Diet and dental caries

Hi, I am Dr Komal Ghiya, pediatric dentist by profession, I am here to share some of my own presentations for educational purposes. I hope a presentation on DIET AND DENTAL CARIES will be useful for all the dental and medical students. Comments are welcome if you like the presentations and if not please suggest some ways I could make them better for you. All the best

1. DIET AND DENTAL CARIES KOMAL GHIYA

2. INDEX INTRODUCTION DEFINITION RELATIONSHIP OF DIETARY FACTORS AND DENTAL CARIES ROLE OF DIFFERENT FOOD CONSTITUENTS IN CARIES: CARBOHYDRATES:SUGAR ALCOHOLS SUCROSE:ARCH CRIMINAL STARCH VS SUGAR LIPIDS PROTEINS MINERALS:PHOSPHORUS FLUORIDE OTHER MINERALS DIET COUNSELLING:TYPES GUIDELINES PROCEDURE IDEAL SNACK MY PLATE CONCLUSION

3. INTRODUCTION MILLERS CHEMICOPARASITIC THEORY:1889 DENTAL DECAY IS A CHEMICOPARASITIC PROCESS CONSISTING OF 2 STAGES,THE DECALCIFICATION OF ENAMEL,WHICH RESULTS IN ITS TOTAL DESTRUCTION AND THE DECALCIFICATION OF DENTIN,AS A PRELIMINARY STAGE,FOLLOWED BY DISSOLUTION OF SOFTENED RESIDUE.THE ACID WHICH AFFECTS THIS PRIMARY DECALCIFICATION IS DERIVED FROM FERMENTATION OF STARCHES AND SUGAR DISLODGED IN THE RETAINING CENTERS OF TEETH SIGNIFICANCE OF MILLER’S OBSERVATION IS THAT ASSIGNED TO AN ESSENTIAL ROLE TO THREE FACTORS IN CARIOUS PROCESS: THE ORAL MICROORGANISMS IN ACID PRODUCTION AND PROTEOLYSIS CARBOHYDRATE SUBSTRATE THE ACID WHICH CAUSES DISSOLUTION OF TOOTH MINERALS STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC FOUNDATIONS AND CLINICAL PRACTICE,1982

4. ATWATER CALORIMETRY CARBOHYDRATES:4 Kcal/g PROTEINS 4Kcal/g FATS 9 Kcal/g NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

5. DEFINITION DIET: NIZEL(1989):TOTAL ORAL INTAKE OF A SUBSTANCE THAT PROVIDES NOURISHMENT AND SUPPLY BALANCED DIET:IS THE ONE WHICH CONTAINS VARITIEIS OF FOODS IN SUCH QUANTITIES AND PROPORTION THAT ARE NEEDED FOR ENERGY. WHO:NUTRITION IS THE INTAKE OF FOOD, CONSIDERED IN RELATION TO THE BODY’S DIETARY NEEDS CHILD DIET:COMBINATION OF FOOD CONSUMED AND THE NUTRIENTS CONTAINED THERE IN, WHICH HAVE A PROFOUND ABILITY TO INFLUENCE COGNITION, BEHAVIOR AND EMOTIONAL DEVELOPMENT IN ADDITION TO ULTIMATE PHYSICAL GROWTH & DEVELOPMENT (DCNA 2003) DENTAL CARIES :MICROBIAL DISEASE OF CALCIFIED TISSUES OF TOOTH,CHARACTERIZED BY DEMINERALIZATION OF INORGANIC PORTIONS AND DESTRUCTION OF ITS ORGANIC STRUCTURE NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

6. RELATIONSHIP OF DIETARY FACTORS AND DENTAL CARIES BACTERIAL VIRULENCE HOST RESISTANCE SALIVA BUFFERING CAPACITY QUANTITY OF CARBOHYDRATES CHEMISTRY OF TOOTH SUBSTANCE STICKINESS FOOD ACIDITY FOOD TEXTURE ORAL RETENTION OF FOOD NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

7. CARBOHYDRATES NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

8. STEPHEN’S CURVE WHEN SUGARS ARE GIVEN,AT PH 5.0-5.5 DEMINERALIZATION OF ENAMEL STARTS AND BELOW THIS RANGE OF PH HYDROXYAPAPTITE CRYSTALS START DISSOLVING PH:5.5 IS THE CRITICAL PH NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

9. ACIDOGENIC APPLES,DRIED BANANAS BEANS BAKED BREAD,WHITE APPLES,FRESH BREAD,WHOLE WHEAT CARAMEL CARROTS,COOKED APPLE DRINK APRICOT CEREALS,NON PRESWEETENED CEREALS SWEETENED CHOCOLATE,MILK COLA,BEVERAGES COOKIES,VANILLA SUGAR CORN FLAKES CORNSTARCHES CRACKERS,SODA CREAM CHEESE DOUGHNUTS PLAIN GELATIN,FLAVORED DESSERT GRAPES MILK MILKCHOCOLATE ORANGES PASTAS PEANUT BUTTER POTATO AMYLASE PEAS,CANNED POTATO AMYLASE POTATO,BOILED RICE,INSTANT COOKED SPONGE CAKE TOMATO,FRESH WHEAT FLAKES NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

10. NONACIDOGENIC CREATE A PLAUE PH OF 6 OR HIGHER ARE RELATIVELY HIGH IN PROTEIN HAVE A MODERATE CONTENT TO FACILITATE ORAL CLEARANCE CONTAIN A MINIMAL CONCENTRATION OF FERMENTABLE CARBOHYDRATE EXERT A STRONG BUFFERING ACTION HAVE A MINERAL CONTENT INCLUDING CALCIUM AND PHOSPHATE CHEESE SUCH AS BLUE CHEESE,CHEDDAR,GOUDA,MONTAREY JACK,MOZZARELLA,SWISS NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

11. MILK AND MILK PRODUCTS Rugg -Gunn, 1993 milk contains about 4.8g lactose per 100g milk. This amount could be sufficient to classify milk as cariogenic, but there is much evidence that lactose is the least cariogenic of the common dietary sugars Prabhakar et al. (2010) plain bovine milk was relatively cariogenic (Southgate, 2000). YOGURT:The lactose content reduces substantially during fermentation although some galactose remains: other constituents are unchanged Tanaka et al. (2010) yogurt consumption:with a lower prevalence of caries Ravishankar , T.L.(2012) Cheese and yogurt without any added sugar (sucrose) are non-cariogenic 

12. SUGAR ALCOHOLS LITTLE OR NO EFFECT ON PLAQUE PH AND DENTAL CARIES SORBITOL CONTAINING CHEWING GUMS-REASONABLE DOUBT RECOMMEND ALTERNATIVE CONFECTIONS CONTAINING SUGAR ALCOHOLS DISSUADE PATIENT FROM USE OF MINTS AND CHEWING GUMS NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

13. STUDIES

14. SUCROSE:ARCH CRIMINAL:NEWBRUN,1969 STREPTOCOCCUS MUTANS:SMOOTH SURFACE CARIES SUCROSE HELP IN GLUCAN FORMATION GLUCANS HELP IN SURVIVAL OF STREPTOCOCCUS MUTANS THUS CAUSE PLAQUE ACCUMULATION AND SMOOTH SURFACE CARIES Leme AFP, Koo H, Bellato CM, Bedi G, Cury JA. The Role of Sucrose in Cariogenic Dental Biofilm Formation—New Insight.  Journal of dental research . 2006;85(10):878-887.

