1. Presented by,
Dr.Shivashankar.K
2nd year P.G.
Dept. of Public Health Dentistry
Nutrition in Dental caries
and Periodontal diseases

2.  Introduction
 Carbohydrate and dental caries
 Protein and dental caries
 Fat and dental caries
 Calcium phosphate and dental caries
 Vitamins and dental caries
 Trace elements and dental caries
 Diet in the etiology of dental caries
 Diet and periodontal disease
 Protein and periodontal disease
 Fat and periodontal disease
 Vitamins and periodontal disease
 Diet in the etiology of periodontal disease
 Diet counselling for periodontal diseases
 Recent studies
 Conclusion
 References
CONTENTS

3. INTRODUCTION

4.  The science which deals with the study of nutrient and foods
and their effects on the nature & function or organism under
different condition of age, health & disease.
-NIZEL 1989
 Nutrients are defined as the constituents of food, which
perform important functions in our body
 Macro and Mirco nutrients
NUTRITION

5.  Nizel (1989): Total oral intake of a substance that provides
nourishment & supply.
BALANCED DIET :
 One providing each nutrient in the (neither deficient nor
excess) needed to maintain optimum health.
- Stewart
DIET

6. EFFECT OF DIET ON ORAL HEALTH
Systemic mechanism
Absorption and circulation
of nutritents to cells and
tissues
These effects are
mediated locally
Local mechanism
Development of teeth,
quality and quantity of
salivary secretion
Influence the metabolism
of oral flora

7. DIET AND DENTAL CARIES

8. DENTAL CARIES

9. INFLUENCE OF NUTRIENT ON TOOTH DEVELOPMENT
AND SUBSEQUENT CARIES FORMATION

10. CLASSES OF NUTRIENTS
 Carbohydrates – Body
fuel
 Lipids – body cushion
 Proteins – body
builder
 Vitamins – director of
cell processes
 Minerals – regulators
of body fluids
 Water – vital for life

11. CARBOHYDRATES AND DENTAL CARIES

12. PROCESS OF CARIES FORMATION

13. 1. Frequency of eating:
 Vipeholm study showed that frequency of consumption of sugars and the oral
clearance time for sugars are important factors affecting cariogenicity.
 In a study of more than 1000 children in USA, indicated that the
frequency or between meal snacks of candies, cookies, chewing gum or
carbonated beverages correlated with the DMF rates (Weiss et al 1960)
 When sucrose is ingested frequently even a relatively low concentration of
1.25% will cause a pH drop between 4 and 5.
FACTORS INFLUENCING CARIOGENICITY OF
SUCROSE IN DIETS

14. • A significant correlation was found between a high sugar concentration in
saliva with a prolonged clearance time and caries activity (Lundquist, 1952).
• This finding implies that retentive, sticky, sweet foods with little
detergency or self cleaning properties may be potentially more cariogenic
than foods that detergent and rapidly clear the oral cavity.
ORAL CLEARANCE RATE

15.  The availability of sucrose for support of bacterial metabolism in plaque
which is influenced by the texture, consistency of food, the stimulation of
saliva by chewing and the rapidity of clearance of the substrate.
 With the advent of highly concentrated processed canned sugar the level of
sucrose consumption as well as concentration of sucrose in food item
increased dramatically.
EFFECTIVE CONCENTRATION OF SUCROSE

16. • Many oral bacteria utilize sucrose, glucose, fructose and other simple
sugars to produce organic acids (Lactic, acetic, propionic)
• It is only from sucrose that most bacteria are able to synthesize both
soluble and insoluble extracellular polymers (dextrans and mutans) which
increase the bulk of plaque and facilitate the attachment of bacteria,
especially streptococcus mutans.
Sucrose a Unique Substrate for
Cariogenic Flora

17. The concentrated and complex mixture of bacteria and plaque give
rise to a wide variety of glycolytic products which cause pH to drop.
STEPHAN (1940) using many microelectrodes, recorded the pH values
of dental plaque in situ before, during, after a glucose rinse.
pH CHANGES IN PLAQUE FROM FOODS

18. DIETARY STUDIES IN HUMAN POPULATION

19. Artificial sugar substitutes
Sorbital
Xylitol
Aspartame
Saccharine
Cyclamate
 Food aditives
REDUCING THE CARIOGENICITY OF THE
DIET

20.  A protein deficient diet fed to
experimental animals during
the preeruptive tooth
development period increases
their caries susceptibility
(Navia J. et al 1970). The
caries may be caused either by
a quality defect in the matrix
of the tooth enamel or equally
important by alteration in the
salivary gland.
PROTEIN AND DENTAL CARIES

