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© Borgis - Nowa Stomatologia 4/2017, s. 213-218 | DOI: 10.25121/NS.2017.22.4.213
Anna Kwiatkowska1, Dorota Szostak-Węgierek2, Elżbieta Bołtacz-Rzepkowska3, Joanna Bagińska4, Renata Chałas5, Milena Marcinkowska-Ziemak1, Magdalena Milewska2, *Agnieszka Mielczarek1
The role of diet in the management of caries. The statement of a working group for the prevention of caries in the adult population
Rola diety w kontroli choroby próchnicowej. Stanowisko grupy roboczej ds. zapobiegania próchnicy w populacji osób dorosłych
1Department of Conservative Dentistry, Medical University of Warsaw
Head of Department: Agnieszka Mielczarek, MD, PhD
2Department of Clinical Dietetics, Medical University of Warsaw
Head of Department: Dorota Szostak-Węgierek, MD, PhD
3Department of Conservative Dentistry, Medical University of Łódź
Head of Department: Elżbieta Bołtacz-Rzepkowska, MD, PhD
4Department of Introductory Dentistry, Medical University of Białystok
Head of Department: Anna Kierklo, MD, PhD
5Department of Conservative Dentistry with Endodontics, Medical University of Lublin
Head of Department: Barbara Tymczyna, MD, PhD
Streszczenie
Właściwe nawyki żywieniowe mają istotny wpływ na ogólny stan zdrowia oraz stan zdrowia jamy ustnej. Aby skutecznie zmniejszyć ryzyko próchnicy należy wziąć pod uwagę wiele przyzwyczajeń dietetycznych. Do tych wpływających dobroczynnie na stan twardych tkanek zęba zalicza się obecnie m.in. spożywanie mleka, twardych serów, probiotyków, niepróchnicowych substancji słodzących, produktów bogatobłonnikowych czy bezcukrowych gum do żucia. Natomiast produkty spożywcze typu cukierki toffi, krówki, słodkie ciastka, krakersy czy chipsy ziemniaczane zalegają długo na powierzchni zębów, przez co stanowią idealną pożywkę dla bakterii próchnicotwórczych i są odradzane. Ponadto spadek pH w jamie ustnej wywołany produktami kwasowymi, takimi jak soki owocowe czy wino, sprzyja powstawaniu demineralizacji tkanek twardych zęba, która prowadzi do rozwoju choroby próchnicowej. Niestety rozwojowi próchnicy sprzyjają również choroby ogólne, m.in. cukrzyca typu 1 i 2, choroby sercowo-naczyniowe, osteoporoza, stany związane z obniżoną odpornością lub ze zmniejszonym wydzielaniem śliny. Stosowanie wielu leków może zwiększać ryzyko próchnicy także ze względu na zawartość w nich sacharozy. Dotyczy to zwłaszcza dostępnych w wolnej sprzedaży syropów na kaszel, pastylek do ssania na ból gardła, preparatów witaminowych i innych.
Summary
Proper dietary habits have a substantial influence on both general and oral health. In order to successfully minimize the risk of caries, various eating habits need to be considered. The consumption of milk, hard cheese, probiotics etc. has a beneficial effect on the teeth. However, such products as large amounts of sweets, chips and crackers that linger in the oral cavity are considered to be harmful since they are an ideal nourishment for cariogenic bacteria; therefore, they are advised against. Moreover, a decrease in saliva pH which happens as a result of the intake of acidic products such as wine and fruit encourages demineralization of enamel and uncovered dentin, which leads to the progression of caries. Unfortunately, there are also several diseases such as diabetes, cardiac insufficiency, osteoporosis, immunodeficiency or hyposalivation that promote caries progression. Sometimes highly cariogenic sucrose is an ingredient of an over-the-counter medicine such as a cough syrup.
Appropriate dietary habits have a significant influence on both general and oral health. When combined with effective oral hygiene and universal use of fluorides mainly included in toothpastes, they represent a significant factor in reducing the risk of caries or the rate of its progression (1, 2).
Diet may increase or reduce the risk of caries by affecting the development of oral bacterial flora and the secretion of saliva. Food products may also affect the level of enamel erosion (3). One of the most important cariogenic factors is the consumption of easily fermentable carbohydrates, primarily non-milk-derived free sugars such as sucrose, honey and sugars contained in fruit syrups and juice. This is due to the fact that they are an easily accessible nourishment for cariogenic bacteria present in the dental plaque. As a result of metabolic processes acids are produced that are responsible for the demineralisation of dental tissues. Starch previously subjected to thermal processing leading to its gelatinisation with the resultant partial degradation of molecules also has a cariogenic effect. In this form this polysaccharide is easily digested by salivary amylase already in the oral cavity (4). It is worth emphasising the fact that the cariogenic potential of fermenting carbohydrates may also be significantly affected by the composition of the meal. Protein and fat content can reduce their cariogenic effect to some extent (4).
An important element modifying the course of caries is the frequency of consumption of carbohydrate-containing products, their consistency and the duration of contact with the surface of the tooth. The risk of caries increases with frequent consumption of sugar, its consumption between meals and in forms which promote adhesion to the dental surface such as toffee, fudge, sweet biscuits, crackers or potato chips. Saliva is an important factor reducing the postprandial pH drop in the oral cavity. However, its action requires time; therefore, high frequency of meals reduces its effectiveness. In addition, one should bear in mind that snacking at night is particularly harmful, since at this time the secretion of saliva is significantly reduced. It is worth emphasising at this point that saliva not only acts as an acid buffer in the mouth, but it also has an anti-bacterial effect, removes food residues from the interdental spaces and supports remineralisation of the enamel (4). All of these actions play an important role in caries prevention.
Acidity increase (pH decrease) is determined by the number and frequency of consumption of not only food products with a high level of viscosity and sugar content, but also acidic drinks and foods (5). These include, for example, fruit juice, energy drinks, cola, wine, citrus fruit and various pickled products. The critical oral pH which may result in the demineralisation of enamel is 5.5 or less (5). The pH value of the majority of juices and carbonated drinks does not exceed 4. This is why it is important not only to reduce the number of meals, but also to limit the consumption of acidic foods and drinks, especially between meals. The manner of consuming drinks, particularly those with a low pH, is also important. Slow sipping or drinking through a straw significantly prolongs the exposure of the teeth to acids. On the other hand, the presence of protein, fat, calcium and phosphorus may increase the pH and enhance enamel remineralisation (4).
In the diet of adults, those foods or their ingredients which have anti-caries properties and an additional beneficial effect on general health are of particular importance. Cheese, milk and unprocessed plant foods are worth mentioning here. The consumption of such products has a significant, positive influence on dental health (6, 7).
Milk has an anti-caries effect despite the fact that it is one of the main sources of sugar in the diet. The sugar contained in milk is lactose, which has the lowest cariogenic potential. Milk additionally contains other protective substances, e.g. calcium, phosphates, casein and lipids. Calcium and phosphates present in large concentrations in cow’s milk supply mineral compounds for the repair of early enamel damage.
Hard yellow cheese also has an anti-caries effect. Following the consumption of cheese the dental surface is covered with a protective lipid layer. In addition, saliva secretion is stimulated and the level of calcium and inorganic phosphates increases. As a result, acids are neutralised faster and the remineralisation of hard dental tissues is supported.
Fibre-rich products such as raw fruit and vegetables or wholemeal cereal products increase saliva secretion and facilitate washing away of food residues (8, 9).
Non-cariogenic sweeteners – substances added to food products instead of sugar:
– artificial sweeteners (intense replacement sweeteners, non-calorific): aspartame, cyclamate, saccharine,
– sugar substitutes (calorific), polyols: sorbitol, xylitol, isomalt, maltitol, mannitol.