15. STARCH VS SUGAR SUGAR: STARCH:POLYSACCHARIDE

16. Rugg-gunn,1986/NEWBRUN 1976,BOWEN,1982,SREEBNY,1978 point out low caries prevalence during starch Lingstrom et al 2000 : When evaluating starch in animal human plaque ph response in situ caries model studies Results: Processed food starches in mordern diet posses a significant cariogenic potential

17. XYLITOL Naturally occurring pentose alcohol that can be derived from various types of cellulose products ,such as wood, straw, cane pulp,or seed hulls Sweetness similar to that of sucrose Produces cooling sensation in the mouth When taken in excess it can produce diarrhea One gram xylitol yields 4 calories REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

18. Classification Of Sugar Substitutes Based on sugar substitute being caloric or non-caloric: a) Caloric / Nutritive sweetener b) Non caloric / Non nutritive sweetener i ) Poly alcohols / sugar alcohols i ) Cyclamate Xylitol  Sorbitol ii) Hydrogenated starch hydrolysate  Lycasin  Palatinit ii) Saccharin iii) Coupling sugar  Sorbose  Palatinose iii) Aspartame iv) Sucralose v) Neotame Based on their origin: A)Natural (derived from plant origin) B)Artificial 1. Monellin 1. Aspartame 2. Licorice 2. Saccharin 3. Dihydrochalcone 3. Cyclamate 4. Miraculin 4. Sucralose

19. Xylitol is neither fermented nor utilized by streptococcus mutants When xylitol is used as a sugar substitute in animal and human studies ,there appeared to be some initial promise that this polyol might have useful anticaries properties However toxicity studies in mice ,it was found that those were fed 20% xylitol in the diet developed malignant neoplasms of urinary bladder REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

20. SORBITOL SUGAR ALCOHOL MADE COMMERCIALLY GLUCOSE BY HYDROGENATION. ABOUT 60% AS SWEET AS SUCROSE AND IS USED SWEETENING AGENT IN DIABETIC FOODS AND SO CALLED SUGARLESS GUMS AND CANDIES. SORBITOL IS ABSORBED FROM GUT AND HAS SLOW ABSORPTION RATE,SO DOESN’T RAISE BLOOD SUGAR LEVEL 1 GRAM-4 CALORIES REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

21. MANNITOL AND DUCITOL OBTAINED FROM HYDROGENATION OF MANNOSE AND GALACTOSE BREAKDOWN TO ORGANIC ACIDS IN THE MOUTH AT MUCH SLOWER RATE SALIVARY BUFFERS HAVE BETTER OPPORTUNITY OF NEUTRALIZING IT REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

22. FLAVINOID SWEETENERS MONELLIN: PROTEIN FOUND FROM FRUIT 3000 TIMES SWEETER THAN SUCROSE SACCHARIN 350 TIMES THAN SUGAR 1985 FDA :CARCINOGENIC INCONCLUSIVE EVIDENCE REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

23. ASPARTAME 4Kcal/gram 180 TIMES SWEETER 20 TIMES MORE EXPENSIVE ADJUSTED SAFE BY FDA REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

24. XYLITOL Naturally occurring pentose alcohol that can be derived from various types of cellulose products ,such as wood, straw, cane pulp,or seed hulls Sweetness similar to that of sucrose Produces cooling sensation in the mouth When taken in excess it can produce diarrhea One gram xylitol yields 4 calories Xylitol is neither fermented nor utilized by streptococcus mutants REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

25. STUDIES Milgrom P, Ly K, Roberts MC, Rothen M, Mueller G, Yamaguchi DK. . (2006) In comparison to sorbitol and mannitol, at 5 weeks S mutans decreases 10X Milgrom P, Ly KA, Tut OK,  Mancl L, Roberts MC, Briand K,  Gancio MJ (2009) Xylitol oral syrup administered topically 2 or 3 times daily at a total daily dose of 8 g was effective in preventing early childhood caries . Lenkkeri AM, Pienihäkkinen K, Hurme S, Alanen P(2012) Use of xylitol/ maltitol or erythritol / maltitol lozenges did not result in caries reduction . Mäkinen KK, Bennett CA, Hujoel PP, et al(1995) xylitol-sorbitol mixtures were less effective than xylitol, but they reduced caries rates significantly compared with the no-gum group Lee W, Spiekerman C, Heima M, et al Xylitol consumption did not have additional benefit beyond other preventive measures

26. LIPIDS INDIRECT EVIDENCE THAT DIETARY FATS MAY HELP TO PREVENT CARIES E.G:ESKIMOS:WHOSE DIETS ARE SOLELY OF ANIMAL ORIGIN AND FURNISH ABOUT 70-80% OF THEIR TOTAL CALORIE AS FAT EXPERIENCE,HAVE VERY LITTLE DECAY MECHANISM : COATING OF TOOTH SURFACES WITH AN OILY SUBSTANCE WOULD MEAN THAT FOOD PARTICLES WILL NOT BE SO READILY RETAINED A FATTY PROTECTIVE LAYER OVER PLAQUE WOULD PREVENT FERMENTABLE SUGAR SUBSTRATE FROM BEING REDUCED TO ACIDS HIGH CONCENTRATIONS OF FATTY ACIDS MAY INTERFERE WITH GROWTH OF CARIOGENICITY INCREASED DIETARY FAT WILL DECREASE THE AMOUNT OF DIETARY FERMENTABLE CARBOHYDRATE NECESSARY FOR ORGANIC ACID FORMATION REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

