Some individuals, with a particular behavior, medical problem or relevant biological factor are of particular risk to cavities because of dietary factors.

Who Needs Diet Guidance Cavities Prevention

Dietary education and guidance are important for the prevention and control of tooth decay. Since tooth decay is a multifactorial disease the relationship is not simple. It cannot be said that all in a particular group will have problems with cavities but should be taken note by dental professionals.

• Infants and toddlers with prolonged breast-feeding on demand.
• Infants and toddlers provided with a feeding bottle at bedtime.
• Individuals with an increased frequency of eating because of a medical problem, for example eating disorders or uncontrolled diabetes.
• Those with an increased carbohydrate intake due to a medical problem, for example Crohn’s disease, chronic renal failure or malnutrition.
• Those with reduced salivary secretion leading to a prolonged clearance rate of sugars, for example those on medications that cause reduced salivary flow, Sjogren’s syndrome or radiation therapy.
• Athletes taking sugar-containing sport supplement drinks.
• Workers subjected to occupational hazards such as food sampling and those working in the confectionery and bakery industry.
• Drug abusers who have a craving for sugar.
• Individuals, of any age, on long term and/or multiple medications which could be sugar-based and/or cause dry mouth.

Effects of Eating Patterns and Physical Form of Foods

Other dietary factors that may hinder or enhance development of cavities include:

• the frequency of eating,
• the physical form of the carbohydrate (liquid vs. solid),
• retentiveness of a food on the tooth surface,
• the sequence in which foods are consumed (for example cheese eaten before a sweet food limits the pH drop), and the
• presence of minerals in a food.

Frequent between-meal snacking on sugar or processed starch-containing foods increases plaque formation and extends the length of time that bacterial acid production can occur. Frequent snacking between meals keeps the plaque pH low and extends the time for enamel and dentin demineralization to occur.

Bacterial fermentation can continue as long as carbohydrate sticks to the enamel and exposed dentinal tooth surfaces. Even though starchy foods vary in their potential to cause cavities, the highly refined starchy foods, such as soft bread and potato chips, which are retained on tooth surfaces for prolonged periods of time, result in a lowered pH which may last up to 60 minutes. High-sucrose confectionery foods deliver high levels of sugar to the oral bacteria immediately after the foods are consumed, whereas high-starch foods deliver progressively increasing concentrations of sugars over a considerably longer period of time.

The sequence in which foods are eaten affects how much the plaque pH falls. Sugared coffee consumed at the end of a meal will cause the plaque pH to remain low for a longer time than when an unsweetened food is eaten following intake of sugared coffee.If peanuts are eaten before or after sugar-containing foods, the plaque pH is less depressed.

Some components of foods are protective against tooth decay. Protein, fat, phosphorus, and calcium inhibit cavities in experimental rats. Aged natural cheeses have been shown to stop the progress of tooth decay. When cheese is eaten following a sucrose rinse, the plaque pH remains higher than when no cheese follows a sucrose rinse. The protective effect of cheeses is attributed to their texture that stimulates salivary flow, and their protein, calcium, and phosphate content that neutralizes plaque acids. Fluoride found in drinking water, foods, and dentifrices increases a tooth’s resistance to decay and enhances remineralization of cavities.

Lipids or fats seem to accelerate clearance of food particles in the mouth. Some fatty acids, linoleic and oleic, in low concentration, inhibit growth of mutans streptococcus bacteria. Lectins, proteins found in plants, appear to interfere with microbial colonization and may affect salivary function.

‘Safe’ snacks

It is difficult to draw up a list of snacks that are safe in all aspects. Although cheese is safe for teeth, its high content of saturated fat may not please cardiologists. Fruit is less decay-producing than sweets, but contains natural sugar. Dried fruits such as raisins and apricots have high sugar content and cannot be considered as ‘safe’ snacks. Many fruits are very acidic and excessive use of such fruits or their juices may cause acid erosion of teeth. However, used in moderation, fruit is safer than sweets. Nuts are a safe snack for older children and adults.

Recommendations for reducing the risk of cavities

• Reduce frequency of eating sugar-containing foods and drinks especially between meals.
• Reduce frequency of drinking fruit-based drinks, even those labeled ‘no added sugar’.
• A few snack foods are ‘safe’ (for example cheese and nuts) but foods containing artificial sweeteners may be less decay-producing.
• Foods containing starch and sugar in combination (for examples cakes and biscuits) and carbonated sugary drinks are especially cavity-producing.