FOOD, NUTRITION AND DENTAL HEALTH
- definition of dental health
Oral health is the health of a person’s mouth, particularly the health of their teeth and gums (WHO, 2003).
Being in good oral health means being free from chronic orofacial pain, cancers of the oral cavity or pharynx (throat), damage to the tissues of the oral cavity, and other diseases or disorders affecting the oral, dental, and maxillofacial tissues.
2- Dental health and general health
Oral health is now an integral part of overall health and well-being .
Recent studies have in fact highlighted links between periodontal diseases and other diseases.
Neglected caries are complicated by local infections (infection of tooth tissues). In addition, the psychological and social impact of these diseases significantly reduces the quality of life.
The most common dental diseases are tooth decay and periodontal disease. These pathologies are linked to diet.
In addition, poor oral health can also impair chewing and digestion of food. Eating behavior as well as oral hygiene measures play an important role in preventing these diseases.
Definitions
a) Nutrition
- Nutrition is a science that studies the links between diet and health.
- In the medical context, nutrition is the process of transforming food into nutrients .
- They are what allow a living organism to function normally.
There are two main families of nutrients:
- Macronutrients include lipids, proteins and carbohydrates (energy nutrients).
- Micronutrients are composed of minerals, vitamins and antioxidants.
When a human being consumes nutrients in insufficient quantities or, on the contrary, in too great a quantity, we enter into the framework of malnutrition.
b) Nutrients
Nutrients are molecules that come from food and are mainly produced by the digestive process.
When these nutrients are assimilated by the body, we speak of nutrition.
Nutrients provide various functions such as energy supply, metabolic regulation and tissue maintenance.
The main nutrients
Carbohydrates. Proteins. Lipids. Water. Cholesterol. Vitamins. Mineral salts and trace elements. Fiber. Iron. Magnesium. Sodium
Being deficient in vitamins or minerals is not trivial. While the ideal solution lies in a balanced diet, food supplements can give a serious boost.
It is a question of finding the right balance because it must be kept in mind that supplements, however complete they may be, are not the same as balanced meals and that an overdose can be as harmful as a deficiency.
c) Human body mass
Human body mass is the measurement of a person’s weight which is calculated in kilograms.
Genetic and environmental factors can influence human body mass and cause it to vary constantly.
Human body mass consists of the masses of bones, muscles, fat, viscera, blood, tissues and other organic substances.
d) Antioxidant
An antioxidant is a molecule that decreases or prevents the oxidation of other chemicals.
Oxidation is part of a REDOX reaction that transfers electrons from a substance to an oxidizing agent.
This reaction can produce free radicals which lead to destructive chain reactions.
These properties are found extensively in the thiol and phenol families.
Oxidation reactions are necessary for life, but they can also be destructive: plants and animals use and produce many antioxidants to protect themselves, such as glutathione, vitamin C and vitamin E, or enzymes such as catalase, superoxidase dismutase and certain peroxidases.
A deficiency or absence of production of antioxidant enzymes leads to oxidative stress.
Antioxidants are also important ingredients in dietary supplements to maintain health and prevent certain diseases.
Our body is capable of producing, from the amino acid cysteine, a powerful antioxidant, alpha-lipoic acid.
The different food groups
Food pyramid
III. Influence of diet on the development of caries and periodontal diseases
Dental caries is an infectious, post-eruptive disease transmitted through the hard tissues of the tooth (enamel, dentin, cementum).
There are 4 recognized factors that come into play in the appearance of carious lesions:
– a diet containing fermentable carbohydrates ,
-a susceptible host,
-a specific oral microflora,
-the time during which these three factors come together in the mouth to interact and cause a drop in pH below the threshold of 5.5, at which point the hydroxyapatite crystals begin to dissolve.
Tooth decay only occurs when these four factors are present and can be prevented by the absence of any one of them.