27. PROTEINS ANIMAL STUDIES:PROTEIN DEFICIENT DIET FED TO EXPERIMENTAL ANIMALS DURING PRE ERUPTIVE TOOTH DEVELOPMENT PERIOD INCREASE CARIES SUSCEPTIBILITY HUMANS:SHOW NO DIRECT EVIDENCE AFTER TOOTH FORMATION:PROTEIN DEFICIENCY MEANS INCREASED INGESTION OF CARBOHYDRATES , NUTS,EGGS,MEAT AND SOME DAIRY PRODUCTS DO NOT DECREASE PLAQUE PH UNDER EXPERIMENTAL CONDITIONS:SCHACHTELE,1984 REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

28. PHOSPHATES REDUCTION OF ENAMEL SOLUBILTY BUFFERING EFFECT IN NEUTRALIZING SALIVARY,BACTERIAL,PLAQUE AND FOOD Ph VALUES REACTION WITH FAT,PROTEINS,AND CARBOHYDRATES TO EFFECT STRUCTURAL CHANGES RENDERING THEM LESS CARIOGENIC INTERFERENCE WITH MEMBRANE CONDITIONS OR ENZYMATIC PROCESSES ON ENAMEL SURFACES TO INCREASE HOST RESISTANCE DECREASE IN BACTERIAL ADHESION INTERFERENCE WITH SYNTHESIS OF EXTRACELLULAR POLYSACCHARIDE FORMATION MAINTENANCE OR INCREASE OF PLAQUE CALCIUM AND PHOSPHORUS LEVELS STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC FOUNDATIONS AND CLINICAL PRACTICE,1982

29. OTHER INHIBITING SUBSTANCES PYRODOXINE FAT TANNIC ACID ZANTHINES FIBROUS FOODS FOODS LIKE PEANUTS,FRUITS AND RAW VEGETABLES REQUIRE VIGOROUS MASTICATION WILL STIMULATE SALIVATION RAISING PLAQUE PH AND THE SALIVA WILL PROMOTE REMINERALIZATION TO HEAL THE INCIPIENT LESION . STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC FOUNDATIONS AND CLINICAL PRACTICE,1982

30. DIETARY FLUORIDE SUPPLEMENTS <0.3 ppm 0.3-0.6 ppm >0.6ppm BIRTH TO 6 MO 6 mo-3 yr 0.25 mg 3 yr-6 yr 0.50mg 0.25 mg 6 yr or later 1.00 mg 0.50mg P CASAMASSIMO,H FIELDS,D MCTIGUE,A NOWAK,PEDIATRIC DENTISTRY,INFANCY THROUGH ADOLESCENCE,5 th edition

31. MINERALS NAVIA’S CLASSIFICATION TYPES MINERALS CARIES PROMOTING ELEMENTS SELENIUM,MAGNESIUM,CADMIUM,PLATINUM,LEAD,SILICON MILDLY CARIOSTATIC MOLYBEDNUM,VANADIUM,STRONTIUM, CALCIUM,BORON,LITHIUM,GOLD DOUBTFULL EFFECT ON CARIES BERELLIUM,COBALT,MAGNESIUM,ZINC, BROMINE,IODINE CARIES INERT BARIUM,ALUMINIUM,NICKEL,IRON, PALLADIUM,TITANIUM STRONGLY CARIOSTATIC FLUORINE,PHOSPHORUS REF:R NIZEL,T PAPAS,NUTITION IN CLINICAL DENTISTRY,,1989

32. DIETARY RECOMMENDATIONS BY AAPD Breast-feeding of infants to ensure the best possible health and developmental and psychosocial outcomes, with careto wiping or brushing as the first primary tooth begins to erupt and other dietary carbohydrates are introduced. • Educating the public about the association between fre-quent consumption of carbohydrates and caries. • Educating the public about other health risks associated with excess consumption of simple carbohydrates, fat, saturated fat, and sodium. Furthermore, the AAPD encourages: • Pediatric dentists and other health care providers who treat children to provide dietary and nutrition counseling (commensurate with their training and experience) in conjunction with other preventive services for their patients. • Food and beverage manufacturers to make nutritional content on food labels more prominent and “consumer-friendly”. • Consumers to monitor the presence and relative amounts of carbohydrates and saturated fats as listed on food labels. Policy on Dietary Recommendations for Infants, Children, and Adolescents,REFERENCE MANUAL V 37 / NO 6 15 / 16,

33. School health education programs and food services to promote nutrition programs that provide well-balanced and nutrient-dense foods of low caries-risk, in conjunction with encouraging increased levels of physical activity. • Research, education, and appropriate legislation to pro-mote diverse and balanced diets. • Pediatric dentists and other health care providers to recommend or prescribe sugar-free medications whenever possible. • Educating parents of the risks of overdose from excessive consumption of candy-like chewable vitamin supplements Policy on Dietary Recommendations for Infants, Children, and Adolescents,REFERENCE MANUAL V 37 / NO 6 15 / 16,

34. RECOMMENDARY DIETARY ALLOWANCES(INDIAN) GROUP BODY WEIGHT (Kg) ENERGY (Kcal /day) PROTEINS(g/day) FAT (g/day) CALCIUM (mg/day) IRON (mg/ day) ZINC (mg/day) MAGNESIUM (mg/day) INFANTS 0-6 MNTHS 5.4 92/kg 1.16/kg 19 500 46MICROGRAM/KG 30 6-12 8.4 80/kg 1.69/kg 27 5 45 1-3 12.9 1060 16.7 25 9 5 50 CHILDREN 4-6YRS 18.0 1350 20.1 30 600 13 7 70 7-9 25.1 1690 29.5 35 16 8 100 BOYS 10-12 34.3 2190 39.9 35 21 9 120 GIRLS 10-12 35.0 2010 40.4 35 800 27 9 160 BOYS 13-15 47.6 2750 54.3 45 32 11 165 GIRLS 13-15 46.6 2330 51.9 40 800 27 11 210 BOYS 16-17 55.4 3020 61.5 50 28 12 195 GIRLS 16-17 52.1 2440 55.5 35 800 26 12 235

