Introduction
Oral health encompasses the well-being of your mouth, including teeth, gums, tongue, throat, and surrounding bones. Maintaining good oral health is crucial for overall well-being and quality of life, influencing your ability to speak, smile, taste, chew, and express emotions. Nutrition, the food and drinks you consume, plays a vital role in maintaining and improving oral health. This article explores the intricate relationship between diet, nutrition, and oral health, providing evidence-based insights and practical recommendations for all age groups, from children to older adults.
How Nutrition Affects Oral Health
Consuming healthy foods and drinks offers numerous benefits for both adults and children. MyPlate serves as a valuable guide to healthier eating habits. Conversely, certain foods and drinks can elevate the risk of oral health problems, while insufficient intake of key nutrients can lead to issues with teeth and other oral structures.
The Role of Parents and Caregivers
Parents and caregivers significantly influence their children's nutrition. Teaching children about foods that are beneficial for their teeth and those that should be avoided is essential. Establishing good nutritional habits early in life provides a solid foundation for healthy eating patterns and food choices in the future. Consider your child's mouth as a gateway to the rest of their body; what they consume can impact their oral health, growth, development, weight, and energy levels.
Key Recommendations for Children's Oral Health
- Limit Sugary Foods and Beverages: Reduce your child's consumption of sugary items, reserving them for special occasions or avoiding them altogether.
- Balanced Diet: Ensure your child's diet includes a variety of fruits, vegetables, whole grains, protein, and dairy products.
- Be Mindful of Hidden Sugars: Many seemingly healthy foods contain sugar, including fruits, some vegetables, and milk.
- Supervise Oral Hygiene: Assist or supervise your child in brushing their teeth twice daily and flossing once daily.
- Regular Dental Checkups: Schedule dental visits every six months for professional advice and early detection of potential issues.
- Choose ADA-Approved Products: Select toothpaste and toothbrushes approved by the American Dental Association (ADA).
Oral Health During Pregnancy
Taking care of your oral health and nutrition while pregnant or planning a pregnancy is crucial. These steps help ensure your future child enjoys good oral health.
- Healthy Foods for Babies: Breastfeeding for at least six months is recommended.
- Avoid Sugary Drinks in Bed: Do not put your baby to bed with a bottle or sippy cup filled with breast milk, infant formula, fruit juice, or other sugary liquids, as these can cause tooth decay.
Oral Health Problems Caused by Poor Nutrition
A poor diet can significantly impact oral health, leading to various issues:
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Dental Caries (Cavities)
Diet plays a significant role in the development of dental caries or tooth decay. Sugary drinks, candy, and highly processed carbohydrates can cause tooth decay because bacteria in the mouth turn them into acid that erodes tooth enamel.
- The Role of Nutrients: A diet lacking essential nutrients can also contribute to tooth decay. Vitamins and minerals are required to maintain strong teeth and bones, including calcium, phosphorus, and vitamin D.
Periodontal Disease
Periodontal disease is a severe gum disease affecting the structures surrounding the teeth, including the gums, alveolar bone, and periodontal ligament. If left untreated, it can lead to tooth loss.
- Impact of Poor Nutrition: Poor nutrition increases the chances of developing periodontal disease because inadequate nutrition weakens the immune system. A diet high in sugar and processed carbs can increase inflammation and susceptibility to periodontal disease.
- Preventive Measures: A healthy diet that includes fruits, vegetables, whole grains, and lean protein can reduce the likelihood of this disease by helping keep teeth and gums maintaining optimal health.
Other Oral Health Conditions
- Vitamin Deficiencies: Deficiencies in vitamin C and zinc can lead to increased bleeding and swelling of the gums, leading to inflammation.
- Oral Thrush: Increased inflammation in the mouth can allow for easy access to bacteria, leading to infections such as oral thrush.
Recommended Foods for Optimal Oral Health
Consuming a healthy diet that includes the following can improve your oral health:
- Whole Grains
- Fruits
- Vegetables
- Lean Proteins
- Low-Fat Dairy: The calcium in dairy products helps strengthen enamel, and vitamin D helps the body absorb calcium. Vitamin C helps the body fight infections, such as gum disease.
- Fibrous Foods: Fresh, fibrous foods like apples, carrots, and celery can help scrub plaque and debris away from tooth surfaces, helping to avoid tooth decay.
The Importance of a Nutritious Diet for Oral Health
Inadequate nutrition can have a significant impact on oral health. A diet high in sugar and processed carbs can lead to tooth decay, periodontal disease, and other infectious diseases. On the other hand, nutrient-rich foods can help strengthen and maintain healthy teeth and gums.
In addition to maintaining a nutritious diet, make sure to practice good oral health habits, such as:
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- Brushing your teeth twice daily with fluoride toothpaste
- Flossing once daily
- Using mouthwash once daily
- Visiting your dentist regularly for bi-annual checkups and cleanings
Diet and Nutrition in Older Adults
Malnutrition poses a significant health challenge in older adults, linked to physical decline affecting daily activities and quality of life. The relationship between diet, nutrition, and oral health in this demographic is particularly crucial.
