Frequent consumption of fermentable carbohydrates that have low oral clearance rates increases the risk for enamel caries and perhaps is even more dangerous for root surfaces.
Highly acidogenic snack foods should be consumed at mealtimes to reduce the risk, and between-meal snacks should be either nonacidogenic (such as xylitol products) or hypoacidogenic (such as sorbitol and HSH products).
Cheeses present a naturally occurring situation that may provide anticariogenic effects from the diet.
Certain additives as well as sugar substitutes show great promise for the provision of between-meal snack foods that reduce the risk of dental caries.
The dental team should thoroughly understand the relationship of diet to caries and conscientiously apply that knowledge to educate the patients in general as well as counsel specific high-risk individuals.
Further emphasis should be placed on the acquisition of sound scientific data for counseling caries patients concerning diet and dental caries.
In the last 20 years, mainly due to optimum fluoride exposure, and practice of good oral hygiene procedures, an important reduction in caries has been observed, despite the fact that sugar consumption was maintained and/or was increasing during the same lapse of time. A sugar-caries relationship cannot be established in most of the industrialized countries and the dietary factor is not as preponderant in the caries process as it used to be two decades ago.
The factors which seem to contribute the most significantly to the cariogenicity of the diet are the frequency of carbohydrate ingestion and eating patterns.
The relative cariogenicity of food is not correlated with the amount of carbohydrate it contains.
Even if sucrose remains the most important sugar consumed in sweets, beverages and confectionery products, all fermentable-carbohydrate foods can be involved in the caries process.
The use of chewing gum and other xylitol-containing products have resulted in defined reduction in caries and represent interesting alternatives for high-caries-risk populations
Caries risk and oral health assessments as well as the evaluation of oral hygiene procedures and fluoride exposure should become essential tools in dietary counselling.
People who receive optimum fluoride exposure and follow regular oral hygiene measures can safely use dietary carbohydrates, preferably during meals and two to three times daily in snacks or drinks.
A decline in the prevalence of dental caries over three decades has occurred without a significant change in the consumption of fermentable carbohydrates, indicating that good dental health is achievable with the presence of cariogenic factors in the diet.
Since, in many countries 80% of the caries is present in only 20% of the population, 'targeted intervention' would seem a better preventive option, stressing the judicious use of fluoride, plaque control, fissure sealants and a sensible diet. Dietary modification is notoriously difficult to achieve, being incumbent upon the subject's willingness to effect a change in behaviour.
Many texts refer to the frequency of consumption of carbohydrates as being all-important, recommending a reduction in the frequency.
However, recent evidence suggests it is the frequency of toothbrushing with a fluoride containing dentifrice which is of fundamental importance in promoting remineralisation of enamel.
Dietary advice should be formulated which is both realistic and positive. Trying to dissuade children from consuming products, which they perceive to be tasty and pleasurable is counter productive and more emphasis should be given to tooth brushing using a fluoride toothpaste. Also, a fundamental shift away from the idea of 'good foods versus bad foods' is required and more emphasis laid on good diets as opposed to bad diets.
Children should be able to enjoy foods traditionally considered 'bad' from a dental viewpoint, as long as they brush their teeth with a fluoride containing dentifrice and have a sensible approach to their consumption.
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