21. Caries in rodents have been reduced significantly by adding
casein to an otherwise cariogenic diet. Since casein is a
phospho-protein, it is possible that phosphate in this protein
compound may have exerted some anti cariogenic effect.
Several animal studies show that the aminoacids such as
lysine and glycine help prevent caries (Nizel et al 1970 ;
McClure et al 1955; Harris et al 1967).
PROTEIN AND DENTAL CARIES

22.  There is indirect evidence that dietary
fats may help prevent caries in
humans. For example those Eskimos
whose diets are almost solely of
animal origin and furnish about 70-
80% of their total calories as fat
experience less decay. It is only when
the fat content of the diet is reduced
to 25% or less that decay starts to
appear.
FATS AND DENTAL CARIES

23.  Coating
 fatty protective layer
 interfere with the growth
 decrease the amount
MECHANISM OF ACTION OF FAT

24.  It has been observed that cheese and butter reduce
the cariogenicity in rats. Ingestion of cheddar
cheese caused the pH raise of buccal plaque (Rugg-
Gunn et al 1975).
 The mechanism of the effect of cheese in raising the
plaque pH is still uncertain but one possibility is that
the bicarbonates in the alkaline saliva secreted in
response to cheese ingestion diffuses into plaque
and neutralizes the acids.
 An additional anticaries action of cheese is that
calcium and phosphate ions are extracted from it
during mastication and enter plaque thus reducing
demineralization and favoring remineralization
CHEESE AND DENTAL CARIES

25.  In Vitamin A deficient animals, atrophic
changes in the ameloblasts, subsequent
abnormalities in tooth morphology has been
observed.
 In man severe Vitamin A deficiency during
tooth formation does not necessarily lead to
defective enamel.
 The only member of the Vitamin B complex
which has been associated with caries is
pyridoxine (Vitamin B6) very high doses (10
times > than normal) have been reported in two
small scale experiments in human subjects
(pregnant and school children) to reduce
caries. (Cole et al 1980).
VITAMINS AND DENTAL CARIES

26. TRACE ELEMENTS AND DENTAL CARIES
Caries promoting elements : Selenium, magnesium, Cadmium, Platinum,
Lead, Silicon.
Elements that are mildly cariostatic : Molybdenum, Vanadium, Strontium,
Calcium, Boron, Lithium, Gold.
Elements with doubtful effect on caries : Beryllium, Cobalt, Manganese, Tin,
Zinc, Bromine, Iodine.
Caries inert elements : Barium, aluminium, nickel, iron, palladium, titanium.
Elements that are strongly cariostatic : Fluorine, phosphorous.

27. Fluoride :
Water borne fluorides which originally were observed to cause
an unattractive discolouration and deformity to tooth enamel,
when ingested at level above 2 ppm, later were proved to be
essential of dental health because they reduced the incidence
of dental decay when ingested daily at optimum levels of 1
ppm.
Fluoride acts to reduce dental decay
TRACE ELEMENTS AND DENTAL CARIES

28. Diet chart
 A diet history concerning food intake patterns, diet adequacy,
consumption of fermentable carbohydrates (including
naturally occurring and added sugars), and the use of
fluoridated toothpaste is a strategy for health professionals to
use to determine the diet related caries risk habits of
persons.
DIETARY MANAGEMENT

29.  What food was eaten?
 How much was eaten?
 How was it prepared?
 How was it served?
DIET RECALL

30. EDUARDO BERNABÉ ET AL. JOURNAL OF DENTISTRY 2014
 Data from 939 dentate adults who participated in the Health 2000
Survey and the Follow-Up Study of Finnish Adults’ Oral Health
showed a
Adults drinking 1–2 and 3+ sweetened beverages
daily had, respectively, 31% and 33% greater net DMFT
increments than those not drinking any sugar sweetened
beverages.
 Clinical significance:
in adults.