1. Cariogenic bacteria
The main groups of bacteria involved in the pathophysiology of dental caries are mutans streptococci (SM), Streptococcus mutans (serotype c, e, f) and Streptococcus sobrinus (serotype d and g), as well as lactobacilli. The acidogenic and aciduric properties of mutans streptococci make them the most cariogenic bacteria in dental plaque
2. Host susceptibility
2.1 The role of saliva
Saliva is made up mainly of water, electrolytes, proteins and glycoproteins. It protects teeth against tooth decay and periodontal disease by acting in four ways:
- through its flow (its clearance), it dilutes, breaks down and eliminates food debris towards the digestive tract,
- its buffering power neutralizes the acid produced by plaque bacteria,
- It has antibacterial properties thanks to the secretory immunoglobulins (IgAs), lysozymes, catalases, lactoperoxidases and other enzymes it contains,
- Its high saturation in phosphate, calcium and fluoride ions, intervenes in the balance between demineralization and remineralization of enamel.
2.2 The tooth
In children in particular, the erupting tooth is still immature, because calcification is incomplete. The enamel is then permeable and more vulnerable to dissolution by acid. With maturation, in contact with saliva and nutrients, the enamel incorporates phosphate, calcium and fluoride ions into the hydroxyapatite crystals. Over time, porosity and permeability will thus be greatly reduced.
Certain anatomical defects of the tooth, such as pits, grooves and fissures, or anomalies such as enamel hypoplasia, constitute areas of vulnerability to caries.
The presence of dental malpositions, or the wearing of orthodontic appliances, by promoting the accumulation of dental plaque, and making brushing more difficult, greatly increases the risk of caries.
3.1- Chemical characteristics of foods
- A balanced diet contains approximately 55% carbohydrates.
- Most foods contain carbohydrates and their cariogenic potential will depend on their ability to ferment and produce acids.
- It is different for each food because it depends on the nature of the carbohydrate but also on its association with other nutrients.
3.2- Physical characteristics of foods
- The physical properties of the food determine the retention time in the mouth which increases the risk of caries when it is slow.
- This will depend on the texture, viscosity, solubility in saliva and adhesion to dental surfaces.
- Foods whose texture requires prolonged chewing are eliminated quickly from the oral cavity because they increase salivary flow and dissolve quickly.
- On the other hand, a food that adheres to oral surfaces will be more likely to maintain prolonged acidity than a liquid food.
- Sugary drinks can provide high amounts of sugar while spending very little time in contact with plaque. They also cause a significant drop in pH.
- Soft drinks and diet energy drinks contain citric acid and phosphoric acid, two substances that can cause direct demineralization of teeth.
- Rinsing your mouth with water, drinking through a straw, and chewing gum containing xylitol can help reduce the negative effects of liquid fermentable carbohydrates.
- Carbohydrates from fruits and vegetables are eliminated within 5 minutes. Chewing gum and sweets give a high concentration of sucrose.
3.3- Eating behaviors
3.3.1- Frequency of food intake
- With each new food intake, the pH remains low for 30 to 60 minutes or more before rising again.
- The more repeated the ingestions, the more frequent and prolonged the production of acids.
- The buffering capacity of saliva is then overwhelmed and demineralization of the teeth intensifies.
- Similarly, if food intake occurs during periods of low salivary secretion (between meals, in the evening at bedtime), it will be cariogenic.
- The traditional lunch has often disappeared in favor of snacking and “fast food” throughout the day.
- Most children and adults eat at least one meal outside the home.
- The place of sweet products is more important; liquid and solid snacks are an integral part of eating habits.
- Among the dangerous eating habits is the “baby bottle syndrome” which is an example of the effect of frequent and prolonged exposure of the tooth to the 7 carbohydrates.
- Bottles of water with added syrup, sweetened milk formulas, teats dipped in honey, Coca-Cola, medicated syrups consumed several times a day and in the evening before going to bed cause considerable dental destruction.
3.3.2- Order of food ingestion
- The order of ingestion of carbohydrate and non-carbohydrate foods during a meal also influences the decrease in saliva pH.
- During a meal, the last food ingested has a great importance on the duration of postprandial acidification of dental plaque.
- Thus, cheese consumed after a sweet dessert reduces the production of acids from carbohydrates. Casein and other milk proteins in cheese protect the tooth by reducing its demineralization.
- Protective factors discovered by sequencing particular foods can also be used to reduce the destructive influence of fermentable carbohydrates.
