble sugars, enabling them to clear from the mouth.

Dietary Modification

Most foods contain orally fermentable carbohydrates and therefore have the potential to participate in the caries process. Although some parents have been successful in modifying the frequency of their children's eating occasions and/or their children's' food choices, it does little good for parents to tell their children that candy is bad for their teeth, but that raisins are good. To prevent cavities, all children should brush twice daily with an ADA-approved fluoride dentifrice, obtain systemic fluorides through either drinking water or daily supplements and have pit-and-fissure sealants placed on their molar teeth soon after they erupt.

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