31. Exploring the relation between body mass index, diet, and dental caries among 6-12-year-old
children
Elangovan A, Mungara J, Joseph E Department of Pedodontics and Preventive Dentistry,
RagasDental College and Hospital, Chennai, Tamilnadu, India
Background and Aim: Childhood overweight and obesity are becoming a major public health concern all over the
world. Change in lifestyles and economic growth have led to sedentary lifestyle and altered dietary patterns. There
are conflicting reports in the literature regarding the association between body mass index (BMI) and dental
caries from various parts of the world. The aim of the present study was to determine if there is an association
between BMI-for-age and dental caries in children and to find out the role of diet with respect to BMI-for-age and
dental caries. Materials and Methods: Demographics and anthropometric measurements were obtained for 600
children and BMI-for-age was calculated. Clinical examination for dental caries was carried out following WHO
criteria. A diet recording sheet was prepared and children/parents were asked to record the dietary intake for 3
days. Data obtained were statistically analyzed using Chi-square, analysis of variance (ANOVA), and multiple linear
regression. Results: After excluding improperly filled diet recording sheets, 510 children were included in the
study. Caries prevalence was more in obese children than in other BMI groups. Caries scores increased as
BMI-for-age increased, though this was not statistically significant. Consumption of fatty foods and snacks was
more with obese children compared to other groups. A correlation was found between caries and snacks.
Conclusion: Dental caries scores showed no relationship between BMI-for-age in children. Both snacks and fatty
food items were consumed more by obese children, which seeks attention.

32. DIET AND PERIODONTAL DISEASE

33.  Glucose and other carbohydrates are also used to produce
extracellular polysaccharides and, therefore, diets containing
sucrose, glucose and other disaccharides can increase the
plaque mass and facilitate the retention and colonization of
the plaque biofilm which forms a substrate for bacteria to
grow leading to periodontal diseases.
-Boyd (2003)
EFFECT OF DIET ON PERIODONTAL HEALTH

34. By interfering with the
A) integrity of gingival epithelial barrier.
B) tissue repair processes.
C) resistance mechanisms of the body.
NUTRITIONAL DEFICIENCIES CONTRIBUTES TO
PERIODONTAL DISEASE

35.  The rapid rate of turnover of epithelium cells of the gingival sulcus
indicates need for continuous synthesis of DNA and RNA and tissue
protein.
 This means that the sulcular epithelium has a high requirement for
nutrient such as folic acid, and protein, which are involved in cell form. To
maintain the integrity of the epithelium vitamin A is also needed.
 At the base of the sulcular epithelium is a narrow basement membrane
made up of collagen….acts as a barrier against the entrance of toxic
meterials into the underlying connective tissue.
NUTRITION AND EPITHELIUM BARRIER

36.  Protein and ascorbic acid are intimately involved in connective tissue
formation .
 Zinc seems to have the property of accelerating wound healing, of
which may be due to anti infective action. Since epithelium tissue
contains 20% of the body's zinc and since zinc is involved in the
healing process, it follows an adequate intake of foods that are good
zinc sources can be helpful.
 Calcium : Phosphorus are important nutrients for promoting density of
alveolar bone.
NUTRITION AND THE REPAIR PROCESS

37.  Protein deficiency impair the body's immune mechanism, they
interfere with antibody formation, activity of the cell that ingest
bacteria, and nonspecific resist factors.
 Protein deficiency diets interfere with body's formation of
immunoglobulin that act as antibodies to toxins. Consequently,
infections will not be readily controllable.
NUTRITION AND IMMUNE MECHANISM

38. EFFECTS OF FOOD TEXTURES ON PERIODONTAL
HEALTH

39. Glucose and other carbohydrates are also used
to produce extracellular polysaccharides and,
therefore, diets containing sucrose, glucose
and other disaccharides can increase the
plaque mass and facilitate the retention and
colonization of the plaque biofilm which forms
a substrate for bacteria to grow leading to
periodontal diseases. -Boyd (2003)
Research studies using an experimental gingivitis
model have shown increased levels of bleeding on
probing when participants were fed with a diet
high in carbohydrates when compared to those on
a low sugar diet
Carbohydrates and periodontal health

40.  The epithelium of the gingival crevice or pocket
adheres to the tooth surface by physiochemical
forces mediated by the proteins and glycoproteins
in the gingival fluid.
 When a foreign body is introduced into the
periodontal pocket in a protein – deficient animal,
the resorption of alveolar crest, the down growth
of the epithelial attachment, and the
inflammatory exudate are increased.
Role of protein on periodontal tissue

41. Periodontal tissues of the gingival crevice or
pocket adheres to the tooth surface mucoproteins
are essential for the maintenance of a regular
distribution of water and electrolytes in the tissues.
Collagen deficiencies in connective tissue may be
due to any of three factors:
1) An inability of fibroblasts to synthesize collagen
(owing to a deficiency in amino acids, such as in
proline and lysine)
2)Failure of soluble collagen to form insoluble
fibers
3)Degeneration of collagen by collagen-liquifying
enzyme derived from Bacteroides melaninogenicus,
an anaerobic organism associated with periodontal
disease
Protein in the biochemistry periodontal tissues

