Indian J Physial Pharmacal 2001; 45 (2): 258-260

LETTER TO THE EDITOR

DENTAL CARIES AND DIETARY HABITS IN SCHOOL GOING CHILDREN

Sir,

(Received on May 31, 2000 )

Dental caries (DC) is a local disease,which occurs on hard tissues of teeth leadingto its destruction by oral microorganisms.Various environmental factors affect dentalcaries prevalence, which are - diet, especiallysucrose rich; demographic factors such asage and sex and improper brushing habits.Caries is a biosocial disease, as livingstandards improve the severity of the diseaseusually increases. In the industrializedcountries dental caries is one of themost ubiquitous and expensive diseases.In developing countries where many ofthe basic needs are not provided for, theproblem of dental disease receives lowpriority.

The factor of diet in relation to carieshas been studied most exhaustively likesucrose, cocoa, milk and fibers. Our studyhence, includes these criteria forfurther analysis. Young children andadolescents consume an enormous quantity,of especially the so-called "junk foods", whichare high in sugar and other carbohydratecontent (1).

Moreover they also consume a goodamount of chocolates, lesser amount offibers and green vegetables, thus takingcariogenic diet and avoiding cariostaticdiets (2).

The cariostatic components of foods,are:

(a) Naturally occurring- Phytate(unrefined flours), cations(unrefined), cocoa butter, andglycirrhizic acid and Plant phytins.

(b) Artificial- Phosphates, metal ions,and trace elements. These preventcaries by inhibiting demineralizationof tooth surface (3).

The importance of sucrose in caries isits role as a substrate in the synthesis ofadhesive and storage polysaccharides, theglucans and levans. These polymers accountfor the "stickiness" required for initiatingand maintaining plaque formation on toothsurfaces. Streptococcus mutans is mostvirulent cariogenic organism. (4). Theenzymes glucosyl- and fructosyl-tranferaseshave been isolated from Steptococcus sangusand Streptococcus mutans. Streptococcus ishighly specific for sucrose and does notutilize fructose, glucose, maltose or lactose.Bibby (1969) demonstrated that fermentablecarbohydrates produced D C only whenremained in contact with a tooth surface fora specific time interval, this condition beingfulfilled best by "junk foods" (5). A study byDodds' also showed the same thing. (6)

Indian J Physiol Pharmacol 2001; 45(2)

In our cross sectional study we randomlychose 804 school going children fromdifferent schools in the age group of 5 to 12years. The group comprised boys (390) andgirls (414). The assessment was done usingdietary questionnaire and DMF (decayed,Missing and Filled teeth) criteria. Themissing criterion was not considered herebecause in this age group it is difficult tosay that it is due to natural exfoliation ordue to caries.

Our study showed that the children whoconsumed more chocolates than sweets werehaving a higher prevalence of dental caries.The prevalence of DC in children with achocolate loving habit was recorded 63%while in children with sweet loving habit, itwas found to be 60% in our study. Regardingthe vegetarian and non-vegetarian habits, itwas noted that non-vegetarians had a lowerprevalence of DC as compared to vegetarianswith figures going to 65.5% in vegetariansand 59.46% in non-vegetarians (p = N.S.).

The most important role forcarbohydrates in dental caries is their abilityto serve as excellent fermentable energysources for a variety of oral microbes. It isshown that the "junk foods" like chocolatescontain added sugars and not the naturalsugars. These added sugars are the mainculprit in the causation of DC, while naturalsugars are regarded noncariogenic, probablydue to a low concentration of sugar. Alsonatural sugar contains fibers and phenolics,which have an anticariogenic effect.

Although cocoa and milk are consideredto have an anticaries effect, yet they producecaries when taken as chocolate, which is dueto its high sucrose content (7). The milk

Letter to the Editor 259

chocolate has low to moderate cariogenicpotential in spite of its high sugar content;this may be because of its high fat content.However, this product also contains tanninderivatives from cocoa, which demonstratecariostatic activity, but remains masked dueto high carbohydrate content.

