Diet and dental caries: human studies

Relationship between the type of food, frequency of intake and various cariogenic and non-cariogenic factors which influence initiation and progression of caries have been studied over the years.

1. DIET AND DENTAL CARIES – HUMAN STUDIES R.K.HARITHA

2. CONTENTS 2

3. INTRODUCTION Multifactorial disease Cariogenicity of dietary carbohydrates Frequency Duration Physical form Chemical composition Nutrient content No scientific proof

4. CLASSIFICATION 4

5. VIPEHOLM STUDY Gustaffson et al 1954 Davies 1955 5

6. PARTICIPANTS DIET CARIES ACTIVITY CONTROL GROUP 60 males Low carbohydrate, high fat diet - 2yrs After 2 yrs, replaced with normal diet + 110gms of sugar a day at meals Completely suppressed Small but significant rise SUCROSE GROUP 57 males 300gms of sucrose in sol. at meals – 2yrs After 2yrs, 75gms of sucrose in sol. at meals No significant increase in increment BREAD GROUP 41 males 42 females 345gms of sweet bread (=50gms of sugar) with afternoon coffee – 2yrs After 2yrs, 4 portions of sweet bread with all meals No demonstrable increase Significant increase M>F CHOCOLATE GROUP 47 males 300gms of sucrose in sol. At meals – 2yrs 110gms of sucrose in sol. + 65gms of milk chocolate b/w meals – 2yrs Low caries Significant increase CARAMEL GROUP 62 males First 2 yrs-control yrs 3 rd yr – 22 caramels 2 portions b/w meals 4 th yr – 22 caramels 4 portions b/w meals Isocaloric quantity of fat with meals Completely suppressed Significant increase Significant increase Fall in caries increment 8 TOFFEE GROUP 40 males 1 st yr – control yrs 2 nd yr – 8 toffees a day with breakfast & lunch Completely suppressed Significant increase 24 TOFFEE GROUP 48males 24 toffees b/w meals in 3 rd & 4 th yr 5 th yr - withdrawal Greatest increase Sharp drop 6

7. ROLE OF DIETARY SUGARS IN DENTAL CARIES 7

8. CONCLUSION CARIES INCREASE with Increase in consumption of sugar Increase in consumption of food with strong retentive property Increased risk if sugar is consumed between meals Varies from individual to individual CARIES DECREASE with Withdrawal of sugar-rich foods Maximum restriction of natural sugars & carbohydrates 8

9. HOPEWOOD HOUSE STUDY Sullivan and Harris 1942-1967 9

10. DIET Lactovegetarian diet - Rich in milk products & vegetables Whole wheat, soyabeans & nuts Mostly uncooked Poor in cheese, sugar & refined carbohydrates Low F in drinking water 10 PARTICIPANTS Hopewood house, New South Wales, Australia 82 genetically heterogenous children Followed upto 13 yrs of age

11. FINDINGS Significant caries reduction Exposed to normal diet after 13 yrs  same caries experience as other State schools  no special protection 11

12. TURKU SUGAR STUDY Scheinin & Makinin 1972-1974 Finland

13. Participants: 125 subjects of all age groups Objectives: To find out the effect of diet (totally sucrose free) on dental caries increment 3 Groups: 1 st group (35) – Chewing gums containing sucrose 2 nd group (38) – Chewing gums containing fructose 3 rd group (52) – Chewing gums containing xylitol 13

14. FINDINGS Dramatic reduction in dental caries after 2 yrs – Xylitol group Caries reduction: Xylitol > Fructose 14

15. TRISTAN DA CUNHA STUDY Holloway et al

16. 16

17. HEREDITARY FRUCTOSE INTOLERANCE 17

18. DURING WORLD WAR II 18

19. CONCLUSION STUDIES FINDINGS VIPEHOLM STUDY Caries increase Caries decrease Increase consumption of sugar Consumption of sticky food Consumption between meals Varies from individual to individual Withdrawal of sugar rich foods with maximum restriction of natural sugars & carbohydrates HOPEWOOD HOUSE STUDY Significant caries reduction on diet restriction inspite of poor oral hygiene & low F consumption No special protection TURKU SUGAR STUDY Caries prevalence Sucrose > Fructose > Xylitol ( anticariogenic ) TRISTAN DA CUNHA STUDY Caries increase on consumption of refined carbohydrates HEREDITARY FRUCTOSE INTOLERANCE Avoiding fructose & sucrose reduces dental caries WORLD WAR II Caries increase on consumption of refined carbohydrates 19

20. REFERENCES SS Hiremath Textbook of Public Health Dentistry 3 rd edition, Elsevier publication Gustafsson , B. E., Quensel , C. E., Lanke , L. S., Lundqvist , C., Grahnen , H., Bonow , B. E., et al. (1954). The  Vipeholm  dental caries study; the effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years Soben Peter Essentials of Public Health Dentistry 6 th edition, Arya publishers  Harris, R. (1963). Biology of the Children of Hopewood House, Bowral , Australia. 4. Observations on Dental-Caries Experience Extending over Five Years (1957-61) Scheinin , A., Makinen , K. K., & Ylitalo , K. (1976). Turku sugar studies. V. Final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man.  20 THANK YOU