Diet, Fluoride, and Dental Caries The University of Sydney Wendell Evans BDS MDS DDSc FICD Population Oral Health

Diet, Fluoride, and Dental Caries

The University of Sydney

Wendell Evans BDS MDS DDSc FICD

Population Oral Health

Dental caries was ranked as the highest diet-related disease in Australia in terms of both total costs and health care costs (Crowley et al 1992).

Crowley S, Antioch K, Carter R, Waters AM, Conway L, Mathers C (1992). The cost of diet related disease in Australia. Canberra: AIHW and NHMRC.

FAO (Food and Agriculture Organsiation - United Nations 1960

DMF* Teeth *Decayed, Missing, Filled

Annual sugar use (kg)

Age 11-12 years

Jenkins GN. The physiology and biochemistry of the mouth, 4th Edition. Oxford: Blackwell Scientific Publications, 1978. Page 388.

Dentalplaque pH

Minutes

10% glucose rinse

Critical pH for tooth enamel dissolution

Jenkins GN. The physiology and biochemistry of the mouth, 4th Edition. Oxford: Blackwell Scientific Publications, 1978. Page 389.

The Vipeholm Study of Diet and Dental Caries

Gustafsson et al. (1954). The Vipeholm dental caries study. Acta Odontlogica Scandinavica 11:232-364.



Sugarconsumed

gm per day

300

200

100

0 Liquid

24 toffees

NewDMFTperyear

4

3

1

0

The Dental Caries Experience of the Children ofHopewood House

Bowral, NSW

Lilienthal et al Med J Aust, June 1953

Hopewood House

82 Children aged 4-9 years

Investigators

Paediatricians

Dental scientists

Findings

• well nourished• healthy

• very poor oral hygiene• no dental caries


12

10

0

4

2

6

8

New Zealand

Sydney Bowral

HOPEWOOD HOUSE

BOWRAL, NSW

DMFT of children aged 6 – 9 years



The Tennessee Study

Weiss RL, Trithart. Between meal eating habits and dental caries experience in preschool children. American Journal of Public Health 50:1097-1104, 1960.



The cariogenicity ofrefined carbohydrates

Beck DJ, Bibby BG. Acid production during the fermentation of starches by saliva. Journal of Dental Research 40:486-491, 1961.

Calcium sucrose phosphate

Harris et al. Observations on the cariostatic effect on a group of children aged 5-17 years. Australian Dental Journal 12:105-113, 1967.

Harris et al. Observations on the cariostatic effect on a group of children aged 5-17 years. Australian Dental Journal 12:105-113, 1967.

Relationship between dietary habits and caries increment assessed over two years in 405 adolescent school children in Northeast England.

Rugg-Gunn et al (1984). Archives of Oral Biology 29:983-992.

.

• 2 year study• children initially aged 11.5 years• 3 day diet diary on 5 occasions• annual bitewings• non-fluoridated environment

Rugg-Gunn et al. Archives of Oral Biology 29:983-992, 1884.




The effects of sugars intake and frequency of ingestion of dental caries increment in a three-year longitudinal study – Michigan, USA

Burt et al. Journal of Dental Research 67:1422-1429, 1988.

Michigan, USA

● 3 year study of 499 children● initially aged 11-15 years● 24 hour diet interviews on 3-4 occasions● non-fluoridated environment● annual bitewings



(3 years)


(3 years)

Summary of findings

Caries incidence was not related to total sugar intake nor to frequency of eating occasions.


The Melbourne Study

Pit and fissure surface caries risk estimates

Effect of cheese

Eating cheese following consumption of a sugary snack (pears in sugary syrup) prevented the depression of plaque pH whereas drinking sugared coffee following pears consumption further depressed pH.

Rugg-Gunn et al. The effect of different meal patterns upon plaque pH n human subjects. British Dental Journal 139:151-156, 1975.

Effect of war time diet

During WW2, severe rationing of sugar occurred. Caries incidence in both Scandinavia and Japan was correlated with sugar consumption.

Most recently, United Nations imposed sanctions against Iraq was associated with a dramatic decline in caries incidence.

These data show the potential for health promotion (at the population level) to target dietary sugar restriction. The common risk factor approach.

Toverud G (1957). The influence of war and post-war conditions on the teeth of Norwegian children. In: Rugg-Gunn AJ. Nutrition and Dental Health. Oxford: Oxford University Press, 1993, 129.