42.  Vitamin A deficiency produces
hyperkeratosis and hyperplasia of
gingival tissue. There is a tendency to
periodontal pocket formation.
 A suitable antimetabolite of vitamin K
might interfere with the growth of
Bacteroides Melaninogenicus and
consequently, prevent the occurrence
of periodontal disease.
 The characteristic oral sign of Vitamin
C deficiency is scurvy which results in
enlargement of the marginal gingivae
that envelopes and almost completely
conceals the teeth.
EFFECTS OF VITAMIN DEFICIENCY ON
PERIODONTIUM

43.  Animal studies show that ascorbic
acid may be involved in both the
pathogenesis and severity of NUG
through its act on collagen synthesis
and its effect on neutrophils of the
immune system
 Thus, nutritional factors do not
cause periodontal disease directly,
but can play an important role in
healing. In turn, periodontal
conditions and their treatment may
impair the desire and ability to eat
and contribute to poor nutrition.
Necrotizing Ulcerative Gingivitis /Periodontitis

44. 1)History- includes general and oral hygiene habits, socioeconomic status,
and food likes and dislikes is necessary to understand the reasons for tood
choices and dietary practices.
2)Dietary screening – screening the adequacy of the diet is to use the dental
health diet score.
3)Dietary prescription - a)Daily food pattern
Dietary management of ANUG/NUP

45. Dietary management of ANUG/NUP
b)Frequency of meals:
c) Menu plan:
Vegetable-fruit group
Bread-cereal group
Milk-cheese group
Meat-poultry,fish and bean group
4)Vitamin supplementation- multivitamin combination (vitamin c and B-complex)

46.  Step 1 :Ascertain the dental health diet score and if necessary,
demonstrate the method for keeping a food intake diary
 Step 2 :explain the nutrition-periodontal relationship
 Step 3 : Assess nutritional status
 Step 4 : Prescribe a diet –improve adequacy of diet
 Emphasize foods that are particularly beneficial to periodontal tissue-
proteins,vit C,A,folic acid,calcium,iron and zinc
 Encourage the elimination of plaque forming sweets and substitution of
fibrous foods
 Allow the patient to prescribe meal.
 Step 5 :Follow up
NUTRITION COUNSELLING FOR A PATIENT WITH
CHRONIC PERIODONTITIS

47.  The National Health and Nutrition Examination Survey (NHANES) is a
program of studies designed to assess the health and nutritional status of
adults and children in the United States.
 NCHS (national centre for health statistics) is part of the Centers for
Disease Control and Prevention (CDC) and has the responsibility for
producing vital and health statistics for the Nation.
 The NHANES interview includes demographic, socioeconomic, dietary, and
health-related questions.
 The examination component consists of medical, dental, and physiological
measurements, as well as laboratory tests.
EPIDEMIOLOGICAL SURVEYS

48. CONCLUSION

49. REFERENCES
Park K. Park’s Textbook of Preventive and Social Medicine, 21st Edition, Banarsidas Bhanot,
2007, Pg: 438 – 487.
Abraham E. Nizel. The science of nutrition and its application in clinical dentistry 2nd edition, W,
B Saunders Company, Philadelphia 1966.
Paula J. Moynihan. The role of diet and nutrition in the etiology and prevention of oral diseases
.Bulletin of the World Health Organization (BLT). Volume 83, Number 9, September 2005, 641-
720
Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental diseases. Public Health
Nutrition. 7(1A): 201–26
Elangovan A, Mungara J, Joseph . Exploring the relation between body mass index, diet, and
dental caries among 6-12-year-old children .J Indian Soc Pedod Prev Dent. 2012 Oct-
Dec;30(4):293-300

50.  Eduardo Bernabé et al. Sugar-sweetened beverages and dental caries in
adults: A 4-year prospective study . Journal of dentistry 2014.
 Kum Sun Lee, Nam-Joong Kim, Eun-Hee Lee, Ja-Won Cho. Cariogenic
Potential Index of Fruits according to Their Viscosity and Sugar Content. Int
J Clin Prev Dent 2014;10(4):255-258
 Paula J. Moynihan. The role of diet and nutrition in the etiology and
prevention of oral diseases . Bulletin of the World Health Organization
(BLT). Volume 83, Number 9, September 2005, 641-720
REFERENCES