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Piśmiennictwo
1. Featherstone JD: Dental caries: a dynamic disease process. Aust Dent J 2008; 53(3): 286-291.
2. Sheiham A, James WP: A new understanding of the relationship between sugars, dental caries and fluoride use: implications for limits on sugars consumption. Public Health Nutr 2014; 17(10): 2176-2184.
3. Barbour ME, Lussi A: Erosion in relation to nutrition and the environment. Monogr Oral Sci 2014; 25: 143-154.
4. Practice Paper of the Academy of Nutrition and Dietetics: Oral Health and Nutrition. June 2014. http://www.eatrightpro.org/~/media/eatrightpro%20files/practice/position%20and%20practice%20papers/practice%20papers/practice-paper-oral-health-and-nutrition.ashx.
5. Bowen WH: The Stephan Curve revisited. Odontology 2013; 101: 2-8.
6. Moynihan P: Foods and dietary factors that prevent dental caries. Quintessence Int 2007; 38(4): 320-324.
7. Sönmez IS, Aras S: Effect of white cheese and sugarless yoghurt on dental plaque acidogenicity. Caries Res 2007; 41(3): 208-211.
8. Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition. http://www.eatrightpro.org/~/media/eatrightpro%20files/practice/position%20and%20practice%20papers/position%20papers/oral-health-and-nutrition-final-paper.ashx.
9. Olczak-Kowalczyk D, Jackowska T, Czerwionka-Szaflarska M et al.: Stanowisko polskich ekspertów dotyczące zasad żywienia dzieci i młodzieży w aspekcie zapobiegania chorobie próchnicowej. Nowa Stomatol 2015; 20(2): 81-91.
10. Riley P, Moore D, Ahmed F et al.: Xylitol-containing products for preventing dental caries in children and adults. Cochrane Database Syst Rev 2015; (3): CD010743.
11. Moerman RV, Bootsma H, Kroese FG, Vissink A: Sjögren’s syndrome in older patients: aetiology, diagnosis and management. Drugs Aging 2013; 30(3): 137-153.
12. Singh ML, Papas A: Oral implications of polypharmacy in the elderly. Dent Clin North Am 2014; 58(4): 783-796.
13. Neumann-Podczaska A, Wieczorkowska-Tabis K, Grześkowiak E: Interakcje lek-lek w geriatrii. Geriatria 2013; 7: 238-242.
14. Zamienniki cukru i ich rola w zapobieganiu próchnicy. Przyjęte przez Zgromadzenie Ogólne Światowego Stowarzyszenia Dentystycznego: 26 września 2008, Sztokholm, Szwecja. J Stoma 2016; 69(4): 477-478.
otrzymano: 2017-10-30
zaakceptowano do druku: 2017-11-21

Adres do korespondencji:
*Agnieszka Mielczarek
Katedra Stomatologii Zachowawczej Warszawski Uniwersytet Medyczny
ul. Miodowa 18, 00-246 Warszawa
tel. +48 (22) 502-20-32
agnieszka.mielczarek@wum.edu.pl

Nowa Stomatologia 4/2017
Strona internetowa czasopisma Nowa Stomatologia