35. VIT C(mg/day) FOLATE (microgram/day) VIT B12 (microgram/day) RIBOFLAVIN (mg/day) NIACIN (mg/day) VIT B6 (mg/day) RETINOL B CAROTENE (microgram/day) THIAMINE (mg/day) INFANTS 0-6 MNTHS 25 25 0.2 0.3 710 micrgram /kg 0.1 350 0.2 6-12 0.4 650 microgram/kg 0.4 2800 0.3 1-3 80 0.6 8 400 3200 0.5 CHILDREN 4-6YRS 40 100 0.2-1.0 0.8 11 0.9 0.7 7-9 120 1.0 13 600 4800 0.8 BOYS 10-12 40 140 0.2-1.0 1.3 15 1.6 1.1 GIRLS 10-12 1.2 13 1.0 BOYS 13-15 40 150 0.2-1.0 1.6 16 1.6 1.4 GIRLS 13-15 1.4 14 600 4800 1.2 BOYS 16-17 40 200 0.2-1.0 1.8 17 1.6 1.5 GIRLS 16-17 1.2 14 1.0

36. VITAMIN D The enamel is the most mineralized substance in the body. It is made of calcium and phosphorus. Vitamin D plays an important role in absorption of calcium and phosphorus from the food that is consumed. Absorption of calcium and phosphorus helps improve the strength of the teeth and bones surrounding it. Also, receptors for vitamin D are found in cells of the immune system which binds to vitamin D and increases the production of antimicrobial protein which helps to fight against the bacteria that cause dental caries. The cells forming enamel and dentin, ameloblast and odontoblast respectively, has vitamin D receptors which help to reduce the risk of dental caries:Preetha Parthasarathy,2016 The analysis of data from controlled clinical trials suggested that  vitaminD  was a promising caries-preventive agent, which lead to a low-certainty conclusion that vitamin D may reduce the incidence of caries. PP Hujoel.,2013 Preetha Parthasarathy et al /J. Pharm. Sci. & Res. Vol. 8(6), 2016, 459-460

37. VITAMIN C  PAPPE E:a contribution to the prophylaxis of caries, to increase the intake of vitamin C [ascorbic acid] by the mother in pregnancy and continuously by the child after birth.  IN GUINEA PIG,ODONTOBLAST ATROPHY AND IRREGULAR DENTIN FORMATION,THUS MORE SUSCEPTIBILTY TO CARIES PAPPE, E. "Vitamin C and dental caries."  Zeitschrift fur Vitaminforschung  15 (1944): 367-387.

38. VITAMIN A VITAMINS A, HAS BEEN ASSOCIATED WITH ENAMEL HYPOPLASIA AND RELATED INCREASES IN THE SUSCEPTIBILITY OF THE TOOTH TO CARIES LESIONS DISTURBANCE WITH DIFFERENTIATION AND FUNCTION OF AMELOBLAST,ENAMEL FORM IS DISTURBED DCNA 2003

39. DIET COUNSELLING

40. DEFINITION giving advice on food selection based on the individual’s reason for liking or not liking certain foods. Counseling requires obtaining information as to why, when, where, what specific food are eaten ,how frequently and what feelings are experienced. NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

41. Objectives of Counseling The main objective of dietary counseling in pediatric oral health is caries prevention. Diet Counselling aims to help parents change their and their children’s dietary behaviours so that they choose diets with low or noncariogenic snacks, limit sweet foods to mealtimes and perform tooth brushing after sugar exposures. Diet Counselling – A Primordial Level of Prevention of Dental Caries. Dr. Girish V Chour , Dr. Rashmi G Chour , Journal of Dental and Medical Sciences, Volume 13, Issue 1 Ver. II (Jan. 2014), PP 64-70

42. 1. Correction of diet imbalance, that could affect the patients general health and sometimes reflect on his oral health. 2. Modification of dietary habits, particularly the ingestion of sucrose containing foods in forms, amt, and circumstances that cause caries formation. 3. Dietary recommendations must be realistic and always based on current dietary behaviours of the family .It is pointless to prescribe changes that a patient cannot or will not implement Additionally, modifications to the diet can only be made over time, aided by repitition and reinforcement. Diet Counselling – A Primordial Level of Prevention of Dental Caries. Dr. Girish V Chour , Dr. Rashmi G Chour , Journal of Dental and Medical Sciences, Volume 13, Issue 1 Ver. II (Jan. 2014), PP 64-70

43. DIET COUNSELLING DIRECTIVE OR NON DIRECTIVE DIRECTIVE COUNSELLING PATIENT IS PASSIVE DECISIONS ARE MADE BY THE COUNSELLOR NON DIRECTIVE COUNSELLING COUNSELLOR MERELY AIDS AND GUIDS THE PATIENT FINAL DECISIONS ARE MADE BY THE PATIENT NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

44. NUTRITIONAL COUNSELLING TECHNIQUES Direct approach – counseling technique that focuses on the dietary problem : Role of the patient – patient provides information on the diet; is passive and listens to the counselor. Role of the counselor – counselor controls the session; analyzes and evaluates the patient’s diet and makes recommendations for improvement. Advantages – easier for the counselor and often requires less time than a more patient-oriented approach. Limitations – fosters patient dependence; little chance of success if the patient is not committed to dietary changes.

45. Nondirect or behaviour modification approach – counseling technique that focuses on the patient Role of the patient – patient actively participates in the diet analysis, evaluation, and modification program. Role of the counselor – counselor provides information on the etiology of dental disease, the role of the diet, and the use of dietary assessment tools Method – Assumption – dietary habits are learned behaviors and can be unicamed and replaced with new behaviors. Collection of baseline data Patient takes ownership of the dietary problem and is committed to change. Patient determines the behavior changes and goals; develops own reward system to use when goals are met. Changes are gradually made in small steps; appropriate changes are rewarded and failures ignored. Close monitoring of progress until new behaviors become self-reinforcing. Advantages – Fosters patient independence; success is more likely since the patient is in control of the change process.

46. Five w and one h criteria WHO, WHAT, WHY, WHEN, WHERE AND HOW. WHO may be benefited? WHAT are the objectives of diet and nutrition counseling? WHY is counseling beneficial? WHEN is counseling conducted? WHERE should the counseling occur? HOW to counsel? Diet Counselling – A Primordial Level of Prevention of Dental Caries. Dr. Girish V Chour , Dr. Rashmi G Chour , Journal of Dental and Medical Sciences, Volume 13, Issue 1 Ver. II (Jan. 2014), PP 64-70

47. Patient Selection Diet counseling will not succeed with every dental patient. Dental health diet score – gives points earned as a result of adequate intake of foods from each of the food groups plus points for ingesting foods specially recommended NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

48. dental health diet score. Score of 60-100 is acceptable If the score is 56 or less diet counseling is indicated and recommended. NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

49. Instructions for calculating Dental Health Diet Score Step - I To ascertain the average daily intake list everything you eat and drink on an ordinary weekend including snacks. Lunch 12:00 Noon 4 oz tomato juice 1 chicken (3 oz) sandwich 1 slice of chocolate cake 1 cup of coffee with 1 tsp sugar P.M. Snack 2:00 P.M. 3:00 P.M. 1 breath mint 1 piece of sugarless gum. NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

