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Sugar- The only Culprit?… have another Coke…

Hidden Sugars

Coca Cola

Sweet Tea

Mt. Dew

Fermentable Carbohydrates

FACTS…Kids and teens are more susceptible to decay because enamel is not mature or fully formed

12- 19 yr old boys who drink soft drinks consume an average of 81 gallons of sugar a year. Girls the same age drink and average of 61 gallons of sugar -- that means 750 cans per year EACH!

It takes two hours of moderate walking to burn off the calories in one 20 oz. soft drink

Soft drinks have no nutritional value. That’s why they are often referred to as “liquid candy” “sugar water” or “wasted –empty calories”

Teens get 13 percent of their calories from carbonated and non-carbonated soft drinks

Other Facts• Soda does not really quench your thirst;

in fact the chemicals present in soda can result in lack of moisture in the body

• Soda has caffeine & sugar so excessive intake could lead to craving for more

• Children respond to caffeine in a much more “exaggerated” way than adults and can literally have an overdose reaction

How Acidic are the drinks you drink?

The pH of regular and diet pop ranges from 2.47-3.35The PH in our mouth is normally about 6.2 to 7.0

(slightly more acidic than water)At a PH of 5.2 to 5.5 or below the acid begins to

dissolve the hard enamel of our teeth http://www.youtube.com/watch?v=SWKB_6lwcx4&f

eature=related

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Acidic

Alkaline

Unsweet no lemon tea (contains fluoride)

GERD

Acidity of Different Types of Drinks

Choc milk PH 7.1!!Diet snapple w/ lemon more acidic than regular 2.5

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“SIP ALL DAY….. GET DECAY” & EROSION!

Hard Facts• Diet or "sugar-free" pop STILL contains acid- just not sugar & still

stimulates cravings• Acid in soft drinks, whether they contain sugar or not, is the primary cause

of weakening tooth enamel (also dulls luster)• Each acid attack lasts about 20 minutes (before neutralized)• The acid attack starts over again with every sip• Bacteria in your mouth cause cavities when tooth enamel is damaged• If you have a receding gum line, acid does more damage below the gum

line than above it. This is particularly a concern for adults– because cementum is weaker than enamel and the acid level does not have to be as “potent” to cause decay

• Estimated 20% of children <2 years old drink soft drinks regularly

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“SIP ALL DAY….. GET DECAY” & FATTER

Fruit vs. sugary drinks - 60 Minutes - CBS News

Soda Substitutes

What to do to reduce decay from soft drinks

Drink soft drinks on rare occasions Don't sip for extended periods of time –

drink all at once (don’t buy ones with re-sealable lids)

Use a straw After drinking, swish your mouth out with

water (tums?) – not proven technique Avoid before bed Read labels! Use fluoride– if higher acid/sugar intake =

need higher fluoride intake/concentrations Drink with a meal instead of alone Eat with neutralizing foods

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Role of Nutrition in Caries

Mutans Streptococci

Including Fermentable carbs

lactobacilli

Simple enough?

BIOFILM

Food or drinkFermentable carbs

EROSION

Sugars-- caries potential= YES

Monosaccharide- glucose, dextrose (most foods) fructose, corn syrup (candy, soft drinks, fruit drinks, nondairy creamers)

Disaccharide- sucrose (fruits/veg/table sugar), brown sugar, turbinado (raw), molasses (breads/waffles), honey, lactose (milk, baked goods, whip top), maltose (beer)

Other carbs- polysaccharides (starch- potatoes, grains, breads, rice, bananas, legumes)

See Harris p. 317

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Factors That Hinder or Enhance Caries

Protective minerals-healthy enamel & ACP?

Fluoride Calcium/phosphorus in saliva Good home care Xylitol Sealants Good nutrition (especially

firm texture foods)

Frequency of eating Physical form- consistency/retention/rate of clearance Sequence of foods Type of food Time eaten

Do they Hinder or Enhance?

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Always a “balance” & can change at different periods in life

Need susceptible host & biofilm

Key Terms to Know….

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Cariostatic Cariogenic Anticariogenic Acidogenic Clearance time Non cariogenic Nutrient dense

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Harris p. 302

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**Readily lower pH in mouth= predictive to caries

Good choices!

Harris p.303

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Cariogenic Foods & Biofilm pH

Frequency a HUGE factor in caries (not quantity)

20 minutes a part- see Wilkins p. 513

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Neutralizing the Acid• Cheese• Nuts/PB• Meat, Chicken, and Fish• Raw Vegetables• Beans• Milk, eggs, plain yogurt• Water• Popcorn• Butter/margarine

*If consumed with or after sugary food/drinks, these products may help to neutralize the acid produced or accelerate the clearance from the mouth

23Hidden sugars?

