Nutritional Guidelines for Pediatric Dentistry

This article is based on the guidelines of the American Academy of Pediatric Dentistry. These guidelines are observed by the dental professionals at the Flikier Institute of Dental Rehabilitation in Costa Rica.

Nutrition and everyday diet play key roles in the development of dental caries. Although there is no direct relationship between protein-calorie malnutrition and tooth decay, vitamins A and D deficiency, along with calcium and phosphorus, can cause alterations in tooth development and delayed eruption of dentition. However, there are many research studies that correlate sugar consumption with caries prevalence, and thus a clear association between consumption and decay can be established, particularly when we consider sugary snacks and other sweets.

Moreover, several foods can influence sucrose concentration and the potential to develop cavities. The specific factors include: nutritional consistency, oral rinse, combining foods, intake frequency, and the digestion process as it relates to pH.

The frequency of cariogenic food intake between meal has a strong relationship with the risk of tooth decay and cavities, this intake favors changes in pH (stomach acidity) and prolongs the time that oral clearance should take place, which in turn increases the likelihood of enamel demineralization.

With regard to consistency and oral clearance, there are several studies show some foods, even though they have a high sugar content, may benefit from higher solubility and are thus quickly eliminated from the dentition. On the other hand we have foods with a high starch content (bread, cereals, potatoes), which may increase pH production and may slow down elimination from the dentition.

Diet is, without a doubt, a determining factor in the development of cavities, and thus information mustbe provided to patients. We must not forget that an increase in sugar not only means a greater risk of tooth decay but an increased risk of obesity, and thus a greater risk of suffering as adults from diseases such as diabetes, cardiovascular disease (hypertension, cholesterol), breathing (apnea, asthma), orthopedic fractures, and liver disorder.

In Costa Rica, the Flikier Institute believes that pediatric dental care should be established in the first year of a child’s life. This is one of the most appropriate preventive strategies against cavities, including dietary recommendations and instructions on how to perform proper oral hygiene from the eruption of the first temporary teeth. A healthy diet will not only favorably influence oral health but also on the overall wellness of the child.

Epidemiological studies show that human milk and breastfeeding in children promotes physical and nutritional development and represents a psychological, social, economic and environmental benefits, while significantly decreases the risk of a significant number of chronic and acute diseases. Thus, breastfeeding and breast milk itself alone, is not cariogenic. However, several studies have shown that in combination with other carbohydrates or administered with high frequency at night or to demand the child, it is associated with early tooth decay in children. Caries that develop as soon as the tooth erupts, on smooth surfaces, rapidly progressing to have a widely destructive impact on teething. For the same reason it is necessary to avoid frequent use of the bottle with juice or carbohydrates. It can be used with water, for example, using it as more reassuring that nutrient.

It is advisable to avoid eating between meals or limit your intake of sugars to mealtimes, where salivary flow is higher and allows rapid oral clearance. This period will depend on the clearance food consistency and solubility of the particles, in addition to individual characteristics such as chewing, quantity and characteristics of saliva. It is therefore very important low frequency in carbohydrate intake.

Thus it has been found that foods containing between 15 and 20% of sugars, especially sucrose, are among the most cariogenic, especially between meals. However, there are other carbohydrates such as fructose, with greater sweetening power than sucrose, but less cariogenic power. Similarly, xylitol, not being used by microorganisms to produce acids, it is not cariogenic, and even have an anticaries effect by increasing salivary flow, increasing pH and reducing levels of Streptococcus mutans by interfering with their metabolism

Moreover, different foods may have cariostatic effects. In animal studies have shown that foods high in fat, protein, calcium and fluoride can protect against cavities. Fats cover the tooth, reducing sugars and retention plate also can have toxic effects on bacteria. Proteins increase the buffer capacity of saliva and have protective effect on enamel. Fats and proteins together raise the pH after the intake of carbohydrates. Other food would be those that through its chewing stimulate salivary flow and, thus, is buffered acidic pH and enamel remineralization is promoted.

In adolescents it is important to reduce the frequent consumption of sugary drinks because it represents a particular factor associated with the development of tooth decay.

On the other hand, it is necessary to implement systems for health promotion remain key health education, not only referring to the dental field specific programs, but are more interesting collaboration strategies with other specialties improving overall health of the individual . In this section we highlight programs maternal education, guidelines on oral health for the staff working in day care, prescription drugs without sugar and actions at the level of food companies to label, appropriately, simple and uniform content of foods.