Dental caries or tooth decay is a common chronic disorder among children. According to National Oral Health Survey for Preschool Children (2005) and School Children (2006), about three fourth of the 5 to 6 year-old children have caries. The notorious impacts of dental caries are well-documented- from acute effects, such as pain, to long-term consequences like eating difficulty and reduced quality of life.
Dental caries occur when the outer layers (as known as enamel) of teeth are dissolved. Teeth will start to dissolve or demineralise when oral pH level falls below 5.5 (acidic). This acidic phenomenon is mainly attributed by organic acids that are produced by oral bacteria. To produce acid, the bacteria need an important substrate that is sugar.
Sugar is referred to all monosaccharide and disaccharide (such as glucose, fructose, and sucrose) that can be found naturally in food or can be added to food and beverages by manufacturers, cooks or consumers. According to NHS Health Scotland (2012), sugar may be classified into two categories:-
- Intrinsic sugar – those that occur naturally within the cellular structure of foods, for example sugars found in whole fruit.
- Extrinsic sugar – those that are not incorporated within the cellular structure and can occur naturally in food and drink, for example in honey or as lactose present in milk.
Recent research indicates that non-milk extrinsic sugars (NMEs) are the prime contributors of tooth decay. NMEs are extrinsic sugars with the exception of lactose in milk and milk products. Foods and drinks containing NMEs are shown in the below table.
- Sugar and chocolate confectionery
- Cakes and biscuits
- Buns, pastries and fruit pies
- Sponge puddings and other puddings
- Dried fruits
- Table sugar added to drinks and in food preparation
- Sugared breakfast cereals
- Jams, preserves, honey
- Ice cream
- Fruit in syrup
- Fresh fruit juices and smoothies
- Sugared soft drinks
- Sugared, milk-based beverages
- Sugar containing alcoholic beverages
Adopted from NHS Health Scotland (2012)
To reduce the risk of dental caries, here are some of the dietary objectives and their respective strategies that you can do for your children:-
- Limit the consumption of NMEs
- Limit feeding bottle contents only to water, formula, or milk
- Do not dip dummies or comforters into sugars, e.g. honey or sugary drinks
- Use less sugar when preparing food
- Replace sweet desserts with healthier options such as whole fruits
- Provide juice in an unsweetened, water-diluted form (50:50 ratio) in a cup
- Check food labels for sugar content
- Choose food with less sugar or with the claim of ‘low/free sugar’. (‘Low sugar’ means sugar content is not more than 5g per 100g solid food or 2.5g per 100ml liquid)
- Look for alternatives if sugar content is high and/or if sugar is listed at the beginning of the ingredient list
- Beware: Over-the-counter chewable or liquid medication and vitamin preparations may contain sugars too. Read label carefully or check with doctor or pharmacist
- Reduce the frequency of consuming NMEs
- Leave a gap of 1-2 hours between ‘eating occasion’ (i.e. consumption of any food or drink)
- This interval is necessary to allow saliva to neutralise mouth acids and allow remineralisation to occur
- Limit food or beverage containing NMEs to be consumed only at meal time
- Serve snack with non-NMEs food and/or beverages such as unsweetened cereals, fruits and vegetables, nuts and seeds, as well as unsweetened milk and other dairy products
- Drink only non-NMEs beverages between meals e.g. plain water, milk and tea.
- Shorten contact time of NMEs in the mouth
- Do not put infants and young children to bed with a feeding bottle.
- Clean teeth and gum with a gauze pad or washcloth after all bottle feedings
- Made all effort to wean children from a bottle and encourage drinking from a beaker or cup by their first birthday
- Discourage prolonged sipping on juice or sugary drinks and harbouring candy, sugared breath mint, or hard candies in the mouth for extended periods
- Encourage teeth brushing or mouth rinsing after meals and snacks.
Besides targeting NMEs, the above strategies aim to maximise oral neutrality, which will reduce the attack of acid to teeth, and to enhance re-mineralisation of enamel after meals and snack. Although restricting NMEs is important for oral health, healthy eating and good oral hygiene control should not be neglected. A balanced and nutritious diet provides all essential nutrients for building and maintaining strong teeth and healthy gum while daily teeth-brushing with the use of fluoridated toothpaste and regular dental check-ups are crucial for oral health, hygiene and functionality. With the combination of all these aspects, your children’s good oral health can be sustained and their angelic smile can certainly be protected. Last but not least, always remember that parents must first be the role model!
- Ministry of Health Malaysia. Malaysia Dietary Guidelines. 2010.
- Ministry of Health Malaysia. Clinical Practice Guidelines: Management of Severe Early Childhood Caries. 2nd edition, 2012.
- NHS Health Scotland. Oral Health and Nutrition Guidance for Professionals. 2012.
- Radler DR and Tougher-Decker R. Nutrition for Oral and Dental Health. In: Mahan LK and Escott-Stump S. Krause’s Food & Nutrition Therapy. 12th ed. 2008.
- Thomas B. Dental disorder. In: Thomas B and Bishop J. Manual of Dietetic Practice. 4th ed. 2007.