In sweets the high fat content lessensthe adherence of sweets to the teeth makingthe oral clearance time shorter therebybecoming lesser cariogenic. The chocolatesare, however, manufactured using skimmedmilk powder containing a very little amountof fat. This makes chocolates more stickythan sweets hence the rate of clearance ofchocolate is more than that of sweetsmaking chocolates more cariogenic. Thus, itis more important that in which dietcombination, the sugar has beenconsumed - either sweets or chocolates(8, 9). Some wellknown studies like Vipeholmstudy by Gustaffsson et al studies showedthat restricting the sugar intake in dietslessened the occurrence of caries (10). TheTurku sugar studies demonstrated thatxylitol is noncariogenic. (11).

The foods with high fat and proteincontent are considered to have ananticariogenic effect (12). On the basis of thisfact it is presumed that non-vegetarian foods,owing to their high fat and protein content,can be anticariogenic as compare tovegetarian food. Although, green vegetables·contain tannins and phytins, which arecariostatic (13) but still these are noteffective in small children because mostchildren in this age group do not like toconsume green vegetables. Fats may possiblydecrease caries activity by altering surfaceproperties of the enamel, by having a direct

260 Letter to the Editor

toxic effect on oral microbes, throughinterference with sugar solubilization, orsimply by the replacement of dietarycarbohydrates. Proteins may function toreduce caries posteruptively direct effect onplaque metabolism, replacement of dietarycarbohydrate, or by increasing salivasecretion, which enhances oral cleaning time

.(14). The adult vegetarian diet, specially the

Indian J Physiol Pharmacol 2001; 45(2)

green vegetables, contain tannins andphytins which are cariostatic but these maynot be effective in small children becausemost children in this age group do not liketo consume green vegetables. This might bethe explanation, as per our study, thatvegetarian children were found to be moreprone to DC as compared to children whowere mainly on non-vegetarian diets.

RAJ KUMAR YADAV*, SHOBHA DAS AND PAYAL R. KUMAR**

*Departments of Physiology,Lady Hardinge Medical College,

New Delhi - 110 001and

**Department of Gastroenterology and HNU'*,All India Institute of Medical Sciences,

New Delhi - 110 029

REFERENCES

1. Hefti, Schmid R. Effects on caries incidence inrats of increasing dietary sucrose levels. CariesResearch 1979; 13: 298-300.

2. Carlsson T, Egelberg J. Effect of diet on earlyplaque formation in man. Odontologisk Revy1965; 16: 112-125.

3. Bibby BG. Fruits, vegetables and dental caries.Clinical Preventive Dentistry 1983; 5: 3-11.

4. Drucker DB, Verran, J. Comparative effects ofthe substance - sweeteners- glucose, sorbitol,sucrose, xylitol and trichlorosucrose on loweringof pH by two oral Streptococcus mutansstrains in vitro. Archives of Oral Biology 1979;24: 965-970.

5. Bibby BG, Goldberg HJV, Chen E. Evaluation ofcaries producing potentialities of various foodstuffs. JADA 1951; 42: 491-509.

6. Dodds MWJ, Edgar WM. The relationshipbetween plaque pH, plaque acid anion profiles,and oral carbohydrates retention after ingestionof several "reference foods" by human subjects.Journal of Dental Research 1988; 67: 861-865.

7. Newbrun E. Sucrose in the dynamics of cariousprocess. International Dental Journal 1982; 32:13-23.

8. Grenby TH. The deposition of dental plaque inyoung adults on a diet containing chocolate andskim milk powder. Archives of Oral Biology 1974;19: 213-215.

9. Paolino VJ, Kashket S. Inhibition by cocoaextracts of biosynthesis of extra cellularpolysacchar ides by human oral bacteria. Archivesof Oral Biology 1985; 30: 359-363.

10. Gustafsson BW et al. The Vipeholm dental cariesstudy. Acta Odontologica Scandinavical 1954; 11:232-364.

11. Scheinin A, Makinen KK. Turku sugar studiesI-XXI. Acta Odontological Scaruiinauica 1975; 33(supplement 70): 1-349.

12. Lewis Menaker (ed). The biologic basis of dentalcaries, harper and Row publisher, Hagerstown.1980, p.352-53.

13. Cole et al. Effect. of pyridoxine, phytate andinvert sugar on plaque composition and cariesactivity in the monkey. Caries Research 1980;14: 1-15.

14. Rugg-Gunn AJ. Diet and dental caries. In Theprevention of Dental Disease, ed.J.J. Murray1983; pp. 3-82. Oxford: Oxford University Press.

* Corresponding Author