and Oral Fact Sheet No. 9.321 Food and Nutrition Series|Health by J. Clifford, L. Bellows and R. Moore* Research shows that adequate Tooth Demineralization Quick Facts nutrition is essential not only for Inside the , bacteria overall physical health, but also for the actively ferment dietary carbohydrates • Regular check-ups and development and maintenance of a to be used as a food source. This cleanings (twice a year) with a healthy mouth, especially the teeth and fermentation produces several acids are important steps in . The relationship between diet that demineralize (breakdown) the tooth maintaining good oral health. and oral health is highly related as good enamel. As the tooth demineralizes, • Brush and floss teeth at least nutrition has a role in preventing tooth bacteria move into the tooth, resulting in once a day–after each meal decay and gum , while the health and formation of a cavity (or of our teeth and gums helps determine a hole in a tooth). or snack is best. the type of foods we can eat. In fact, • In communities with when one or more nutrients in a diet is Implications for Nutrition and Diet low levels in the missing, the first symptoms of deficiency An untreated cavity is painful and often manifest in the mouth (usually water supply, use of a can result in , which may lead with , B-complex vitamins, and or to the inability to chew certain foods. protein deficiency). Good oral health containing fluoride is highly Malnutrition or abnormal digestion may practices begin early in life and should recommended. result, since these conditions often be maintained throughout life. prevent a person from chewing and • Limit foods and beverages eating adequate amounts of food as well that are high in simple The Process of Tooth Decay as eating some hard, high-fiber foods. carbohydrates or sugar. The process of tooth decay Additionally, many such as Choose healthy snacks with (otherwise known as dental caries or diabetes and low levels of sugar. cavities) begins when certain bacteria, may exacerbate these conditions and • To prevent “nursing bottle which are always present in the mouth, lead to poor oral health. syndrome,” never allow a break down components of . Since bacteria need carbohydrates These components then adhere to tooth for food, the rate of cavities can be child to fall asleep with a enamel, forming dental plaque—a clear, reduced by cutting back on simple bottle. gelatinous material that allows bacteria carbohydrates such as , to remain on the teeth. If dental plaque , and (Table 1). is not removed frequently (at least once a day) by proper brushing and flossing, Flouride and Tooth Mineralization the plaque becomes tightly attached A well balanced, is to the tooth and only a professional equally important during infancy, cleaning can remove it. Dental plaque childhood, and adolescence. During can also cause , a condition these growth periods, primary and that causes inflammation of the gums permanent teeth are mineralized- before and is also referred to as gum disease. the teeth even erupt into the mouth. Gingivitis can breakdown tissue and Mineralization and tooth development possibly lead to tooth loss. require fluoride, a mineral that is incorporated into the tooth structure, © Colorado State University making the tooth strong and decay Extension. 12/92. Revised 8/17. resistant. Fluoride intake from birth has been shown to reduce dental caries by extension.colostate.edu *Original publication by L. Bellows, Colorado State University Extension food and nutrition specialist and as much as 60%. assistant professor; R. Moore, graduate student. Updated by J. Clifford, Extension Nutrition Specialist, 8/2017 Table 1. Foods that may act to increase or decrease the risk for dental caries (tooth decay). Increases Risk* Decreases Risk Facts About Carbohydrates and Bacteria Sugar-sweetened beverages (soda, energy Sugar-free food items. drinks, processed juice). • Sucrose (table sugar) is the primary carbohydrate that bacteria prefer. However, other simple carbohydrates Sticky foods (candy, caramel, syrup). and vegetables (have also been shown to reduce the risk for oropharyngeal cancer). such as fructose, lactose, and Snacks with sugar (cookies, cakes, pastries). Foods rich in protein such as lean meats, eggs, glucose, are easy to ferment and also fish, beans, and legumes. support bacteria growth. Simple sugars such as honey, sucrose, and Whole-grains, specifically breads and cereals molasses. low in sugar. • Simple sugars are found in many foods and may also be known as: *The length of time that these foods are consumed is also a factor in the risk for tooth decay, as table sugar, corn syrup, honey, consuming these foods for an extended period of time acts to increase the risk for decay. molasses, and dextrose.