50. Food Group Portion Size Considered One Serving Number of Servings Points MILK (milk and cheese) 8 oz (1 c) milk 1½ oz Cheddar cheese    x 8 = 24 (highest possible score = 24) Food Group Recommended Adult Servings Portion Size Considered One Serving Number of Servings Points MEAT 2 2-3 oz lean cooked meat, fish, or poultry 2 eggs _____ x 12 = 24 (highest possible score = 24) NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

51. Food Group Recommended Adult Servings Portion Size Considered One Serving Number of Servings Points FRUITS AND VEGETABLES (dark green and deep yellow fruits and vegetables) 1 ½ c cooked fruit or vegetable 1 medium raw fruit or vegetable _____ x 6 = ___ (highest possible score = 6) BREAD AND CEREALS (enriched or whole grain) 4 1 slice bread ¾ c dry cereal _____ x 6 = ___ (highest possible score = 24) TOTAL Score (Highest Possible = 96) NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

52. Step - II Circle the foods in the diary that have been sweetened with added sugar. Classify the uncircled foods into appropriate food groups. NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

53. NUTRIENT SCORE:STEP 3 ALL SCORED 7 PROTEIN CHEESE,MILK,MEAT PROTEIN AND NIACIN CHEEESE,DRIED BEANS,DRIED PEAS,EGGS,FISH,MEAT,MILK,NUTS,POULTRY ASCORBIC ACID BROCCOLI,GRAPEFRUIT,GREENS CALCIUM BROCCOLI,EGGS,MILK VITAMIN A APRICOTS,BROCCOLI,BUTTER,CANTALOUPE,CARROTS,COLLARDS,EGGS,GREENS,LIVER,MARGARINE,MILK,PEACHES,SQUASH,SPINACH,SWEET POTATOES IRON BEEF,BROCCOLI ,EGGS,GREEN LEAFY VEGETABLES,LIVER,OYSTERS,SARDINES,SHRIMP FOLIC ACID ASPARAGUS,BROCCOLI,CEREALS,KIDNEYS,LIVER,SPINACH,YEASTS NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

54. ALL SCORED 7 RIBOFLAVIN BROCCOLI,CHCKEN BREATS,EGGS,HAM,LIVER,MILK,MUSHROOMS,ORK,OKRA,SPINACH ASCORBIC ACID BROCCOLI,BRUSSEL SPROUTS,CANTALOUPE,GRAPEFRUIT,GREEN PEPERS,GREENS,ORANGES,RASPBERRIES,STRAWBERRIES,TOMATOES CALCIUM AND PHOSPHORUS BROCCOLI,CHEESE,EGGS,GREEN LEAFY VEGETABLES,MILK,ORANGES,STRING BEANS ZINC BEEF,LIVER,LOBSTER,OYSTER,SHRIMP NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

55. Step – IV Sweets Score Classify each sweet into liquid, solid and sticky or slowly dissolving. For each time a sweet was eaten, place a check in the frequency column. In each group add up the number of sweets eaten and multiply by the number provided. Add up all the points for the total score. NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

56. FORM FREQUENCY POINTS LIQUIDS SOFT DRINKS, FRUIT DRINKS,COCOA,SUGAR AND HONEY IN BEVERAGES,NONDAIRY CREAMERS, ICECREAM, GELATIN, DESSERT,FLAVOURED YOGURT, PUDDING, CUSTARD, POPSICLES -------*5= SOLID AND STICKY CAKE, CUPCAKES, DONUTS, SWEET ROLLS, PASTRY, CANNED FRUITS IN SYRUPS, BANANAS, COOKIES, CHOCOLATE CANDY, CARAMEL, TOFFEE, JELLY BEANS, OTHER CHEWY CANDY, CHEWING GUM, DRIED FRUIT, MARSHMALLOWS, JELLY, JAM -------*10= SLOWLY DISSOLVING HARD CANDIES, BREATH MINTS, ANTACID TABLETS, COUGH DROPS -------*15=

57. TOTALING THE SCORE FOOD GROUP SCORE 72-96 EXCELLENT 64-72 ADEQUATE 56-64 BARELY ADEQUATE 56 OR LESS NOT ADEQUATE SWEET SCORE 5 OR LESS EXCELLENT 10 GOOD 15 OR MORE WATCH OUT ZONE NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

58. GUIDELINES FOR COUNSELLING GATHER INFORMATION EVALUATE AND INTERPRET INFORMATION DEVELOP AND IMPLEMENT A PLAN OF ACTION SEEK ACTIVE PARTICIPATION OF THE PATIENT’S FAMILY FOLLOW UP TO ASSESS THE PROGRESS MADE NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

59. Communication techniques Three rules for achieving effective communication Keep eye-to-eye contact in the patient. Communication can be verbal or non-verbal. Interviewers non-verbal actions are helpful in helping the patient to change his behavior. Message must be adapted to the patient’s needs and level of understanding. NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

60. DIET COUNSELLING BEFORE COUNSELLING (1)EXPLAIN THE PATIENT THE REASON FOR COUNSELING (2)DENTAL HEALTH DIET SCORE (3)FOOD INTAKE – DIET DIARY THE COUNSELING VISIT 4) REASONS FOR DIET 5) EDUCATION ABOUT THE ROLE OF DIET IN DEVELOPMENT AND PREVENTION OF DENTAL CARIES 6) CARIOGENIC POTENTIAL OF DIET 7) ADEQUACY OF DIET LISTED IN FOOD DIARY NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

61. 8) DIAGNOSIS OF PROBLEM 9) DIET PRESCRIPTION 10) COMPARE OLD AND NEW DIET 11) SUMMARY 12) FOLLOW- UP NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

62. Motivating Patients to Modify Food Habits A person passes through four preliminary decision stages in changing a dietary pattern – e.g. If giving up a hard candy to prevent dental decay is used as an example, the stages can be illustrated as :- Awareness – Hard candies produce acid, which can cause my teeth to decay. Interest – May be I should give up the hard candies. Involvement – I definitely will give up hard candy. Action – I have given up hard candies. Habit – I haven’t had a hard candy in six months.

63. Motivation A study was conducted to compare the effect of a motivational interviewing counseling treatment with that of traditional health education on parents at high risk of developing dental caries. Parents of 240 infants aged 6-18 months were randomly assigned either a motivational interview (MI) or traditional health education. The results showed that the children in MI group had 0.71 new carious lesion while control group had 1.91 lesion and thus motivational intervening was concluded as a promising approach ( Weinstein P, Harrison R et al. Motivating patients to prevent caries in their young children. JADA vol 135, June 2004.)