Key Considerations for Older Adults
- WHO and ADA Recommendations: The World Health Organization (WHO) and the American Dental Association (ADA) emphasize the bidirectional relationship between diet and nutrition and oral health, highlighting its importance in achieving healthy aging.
- Impact of Oral Health on Nutrition: Poor oral conditions, such as periodontal disease, can induce pain, infection, and tooth loss, affecting nutritional intake.
- Nutritional Deficiencies: Surveys indicate that older adults, especially those in disadvantaged communities, often suffer from nutritional deficiencies or imbalances that affect their oral health.
- Malnutrition and Health Outcomes: Malnutrition is associated with frailty, hospitalization, mortality, and morbidity.
- Importance of Functional Dentition: Good oral health and functional dentition are essential to maintain sufficient nutritional intake and reduce the risk of malnutrition.
Physiological and Social Factors
- Decline in Abilities: Older adults often experience a decline in cognitive and functional abilities, affecting their ability to prepare food, cook, and maintain oral hygiene.
- Physiological Changes: Age-related changes lead to taste bud and salivary gland atrophy, altering taste sensation, decreasing appetite, and increasing the risk of oral diseases.
- Chronic Conditions and Medications: Chronic medical conditions and associated medications can further reduce self-care abilities and increase the risk of hyposalivation.
- Social Determinants of Health: Social factors like living alone, low income, and low health literacy can limit access to food and dental care.
Macronutrients, Micronutrients, and Oral Health
"Diet" refers to the food and drink an individual consumes, as well as the mental and physical circumstances (frequency and methods of intake) related to eating. "Nutrition" refers to macronutrients (protein, carbohydrates, and fat) and micronutrients (vitamins and minerals) that the body needs. The intake of certain types of macronutrients or micronutrients as well as dietary behavior, such as the frequency of intake, may impact oral health.
Dental Caries
Dental caries results from the demineralization of dental hard tissues due to the acidic by-products the bacteria in the biofilm (dental plaque) produces via fermentation of dietary carbohydrates. Half of the global older adult population has untreated dental caries, and diet is one of the caries risk factors in older adults.
- Fermentable Carbohydrates: There is unequivocal evidence showing that fermentable carbohydrates (sugars and starch) are essential in caries initiation and progression.
- Free Sugars: The World Health Organization recognizes that free sugars are key elements in caries development, including sugars added to foods and drinks, as well as those naturally present in honey, syrups, and fruit juices.
- Sucrose: Sucrose is particularly concerning because it can be rapidly converted into acid, resulting in a profound drop in pH.
- Sugar Intake Recommendations: The World Health Organization recommends limiting free-sugar intake to below 10% of total energy intake.
- Snacking Habits: Frequent snacking habits, common among older adults, can increase the risk of caries development due to constant exposure to sugars.
Periodontal Disease
Periodontal disease is the inflammation of the periodontium, in which dental plaque elicits a series of host responses to mediate inflammation, resulting in tissue destruction characterized as pocket formation, gingival recession, and alveolar bone resorption in susceptible individuals. Periodontal disease is cumulative and prevalent in old age, affecting more than 60% of the global older adult population.
- Dietary Patterns and Nutrient Intake: Emerging evidence indicates that certain dietary patterns and nutrient intake can influence the development of periodontal disease.
- Beneficial Nutrients: Intake of fatty acids, vitamin C, vitamin E, beta-carotene, fiber, dairy calcium, fruits, and vegetables is inversely associated with the risk of periodontal disease.
- Anti-Inflammatory Effects: N-3 polyunsaturated fatty acids and dietary antioxidants regulate inflammatory responses and reduce oxidative stress in periodontal tissues.
- Dairy Products: Increased intake of total dairy calcium from dairy products reduces the risk of periodontitis.
Tooth Wear
The prevalence of tooth wear increases with age. Tooth wear includes attrition, abrasion, erosion, or any combination thereof.
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- Dental Erosion: Dental erosion is strongly linked to diet and is defined as the progressive and irreversible loss of dental hard tissue caused by a chemical process of acid dissolution that does not involve bacteria.
- Acidic Foods and Beverages: The source of acid can be intrinsic (gastric reflux) or extrinsic (consumption of acidic foods/beverages like carbonated drinks and fruit juice).
- Fruit Juice Consumption: Frequent consumption of natural fruit juice increases the risk of dental erosion.
- Timing of Fruit Intake: Fruit intake between meals significantly increases the risk of tooth wear progression.
- Dietary Supplements: Chewable vitamin C tablets can increase the risk of dental erosion.
Oral Cancer
Oral cancer ranks as the 13th most common cancer worldwide, with alcohol consumption being a leading cause.