• Bacteria also can ferment complex carbohydrates (such as starches), but the process takes longer. Many Fluoridated Water and iodine, along with vitamins A, C, complex carbohydrates are sticky and Many community water supplies and D) have the potential to cause become lodged between teeth and are fluoridated at the rate of1 part per obvious changes in tooth formation gums which allows the bacteria time to million (ppm), a safe and effective rate in the child. However, even slight for effectively reducing dental cavities. deficiencies may cause changes in ferment the carbohydrate. tooth structure that could place a child The normal daily intake of fluoride from • Although fresh fruits and vegetables at greater risk for tooth decay later in fluoridated water is about 1 ppm per do contain carbohydrates that can life. Maintaining a healthy, balanced day. When teeth are forming, an intake be fermented by bacteria, their high of more than 2 parts per million may diet throughout is important water content acts to dilute the sugars, cause fluorosis, a condition in which for both mother and child. Before and fiber content helps clean the becomes toughened, deciding to take a supplement during mottled and discolored. However, pregnancy, consult a physician or teeth, thereby protecting against tooth teeth still remain strong and resistant registered dietitian. decay. to decay. Early Childhood Caries (ECC) Sources of Fluoride Otherwise known as “baby-bottle In communities where drinking tooth decay,” this preventable dental water has little or no fluoride, problem affects young children and prescription fluoride drops or tablets is characterized by the rapid decay of may be prescribed by a doctor. A primary upper teeth and some lower back popular alternative to supplements is molars. The lower front teeth are seldom Below are important oral health the daily use of fluoridated toothpaste affected. This condition develops when guidelines to help prevent cavities in and mouthwash. Contact your local a child is given a bottle that contains children: water department for more information juice, milk, formula, or other sweetened on fluoride levels in your community beverage at bed or nap time. While the Birth – 12 months water supply. child is awake and sucking, saliva flow helps sugars away from teeth. As • Begin oral practices (brushing the child falls asleep, sucking and saliva or rinsing the mouth) after the first tooth Oral Health During Pregnancy, flow decreases, and the sugars in the erupts. Infancy, and Childhood liquid collect around the teeth allowing • Encourage routine consumption of milk, Tooth development begins shortly for an excellent feeding ground for rather than on-demand feeding. after conception, usually between the bacteria. •Limit bottle contents to water, milk, or sixth and eighth weeks of gestation, Painful decay results from this practice. formula. and continues throughout pregnancy. If left untreated, infections and abscesses • Wipe gums with a washcloth or At birth, 83% of a child’s tooth enamel are possible. Premature loss of upper gauze pad after feedings to reduce the has already formed, thus emphasizing teeth may lead to the child developing transmission of bacteria. the importance of adequate maternal poor “-thrust.” This could cause • Do not leave child to fall asleep with a nutrition throughout pregnancy. Only poor alignment of permanent teeth and bottle. severe nutritional deficiencies and future orthodontic and speech problems. • Attempt to wean the child from the excesses in the mother (such as A child should never be left to fall asleep bottle by 15 months of age. , phosphorus, fluoride, iron, with a bottle. 1 – 3 years Tips to Maintain Good Oral References Health • Brush child’s teeth 2 times per day for 2 Diet, Nutrition and . Patricia M. minutes. Consult a physician about using Read food labels to identify and limit Randolph and Carol I. Dennison, C.V. a fluoride toothpaste. foods high in simple sugars and Mosby Co., 1981. • Children should avoid or limit carbohydrates. Look for words that end Mahan, L.K., Escott-Stump, S., Raymond, consumption of sugar beverages such as in “–ose” such as fructose, glucose, lactose J.L., & Krause, M.V. (2012). Krause’s soda, juice, and sports drinks. and sucrose. Food & the Nutrition Care Process. St. • Meats and foods high in fiber such as Louis, MO: Elsevier/Saunders. 3 – 10 years fresh fruits and vegetables, help clean Nutrition: Principles and Application in • Feed starchy, sticky, or sugary foods with the teeth of food particles and sugars . Carol West Suitor and foods low in sugar. during the chewing process. These foods Merrily Forbes Hunter, J.B. Lippincott • Consume dairy products with meals and promote saliva flow, which helps rinse the Co., 1980. snacks. teeth of food particles. Saliva also acts to Nutrition: Concepts and Controversies. Eva • When consuming high sugar neutralize the acid. May Nunnelley Hamilton and Eleanor carbohydrates, also include a fruit or • Though eating three meals a day is Noss Whitney, West Publishing Co., 1979. vegetable (to induce salivation). important for adequate energy and Position of the Academy of Nutrition and • Limit consumption of sugary beverages nutrient intake, snacking between meals Dietetics: Oral Health and Nutrition. J such as soda, juice, and sports drinks. presents special dental health problems Acad Nutr Diet. 2013;113:693-701. • Limit bedtime snacks. especially if the snacks are high in simple Position of the Academy of Nutrition and • Encourage sugar-free after sugars. Choose nutrient dense snacks Dietetics: The Impact of Fluoride on meals and snacks. that do not harm teeth, such as cheese, Health. J Acad Nutr Diet. 2012;112:1443- • Brush teeth 2 times per day for 2 minutes yogurt, meats, plain nuts, peanut butter, 1453. using fluoride toothpaste fresh fruits and vegetables, unsweetened Touger-Decker R, Sirois DA, and CC Mobley. breads or cereals, and popcorn. Nutrition and Oral Medicine. Available • Foods that contain calcium and at www.springer.com/978-1-58829-192-9 Oral Health for Older Adults phosphorus may act to re-mineralize last accessed on June 17, 2013. Adults over the age of 65 comprise teeth, a process that replenishes minerals U.S. Department of Health and Human a large portion of the population after they have been removed by acids. Service Federal panel on community with untreated dental diseases such • Beverages without sugar (fluoridated water fluoridation. (2015). as dental cavities and periodontal water, milk, tea, coffee) are the best U.S. Service Recommendation disease. In fact, 25% of these choices to prevent tooth decay. Avoid for Fluoride Concentration in Drinking individuals have no natural teeth, and sugar sweetened beverages such as soda, Water for the Prevention of Dental are more likely to experience chronic juice, or sports drinks. Caries. Retrieved from http://www. disease and take medications; both • Using artificial sweeteners in place of publichealthreports.org/documents/ of which may have negative effects on real sugars does not contribute to tooth PHS_2015_Fluoride_Guidelines.pdf oral health. The diets of older adults decay. who have experienced tooth loss, • Chewing sugar-free gum is another wear , or have implants, are option that will increase saliva in the of special concern because eating mouth and remove food particles that adaptations may be required. Dentures cause tooth decay. are not equivalent to natural teeth, • Thoroughly brushing one’s teeth after and those with dentures tend to take meals and snacks is the best way to larger bites of food items and may remove sugars and food particles from avoid some hard fruits and vegetables tooth surfaces. all-together. • Brush teeth at least twice daily with Since this population is at an fluoride containing toothpaste, preferably increased risk for malnutrition and after meals and snacks. nutrition deficiency, it is important that • Floss and use mouth rinse, once daily. these individuals seek advice from • Visits to the dentist and regular cleanings a medical professional or dietitian from a (at least 2 per regarding tips for preparing and eating year) are very important. certain foods.

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