DMFT in Iraq before and after United Nations

Sanctions (UNS)

Jamel H, Plasschaert A, Sheiham A. Dental caries experience and availabilit of sugars in Iraqi children before and after the United Nations sanction. International Dental Journal 54: 21-25, 2004

Fluorine☻ 13th most abundant element in the earths crust (WHO,1984)☻ most electronegative of the elements☻ emitted from volcanoes as gaseous fluorine which reacts immediately with water to form HF☻ mainly found in rock and soil in various forms of barely soluble calcium fluorides☻ concentration in seawater about 1.2 mg/L (ppm)☻ concentration in fresh water ranges from near zero to 25 ppm (in the Rift Valley, Tanzania)☻ world-wide fresh water fluoride concentrations are generally less than 0.1 ppm but commonly up to 2 ppm in some areas

0.0 ppm

1.2 ppm

0.0 ppm

Source: McClure FJ. Water fluoridation: The search and the victory. Bethesda: National Institute of Dental Research, 1970.

0.1 ppm1.0 ppm

1.2 ppm

Permanent teeth DMF reductions at Grand Rapidsafter 10 and 15 years of fluoridation.

Source: McClure FJ. Water fluoridation: The search and the victory. Bethesda: National Institute of Dental Research, 1970.

Percent caries reduction in 113 studies into the effectiveness of water fluoridation in 23 countries.

Source: Murray JJ, Naylor MN. Fluorides and dental caries. In: Murray JJ (Editor). Prevention of oral disease 3rd edition. Oxford: Oxford University Press, 38, 1996.

Australian12-year-olds

The effect of water fluoridation

The combined effect of water fluoridation and fluoridated toothpaste

Victorian 12-year-olds

Source: Spencer AJ, Slade GD, Davies M. Water fluoridation in Australia. Community Dental Health 46:188-198,1986

Water fluoridation in theBlue Mountains reduces riskof tooth decay

RW Evans1, A Hsiau1, PJ Dennison1, A Paterson2, and B.Jalaludin2

Australian Dental Journal 54: 368-373, 2009

0

0.5

1

1.5

2

2.5

3

Blue Mountains

Hawkesbury

1993 2003

Meandmft

2.58a

0.69b

1.100.71

A = a = 135% more than Hawkesbury at baselineb = 73% less than Hawkesbury at baseline

Primary teeth Caries experience of lifelong

residents aged 6 – 8 years


1Community Oral Health and Epidemiology, 2Formerly NSW Health

0

10

20

30

40

50

60

70

80

90

100

1993 2003

Primary teeth Percent of lifelong residents

aged 6 – 8 years with no decay

62%71%

38%

72%

Blue MountainsHawkesbury



0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Blue Mountains

Hawkesbury0.87a

0.22b

0.58

0.36

PERMANENT TEETH Caries experience of lifelong residents aged 9 – 11 years

a = 50% more than Hawkesbury at baselineb = 75% less than Hawkesbury at baseline

MeanDMFT

1993 2003



Blue MountainsHawkesbury

PERMANENT TEETH Percent of lifelong residents

aged 9 – 11 years with no decay

0

10

20

30

40

50

60

70

80

90

100

1993 2003

61%

87%

71%

81%



Fluoride toothpaste

The Cochrane Database of Systematic Reviews

Fluoride toothpastes for preventing dental caries in children and adolescents Marinho VCC, Higgins JPT, Sheiham A, Logan S

Date of Most Recent Substantive Update:3 September 2002

The overall caries-inhibiting effect (that is preventive fraction, %PF) derived from the pooled results of 70 trials was 24% (95% CI, 21 to 28%).

This effect was independent of background domestic drinking water fluoride status.

The caries increments ranged from 1.14 to 7.66 D(M)FS per year.

In addition there was: ☻ a 14% increase in the PF moving from once to twice daily tooth brushing

☻ an 8% increase in the PF per 1000 ppm increase in the fluoride concentration

Fluoride varnish

The Cochrane Database of Systematic Reviews

Fluoride varnishes for preventing dental caries in children and adolescents Marinho VCC, Higgins JPT, Logan S, Sheiham A. 29 May 2002

Nine studies were included in this meta-analysis, involving 2709 children.

For the seven studies that contributed data for the main meta-analysis, the D(M)FS pooled prevented fraction estimate was 46% (95% CI, 30% to 63%; p<0.0001).

The pooled d(e/m)fs prevented fraction estimate was 33% (95% CI, 19% to 48%; p<0.0001).

The role of diet in caries prevention – an ecological model

Dietary challenge

Caries risk

For a given dietary challenge, risk of caries at any tooth site will depend on (1) fluoride exposure, (2) plaque bulk, and (3) access to saliva.

Loveren C van, Duggal MS. The role of diet in caries prevention. International Dental Journal 51:399-406,2001.

Better access to saliva

Better oral hygiene



Caries risk

Dietary challenge

Better use of fluorides


Better





Better oral hygiene

For reduced dietary challenge

For reduced dietary challenge


Better use

Better



Scope to reduce caries risk is limited



Better oral hygiene

Documents

Diet, Fluoride, and Dental Caries The University of Sydney Wendell Evans BDS MDS DDSc FICD Population Oral Health