- Fats and proteins consumed during a meal help coat the surface of the teeth to protect them from sugars.
- Consuming dairy products allows saliva to maintain high levels of calcium and phosphorus and to benefit from the benefits of remineralization by preventing the pH of the mouth from dropping below 5.5.
- Fluoride in food and water also helps remineralize tooth enamel.
4. Epigenetic determinants (genes)
Of an environmental, socio-economic or psycho-social nature, they include in particular:
- -the place of life,
- -fulfillment in the family, at work, in society,
- -the school level,
- -the professional situation,
- -disposable income.
- -Heredity would also have a significant role in the incidence rate and in the progression of caries by influencing oral bacterial colonization.
5/ Influence of dietary balance on oral health
a) Influences of chewing on oral health
At the teeth level: Self-brushing reduces cavities. Fibrous foods rub against the enamel and remove impurities.
At the bone level: Dental contact and friction stimulate the growth of both maxillae. Functional excitation leads to the growth of dental buds.
b) Influences of nutritional intake on oral health
They correspond to the systemic factors responsible for reactions at the level of the teeth and saliva.
On tooth formation: Deficiencies in vitamin D and calcium can cause disturbances in the development of teeth.
On salivary composition: The influence of diet on its composition could be incriminated in the development of caries (salivary flow intervenes in the increase in PH)
Diet is one of the factors in cariogenesis according to Keyes
KEYES DIAGRAM MODIFIED BY KONÏG
6/ Eating disorders: TCA
• Eating disorders (ED) manifest themselves in two forms: restrictive anorexia and bulimia anorexia.
• During dental care, it is important not to make these patients who are in great pain feel guilty.
• Eating disorders are frequently associated with other pathologies such as gastroesophageal reflux, addictions, hyposialia.
• Loss of attachment in subjects with TCA is clinically manifested by gingival recessions rather than the presence of periodontal pockets.
• Periodontal therapies are most often oriented towards plastic surgery, taking into account the associated erosive lesions.
Eating disorders (ED) are the manifestation of psychological or psychiatric disorders which will manifest themselves through obesity or, on the contrary, a body mass index (BMI) lower than the values referred to as “normal”.
a) Oral manifestations of TCA
The dentist with a good knowledge of the oral manifestations of eating disorders can play a leading role in establishing the diagnosis and initiating medical treatment if this is not already in place.
However, it is important, in all cases, not to make patients feel guilty and to initiate the discussion one-on-one without the parents present.
Erosions; Periodontal damage; Hypersensitivity; DAM-type pain; Salivary gland pathologies
b) Periodontal treatment in patients with eating disorders
Controlling the various etiopathogenic factors is a prerequisite before deciding on periodontal surgery.
The doctor’s advice may be necessary, particularly to obtain more information on the somatic state of these patients.
Vomiting, even infrequent, can persist for a long time after severe anorexia-bulimia. In summary, these patients do not seem to have a high prevalence of chronic or aggressive periodontitis. On the other hand, mucogingival problems are numerous. They are associated with a thin gingival biotype, compulsive and traumatic brushing (explaining low plaque indices), multiple erosions and vitamin deficiencies. Consequently, the therapeutic approach is most often associated with an initial therapy based essentially on information on plaque control, which should rather be slowed down in terms of frequency, and with periodontal plastic surgery, particularly root coverage and thickening. The indication for the latter must be weighed up because of the risk of recurrence associated with the difficulty of controlling etiopathogenic factors.
Conclusion
Several factors come into play to balance your diet: age, gender, level of physical activity.
Daily energy intake should be adjusted based on these factors to avoid a calorie surplus or deficit.
From an odontological point of view , the alterations will mainly concern the calcified dental tissues but also the periodontium , with specific lesion configurations.
FOOD, NUTRITION AND DENTAL HEALTH
Early cavities in children need to be treated promptly.
Dental veneers cover imperfections such as stains or cracks.
Misaligned teeth can cause difficulty chewing.
Dental implants provide a stable solution to replace missing teeth.
Antiseptic mouthwashes reduce bacteria that cause bad breath.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush preserves enamel and gums.