64. Assessment of Dietary Habits Food Balance Sheet Weighing Method and Duplicate – Portion Technique Interview Methods Questionnaires Jee-Seon Shim  Kyungwon Oh and  Hyeon Chang Kim Dietary assessment methods in epidemiologic studies Epidemiol Health 2014; 36

65. Weighing Method and Duplicate – Portion Technique Most accurate data on food consumption are obtained by weighing. A special form of this method is the double portion method . Portions similar to those consumed are collected by the subjects and then analyzed by the investigator. Advantages . Amounts consumed can be recorded and analyzed more accurately, then by any other method. Jee-Seon Shim  Kyungwon Oh and  Hyeon Chang Kim Dietary assessment methods in epidemiologic studies Epidemiol Health 2014; 36

66. Disadvantages : Size of sample is limited. Potential risk that the person involved do not consume and buy all types of foods e.g. sweets that they normally do. Highly trained personnels are needed for supervision. Jee-Seon Shim  Kyungwon Oh and  Hyeon Chang Kim Dietary assessment methods in epidemiologic studies Epidemiol Health 2014; 36

67. Interview Method It is a new technique for collecting food consumption data. There are two variations of the interview method i.e. diet recall and diet history. In diet recall, food consumed by subject under survey during 1 or 2 days is recalled by interviewing. Jee-Seon Shim  Kyungwon Oh and  Hyeon Chang Kim Dietary assessment methods in epidemiologic studies Epidemiol Health 2014; 36

68. Interview Method It is a new technique for collecting food consumption data. There are two variations of the interview method i.e. diet recall and diet history. In diet recall, food consumed by subject under survey during 1 or 2 days is recalled by interviewing. Jee-Seon Shim  Kyungwon Oh and  Hyeon Chang Kim Dietary assessment methods in epidemiologic studies Epidemiol Health 2014; 36

69. TWENTY-FOUR HOUR DIETARY RECALL Interviewer collects data from the patient on all food consumed over a 24-hour period. Advantages (1) Requires 20 minutes for the interview (2) Allows nutrient analysis (3) Allows analysis of food group consumption (4) Allows sugar-intake evaluation Limitations (1) Requires a trained interviewer (2) Relies on the patient’s memory (3) Represents only 1 day of food consumption (4) Requires a nutrient data file on foods to analyze nutrients Jee-Seon Shim  Kyungwon Oh and  Hyeon Chang Kim Dietary assessment methods in epidemiologic studies Epidemiol Health 2014; 36

70. THREE TO SEVEN DAY FOOD RECORD OR DAIRY Patient keeps a record of food and eating times for 3 to 7 days Advantages (1) No interviewer required except to give directions on how to fill out the record (2) Allows for both nutrient and food-group analysis (3) Allows for sugar-intake evaluation (4) An average intake of several days may be more representative of the patient’s food intake than 1 day Limitations (1) Represents the food consumption of only the days included in the record. (2) Relies on the cooperation and ability of the patient to keep the record. Jee-Seon Shim  Kyungwon Oh and  Hyeon Chang Kim Dietary assessment methods in epidemiologic studies Epidemiol Health 2014; 36

71. Comparing a 7-day diary vs. 24 h-recall for estimating fluid consumption S onia Hernández-Cordero et al BMC Public Health 2015 15 :1031:7 DAY DIARY TO BE MORE CORRECT REPRODUCTION OF DIET THAN 24 HR RECALL

72. Food Group Portion size considered one serving 1 st day 2 nd day 3 rd day 4 th day 5 th day Average MILK (milk & cheese) 8 oz (1 cup) milk 1½ c cottage cheese | || ||| | || 2 MEAT (meat, fish, poultry, nuts, dry beans) 2-3 oz lean cooked meat, fish or poultry || | || | 1+ FRUITS and VEGETABLES (including citrus fruits, dark green and deep yellow vegetables) ½ c cooked 1 medium raw || | ||| ||||| 2 BREAD and CEREALS (Enriched Or Whole Grain) 1 slice bread ¾ c dry cereal ½ c cooked cereal, rice, noodles, macaroni ||||| ||||||| |||| |||||| ||| 4 FOOD DIARY

73. QUESTIONNAIRES It is identical with dietary history with the difference that no interviewer is needed. Questionnaires and relevant informations are given to the respondents, who fill in and written them. Jee-Seon Shim  Kyungwon Oh and  Hyeon Chang Kim Dietary assessment methods in epidemiologic studies Epidemiol Health 2014; 36

74. Methods for collecting data on food intakes Nutritional screening questionnaire Description – patient indicates frequency of sugar and food-group intake over a day or week. Advantages Can be filled out by the patient while waiting in the oral healthcare setting Requires 15 to 20 minutes to complete Allow analysis of food-group consumption Allows sugar-intake evaluation Limitations No nutrient analysis Relies on the patient’s memory

75. Nutritional Screening Questionnaire Name___________________ How many meals do you have a day? ________________ About what times are these eaten? __________________ Would you consider your appetite to be Good ___________________ Fair __________________ Poor __________________ How often do you eat between meals? Never ___________________ Occasionally ______________ Often _____________________ What foods do you usually eat between meals? ____________________ _____________________________________________________________

76. How often do you drink soft drinks, fruit drinks, or any other sweetened beverages? Never ___________________ Occasionally ______________ Often _____________________ (time / day) When do you drink these beverages? With meals ________________ Between meals ______________ At both / either time(s) _____________ How often do you drink coffee and / or tea ? Never ___________________ Occasionally ______________ Often _____________________ (cups/day) How do you drink your coffee/tea? With : Milk/ cream __________________ Sweetener ________________ (Specify the kind)

77. How often do you use gum and/or mints? ? Never ___________________ Occasionally ______________ Often _____________________ What brand do you use? How often do you use cough drops, throat lozenges, and/or antacid tablets? (Please circle which ones) Never ___________________ Occasionally ______________ Often _____________________ How often do you take vitamin or mineral supplements?? Never ___________________ Occasionally ______________ Often _____________________ What is your supplement? ___________________ (Specify the type of vitamins or minerals)

