Since man broke from the natural food chain & developed new energy resources and applied technology to food processing, our dietary habits have undergone major changes, both the qualitative nature of our diet and pattern of eating have changed and are still changing. Ingestion of food may affect oral – dental health by both systemic and local mechanisms. Nutritional effects are mediated systematically and dietary effects are mediated locally in the oral cavity. The systemic effects results form the absorption and circulation of nutrients to all cells and tissues and may be mediated through influences on development of teeth, the quality and quantity of salivary secretion, improved host resistance and improved function. Dietary constituents expert their local effects by influencing the metabolism of the oral flora and by modifying salivary flow rates and, in- directly, the qualitative aspect of salivary secretions. Also important is the manner in which food items affect taste perception and condition dietary preferences and patterns of eating.
Numerous epidemiological studies have failed to show any clear- cut relationship between nutritional status and dental caries. Indeed, in a study of the caries prevalence of populations in Ethiopia, Thailand, Vietnam and Alaska nutritional deficiencies in thiamine, vitamin A and riboflavin have been documented, but the caries levels in these countries was found to be relatively low. Neither the great variation in the levels of caries nor its widespread nature correlates with nutritional stagnations. Paradoxically, the populations of highly industrialized, well nourished nations have a higher prevalence of dental caries than the less affluent peoples of the world and caries can be regarded as a disease arising from the local effects of over consumption of certain foods. There is no support for the premise that overt malnutrition and high caries experience coexist. However, this statement should not be construed as implying that teeth never differ in structure and composition and therefore, in caries resistance as a result of nutritional influences.
A significant point is that dental caries is an interaction- between diet, cariogenic flora and the tooth of the host. Significant, also, is the fact that the tooth is relatively passive in the caries process. The environmental challenge to teeth form products of bacterial- substrate reaction is often the most important variable in the caries process. Thus, even teeth that are well formed and mineralized cannot withstand a strong environmental challenge from the chemical by- products of a highly cariogenic flora and a high concentration of substrate in the oral cavity. Conversely, poorly mineralized teeth may not decay if the local substrate and therefore the concentrations of acidic metabolic byproducts of oral bacteria are relatively low. One should also recognize that nutritional and dietary influences present during the development of teeth are chronologically years apart from the environmental influences that operate on erupted teeth. Diets and eating patters change with age, making it difficult to assets nutritional influences on dental tissues.
Chemical analysis of the inorganic constituents of dental tissue has not disclosed significant difference between carious and non carious teeth except for difference in fluoride concentrations in teeth with low caries susceptibility from residents living in a fluoride community as compared to those in a non fluoride community. This is a more difficult problem that might appear at first sight. If enamel from caries free tooth is taken for analysis there is no proof that it would remain caries-free if it had remained in the mouth. When the apparently sound enamel of a carious tooth is sampled it is always possible that changes have already occurred as a result of mild acid attack or from caries of a neighboring tooth. If there are subtle differences between teeth that develop under ideal nutritional and metabolic conditions resulting in a high caries resistance, compared to teeth that develops when nutritional or metabolic deficiencies exist, these have not yet been uncovered by chemical analysis. More and profitable may be studies at a molecular level of the crystalline, degree of dislocation of enamel crystals and degree to which apatite crystals may be calcium deficient.
The teeth develop as if they have a priority for taking up deficient nutrients at the expense of bone. This is at least partly explained by the fact that bone may be resorbed to release calcium and phosphorus to meet general body needs but this does not occur in the teeth.
There are, at least, three dramatic exceptions to the statement that nutritional status and caries prevalence are unrelated. The first, already referred to, is that ingestion of trace quantities of fluoride during dental development enhances the resistance of teeth against caries attack. Secondly, vitamin D affects the development of teeth and, as some unconfirmed evidence suggests, the susceptibility of teeth to caries. Pieces of the fascinating vitamin D puzzle are only now falling into place although its influence on teeth and caries has been neglected. Thirdly, it is known from animal experiments, and suggested by clinical trials in man, that the nutritional and dietary environment of the tooth immediately after eruption influences its caries resistance.
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