Reading food labels

MY FITNESS PAL APP

10% Desired weight

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Other Sweeteners

Polyols• Sorbitol• Mannitol• Xylitol

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What’s all this about?

XYLITOL

XYLITOL

Interferes with MS metabolism Stimulates saliva =reduces decay Helps with clearance & xerostomia

*recommend gum with xylitol– should be one of 1st ingredients -- check the labels!

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Other Sweeteners

Intense “True” artificial sweeteners

• Saccharin• Aspartame• Cyclamate• Sucralose• Others…..FDA Approval?

What about PKU?

STEVIA

Safety concerns?

http://www.youtube.com/watch?v=3M2krP3SXNU

http://www.youtube.com/watch?v=A-hUyw2lcio

Dr OZ

Avoiding the “roller coaster ride”

effects moods!

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Purpose & Objectives for the Dental Dietary Assessment & Counseling

Allows the patient an opportunity to see own eating & snacking habits (take ownership)

Identify whether patient is meeting daily requirements (myplate)(do 1st) Find ways to incorporate missing foods

(offer specific suggestions- not just “you need more veggies”)2nd Identify frequency, consistency of diet, cariogenic potential of diet

Provide individual recommendations 3rd offer general suggestions based on Dietary recommendations

**referral if needed

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We are in NO way an expert!

?????!!!!

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Forms Used for Assessment

• Carbohydrate Intake –Short form noted as “Dietary planning”

• 3 Day Diet (w/instructions and nutritional assessment sheet)- “Nutritional Counseling”

For different reasons– don’t do both on one person!

Let’s look at Carb intake

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Considerations # of servings in each group- is it adequate? # of Cariogenic foods - have pt circle first in RED Consistency of diet Frequency (Snacking?) Retention time of foods chosen Multiple nutrient dense foods? Sequence of foods eaten & times (skipping meals?)

Get some help!

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Goal Diet (Adults)

Total Carbohydrates 45-65% (<7% sugars) Protein 10-35% Fat 20-30% (saturated <10 if possible)

From Guidelines 2010

Processed foods

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Just a Few Basic Dietary Recommendations

• Limit eating events to 3 a day. Reduce snacking (unless required, such as with diabetes)

• If patient snacks, recommend fresh fruit, vegetables, popcorn, and dairy (give list of better food choices for caries)

• Cariogenic foods, such as retentive starches and sugary foods and liquids should be consumed during meals if possible

• Liquids clear cavity faster than more retentive items

• When oral hygiene does not follow a meal or snack, end the eating event with a dairy product (cheese or milk) or another food that helps clearance or neutralizes acid (xylitol gum?)

Always refer high-risk patients

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Other Possible Suggestions• Encourage a variety of foods• Stress the importance of eating vegetables, fruits, and whole grains• Explain how to read labels and that most sugars end in “ose;” emphasize <

sugars/fermentable carbs• Explain the relationship between sugar/carbs/erosion & tooth decay• Give examples of “hidden sugars” & counsel regarding “sipping” drinks• Give examples of ways to add foods that they show deficiencies in• Stress using sodium and salt in moderation- “no salt added” does not mean that

the product is low in sodium– read labels• Emphasize less processed foods versus whole/natural sources• Emphasize that alcohol intake should be in moderation; alcohol is high in calorie

and contains few nutrients• Encourage an active lifestyle and to consult resources or a dietician for more

specific recommendations- especially if systemic disease exists

• Discourage eating snacks before bed, unless followed by thorough OH• Drink water (best choice) but if not unsweet tea?• Discourage skipping meals• Recommend a multi-vitamin daily• Look at additional sources of fluoride or Peridex for caries control• Provide with resources (websites, color handouts, etc…..)• Remember, small changes can make a big impact in the long run• Use Dietary Guidelines for general suggestions• Don’t take it for granted that “they know already”• LISTEN to your patients desires• Consider Biotene or other xerostomia aids if needed, rather than sucking on candy

Other Possible Suggestions

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Other Resourceshttp://www.USDA.gov

http://www.health.gov/healthypeoplehttp://diabetes.orghttp://www.ific.org

http://www.floss.comhttp://ada.org/consumer/diet.html

http://www.eatright.com/aoral.htmlhttp://www.ahrq.gov/clinic/uspstf/uspsdiet.htm

www.nat.uiuc.edu