78. Are you presently on any special or restricted diet? Yes____ No ____ If so, what kind? _________________________________________ Never Times/day Times/week 10 a How often do you eat/drink milk, cheese, yoghurt, or other dairy foods? ________ ________ ________ b How often do you eat whole-grain or enriched breads, cereals, or pasta? ________ ________ ________ c How often do you eat cooked or raw vegetables? ________ ________ ________ d How often do you eat/drink citrus fruit or juice (orange, grapefruit, tomato)? ________ ________ ________ e How often do you eat one of the following carrots, pumpkin, sweet potatoes, greens, broccoli, spinach (or other dark yellow or green vegetable or fruit)? ________ ________ ________ f How often do you eat meat, fish, poultry or eggs? ________ ________ ________ g How often do you eat peanut butter, nuts, dried peas or beans, or soybean products? ________ ________ ________ h How often do you eat your meals in restaurants or fast-food places? ________ ________ ________

79. SUGAR CLOCK-JHONSON AND BIRKHED:1991 Advanced Dental Nursing, Robert Ireland,2 ND EDITION

80. SUGAR CLOCK Advanced Dental Nursing, Robert Ireland,2 ND EDITION

81. ELICITS FROM DIET HISTORY HOW MANY TIMES A DAY DOES THE CHILD EAT? IS THERE DIVERSED SELECTION OF FOODS?ARE MEALS WELL BALANCED? ARE RECOMMENDATIONS REGARDING THE FOUR BASIC FOOD GROUPS BEING SATISFIED? WHAT IF FREQUENCY OF SNAKCING? ARE FOODSS HIGH IN (REFINED) CARBOHYDRATES CONSUMED FREQUENTLY?ARE THEY CONSUMED DURING ,AFTER ,OR BETWEEN MEALS? ARE SNACK FOOD F THE KIND THAT DISSOLVE SLOWLY OR THAT ADHERE TO THE TEETH? P CASAMASSIMO,H FIELDS,D MCTIGUE,A NOWAK,PEDIATRIC DENTISTRY,INFANCY THROUGH ADOLESCENCE,5 th edition

82. Diet prescription to aid in dental caries prevention and control I. Evaluation of your diet suggests that The QUALITY of your diet can be improved by including : More milk More fresh fruit The BALANCE of your meals can be improved by including : Fruit juice at breakfast Milk at lunch Salad at dinner NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

83. II. Dental plaque and the decay-producing potential of your diet can be decreased by Eliminating these sugar-containing items : Hard candies and cough drops Chocolates and pastries Substituting the following non-plaque-promoting items : Toasted bread and butter Nuts, cheese curls, apples, oranges. NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

84. III. Eating pattern that improves quality of your diet : Breakfast One glass of orange juice One bowl of cold cereal and fresh fruit. Lunch Half grape fruit One serving cottage cheese One apple NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

85. Dinner Fresh fruit cup Salad One piece of bread Two lamb chops Frequency of eating between meals should be minimized and limited to : Nuts Crackers and cheese Milk Fresh fruits NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

86. THE INDAN PLATE Most food plans include three to four carbohydrate choices (45–60 carbohydrate grams) at each meal and one to two choices (15–30 carbohydrate grams) at each snack. Breakfast (4 choices) 1 egg 2 toast or roti (small) 1 teaspoon butter 1 ⁄2 cup juice 1 cup tea with milk Snack (2 choices) 4 crackers or 1 cookie, 3” (7.5 cm) 1 cup tea with milk INDIAN FOODS:IDC,2010

87. Lunch (4 choices) 2 chapatis (small) 1 cup dhal 1 ⁄2 cup yogurt, plain 1 cup curried cauliflower Dinner (4 choices) 11 ⁄3 cups basmati rice 4 ounces (120 grams) curried chicken 3 ⁄4 cup cucumber, tomato, y Yogurt salad (raita) 1 cup curried eggplant INDIAN FOODS:IDC,2010

88. THE IDEAL SNACK PHYSICAL FORM SHOULD STIMULATE SALIVATION SHOULD PRODUCE A MINIMAL AMOUNT OF INTRAORAL RETENTION CHEMICAL COMPOSITION: SHOULD INCLUDE A RELATIVELY HIGH PROTEIN AND LOW FAT CONTENT, MINIMAL FERMENTABLE CARBOHYDRATES, A MODERATE MINERAL CONTENT)PARTICULARLY CALCIUM,PHOSPHATE AND FLUORIDE) AN INHERENT pH ABOVE 5.5 ,SO AS NOT TO INCREASE ORAL ACIDITY, LARGE INHERENT ACID BUFFER CAPACITY DURING MASTICATION LOW SODIUM CONTENT NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

89. STUDY MORGAN AND LEVIELLE:SURVEYED SNACKING PATTERN OF 200 US CHILDREN:45.8% SNACKED.EACH CHILD CONSUMED 1.37 SNACKS PER DAY. ADDITIONAL NUTRIENTS NEED TO BE PROVIDED STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC FOUNDATIONS AND CLINICAL PRACTICE,1982

90. I. Acceptable Snacks From the Four Food Groups Milk Group : Milk, cheese – hard or soft varieties Meat Group : Turkey, chicken, nuts of all kinds, sunflower seeds Fruit & vegetable Group : Raw fruits like oranges, grapes, grapefruit, peaches, pears raw vegetables like carrots, celery, cucumbers, lettuce, salad greens and tomatoes Unsweetened fruit juices, tomato or vegetable juices Bread & Cereal Group : toast, pretzels II. Snacks to avoid Candy, mints cake, cookies pie, pastry, ice cream sundaes, caramel popcorn, candy apples, candy-coated gum. NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

91. MEAL AT SCHOOL Regarding meals at schools,the parent must work with school authorities to provide wholesome and nutritious meals that also have eye appeal for the child Parents should work with specific teachers to encourage use of appropriate snacks and party food for special occasion P CASAMASSIMO,H FIELDS,D MCTIGUE,A NOWAK,PEDIATRIC DENTISTRY,INFANCY THROUGH ADOLESCENCE,5 th edition

92. FOR CHILDREN AFTER AGE 6 MONTHS TILL 5 YEARS Breast-milk alone is not enough for infants after 6 months of age. Complementary foods should be given after 6 months of age, in addition to breast-feeding. Do not delay complementary feeding. Feed low-cost home-made complementary foods. Feed complementary food on demand 3-4 times a day. Provide fruits and well cooked vegetables. Observe hygienic practices while preparing and feeding the complementary food. MANUAL OF DIETARY GUIDELINES FOR INIDANS:NATIONAL INSTITUTE FOR NUTRITION

93. FOOD FOR CHILDREN ABOVE 5 YEARS AND ADOLESCENCE Take extra care in feeding a young child and include soft cooked vegetables and seasonal fruits. Give plenty of milk and milk products to children and adolescents. Promote physical activity and appropriate lifestyle practices Discourage overeating as well as indiscriminate dieting. recommended dietary allowances for calcium are about 600-800 mg/day below the age of 5 years should be given less bulky foods, rich in energy and protein such as legumes, pulses, nuts, edible oil/ghee, sugar, milk and eggs. Vegetables including green leafy vegetables and locally available seasonal fruits should be part of their daily menu. MANUAL OF DIETARY GUIDELINES FOR INIDANS:NATIONAL INSTITUTE FOR NUTRITION

94. MANUAL OF DIETARY GUIDELINES FOR INIDANS:NATIONAL INSTITUTE FOR NUTRITION

95. DIETARY SUBSTITUTES FOR INDIAN CHILDREN MANUAL OF DIETARY GUIDELINES FOR INIDANS:NATIONAL INSTITUTE FOR NUTRITION

96. MANUAL OF DIETARY GUIDELINES FOR INIDANS:NATIONAL INSTITUTE FOR NUTRITION

97. GENERAL PRINCIPLES FOR CARIES CONTROL AND PREVENTION LIMIT THE NUMBER OF EATING PERIOD TO THREE REGULAR MEALS PER DAY,STRESSING THE NEED TO AVOID BETWEEN MEAL SNACKS. INCERASE THE INTAKE OF PROTECTIVE FOODS SUCH AS VEGETABLES,FRUITS,MILK AND CHEESE,MEAT FISH AND LEGUMES WHICH ARE RICH IN MINERALS,VITAMINS AND PROTEINS. DECREASE THE TOTAL AMOUNT OF CARBOHYDRATES SO THAT THEY PROVIDE NO MORE THAN 50 % AND NO LESS THAN 30% OF CALORIES. IDEALLY,IT IS BEST TO WEAN THE PATIENT FROM THE TASTE OF SWEETS.RESTRICT THE CONSUMPTION OF SUGAR CONTAINING FOODS TO MEALS.COMPLETE ELIMINATION OF STICKY,CONCENTRATED SWEETS ESPECIALLY BETWEEN MEALS. NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

98. MINIMIZE SUGAR INTAKE IF ELIMINATION IS NOT FEASIBLE. LIBERAL USE OF TOOTH CLEANSING FOODS SUCH AS RAW FRUITS AND RAW VAGETABLES SO THAT THERE WILL BE SOME CLEARANCE OF FOOD DEBRIS AND STIMUALTION OF SALIVARY FLOW. RECOMMEND DRINKING AND COOKING WITHH FLUORIDATED WATER OR INGESTION OF FLUORIDE SUPPLEMENTS IF PATIENT LIVES IN A NON FLUORIDATED AREA FROM BIRTH TO 13 YEARS OF AGE. RECOMMEND USE OF FLUORIDE DENTRIFICE AND MOUTH RINSE. NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

99. MY PYRAMID AND MY PLATE DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE CHILD AND ADOLESCENT,10 TH EDITION

100. CONCLUSIONS THUS A BALANCED DIET IS VERY MUCH NECESSARY FOR CONTROL OF DENTAL CARIES.

101. REFERENCES STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC FOUNDATIONS AND CLINICAL PRACTICE,1982 DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE CHILD AND ADOLESCENT,10 TH EDITION NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION P CASAMASSIMO,H FIELDS,D MCTIGUE,A NOWAK,PEDIATRIC DENTISTRY,INFANCY THROUGH ADOLESCENCE,5 th edition

102. REFERENCES Prabhakar , A. R., Kurthukoti , A. J., and Gupta, P. (2010). Cariogenicity and acidogenicity of 20 human milk, plain and sweetened bovine milk: an in vitro study. J. Clin . Pediatr . Dent. 34, 239- 248 Southgate, D. A. T. (2000). Milk and milk products, fats and oils. In: Human nutrition and dietetics. (ed. JS Garrow , WPT James, A Ralph). Churchill Livingstone, Edinburgh, pp 375-383. Tanaka, K., Miyake, Y., and Sasaki, S. (2010). Intake of dairy products and the prevalence of dental caries in young children. J. Dent. 38, 579-583. Rugg -Gunn, A. J. (1993). Nutrition and Dental Health. Oxford University Press, Oxford.

103. REFERENCES Lingstrom , P., Johanes Van Houte , and Y. Shelby Kashket . "Food starches and dental caries."  Critical Reviews in Oral Biology & Medicine  11.3 (2000): 366-380. Policy on Dietary Recommendations for Infants, Children, and Adolescents,REFERENCE MANUAL V 37 / NO 6 15 / 16, Milgrom P, Ly KA, Tut OK, et al. Xylitol pediatric topical oral syrup to prevent dental caries: a double blind, randomized clinical trial of efficacy.  Archives of pediatrics & adolescent medicine . 2009;163(7):601-607. Mäkinen KK, Bennett CA,  Hujoel PP,  Isokangas PJ,  Isotupa KP, Pape HRJr ,  Mäkinen PL,J Dent Res. 1995 Dec;74(12):1904-13.Xylitol chewing gums and caries rates: a 40-month cohort study. Lenkkeri AM, Pienihäkkinen K, Hurme S, Alanen P. The caries-preventive effect of xylitol/ maltitol and erythritol / maltitol lozenges: results of a double-blinded, cluster-randomized clinical trial in an area of natural fluoridation.Int J Paediatr Dent. 2012 May;22(3):180-90. Leme AFP, Koo H, Bellato CM, Bedi G, Cury JA. The Role of Sucrose in Cariogenic Dental Biofilm Formation—New Insight.  Journal of dental research . 2006;85(10):878-887.

104. REFERENCES PP Hujoel.Vitamin D and dental caries in controlled clinical trials: systematic review and meta- analysis Nutrition Reviews 2013; 71(2): 88-97. PAPPE, E. "Vitamin C and dental caries."  Zeitschrift fur Vitaminforschung  15 (1944): 367-387. Diet Counselling – A Primordial Level of Prevention of Dental Caries. Dr. Girish V Chour , Dr. Rashmi G Chour , Journal of Dental and Medical Sciences, Volume 13, Issue 1 Ver. II (Jan. 2014), PP 64-70 Weinstein P, Harrison R et al. Motivating patients to prevent caries in their young children. JADA vol 135, June 2004.) S onia Hernández-Cordero Comparing a 7-day diary vs. 24 h-recall for estimating fluid consumption BMC Public Health 2015 15 :1031:7