- Risk Factors: The risk of oral cancer increases with age and alcohol consumption.
- Protective Factors: Greater consumption of non-starchy vegetables may decrease the risk of oral cancer.
The Impact of Oral Health on Nutritional Intake
The oral cavity is the first part of the digestive tract and is responsible for chewing, salivation, and swallowing to transport food bolus to the stomach for nutritional intake. In older adults, several common dental problems such as dental caries, periodontal disease, tooth wear, and oral cancer may induce pain, infection, and tooth loss and jeopardize the normal digestive process for nutritional intake.
Dental Caries, Periodontal Disease, and Tooth Wear
Dental caries, periodontal disease, and tooth wear may induce dentine hypersensitivity or even pain, which limits food choice, reduces chewing efficiency, and hinders nutritional intake.
Dental Caries and Dietary Recommendations
Dental caries occur when the demineralization of the enamel exceeds its demineralization capacity. Dental caries is a dynamic process that involves susceptible tooth surfaces, cariogenic bacteria, mainly Streptococcus mutans, and a fermentable carbohydrate source.
- Sucrose: Sucrose is the most common dietary sugar and is considered the most cariogenic carbohydrate.
- Frequent Consumption of Carbohydrates: Frequent consumption of carbohydrates in the form of simple sugars increases the risk of dental caries.
Sugar Substitutes
Sugar substitutes pose numerous benefits for preventing and controlling mainly diabetes mellitus, weight, and dental caries.
- Caloric and Non-Caloric Sweeteners: Sweeteners are classified into caloric (carbohydrate-based) and non-caloric (non-carbohydrate based).
- Xylitol: Xylitol is a non-cariogenic and antibacterial sugar alcohol that is added to various products for caries prevention.
Dietary Recommendations to Prevent Dental Caries
- Promote regular eating patterns.
- Promote eating cariogenic foods only with meals.
- Offer non-cariogenic or low-cariogenic snacks, like cheese and fruits.
- Avoid sugar-containing foods that are sticky or slowly eaten.
Other Issues
Malnutrition, especially in children, results from improper dietary behaviors and feeding practices in infancy and childhood. It is usually related to limited access to fresh and nutritious food, which is replaced with low-cost and high in sugars food.
- Vitamin Deficiencies: Vitamin A deficiency leads to impaired epithelial tissue development, tooth formation, and enamel hypoplasia. Vitamin D and calcium deficiency cause hypo-mineralization, delayed eruption, the absence of lamina dura, and abnormal alveolar bone patterns. Delayed wound healing, dentin malformations, bleeding gums, and defective collagen formation may result from vitamin C deficiency. Angular cheilosis and periodontal diseases are associated with a lack of vitamin B.
The Role of Healthcare Professionals
An interdisciplinary team of dentists, general practitioners, nurses, and dieticians must work together to ensure patients are well informed of the connection between proper nutrition and oral health and receive dietary advice to prevent dental caries and other systemic conditions related to poor nutrition. Healthcare professionals must also perform basic nutrition screening and assess patients' diets. Furthermore, dental hygienists can also provide dietary advice along with oral hygiene instructions. Collaboration between all these health care providers will greatly improve patients' outcomes.
Practical Tips for Maintaining Good Oral Health
- Brush Regularly: Brush your teeth at least twice a day with fluoride toothpaste.
- Floss Daily: Floss at least once a day to remove plaque and food particles from between your teeth and along the gumline.
- Limit Sugary Foods and Drinks: Reduce your intake of sugary snacks and beverages, which can contribute to tooth decay.
- Stay Hydrated: Drink plenty of water throughout the day to help keep your mouth clean and stimulate saliva production.
- Chew Sugar-Free Gum: Chewing sugar-free gum after meals can help increase saliva flow and neutralize acids in your mouth.
- Eat a Balanced Diet: Focus on consuming a variety of nutrient-rich foods, including fruits, vegetables, whole grains, lean proteins, and low-fat dairy products.
- Avoid Tobacco: Refrain from using tobacco products, which can increase the risk of oral cancer and gum disease.
- Limit Alcohol: Moderate your alcohol consumption, as excessive alcohol intake can contribute to oral health problems.
- Regular Dental Checkups: Visit your dentist regularly for professional cleanings and examinations.
Oral Health and Systemic Conditions
There is a proven relationship between oral and general health. Many health conditions may increase the risk of oral diseases, and poor oral health can negatively affect many general health conditions and the management of those conditions.
Infective Endocarditis (IE)
Infective endocarditis (IE), an infection of the inner lining of the heart muscle, can be caused by bacteria that live on teeth. This means that improving oral hygiene may help in reducing the risk of developing IE.
Cardiovascular Disease
Periodontal disease may be associated with heart disease and shares risk factors including tobacco use, poorly controlled diabetes, and stress.
Pregnancy
Poor oral health during pregnancy can result in poor health outcomes for both mother and baby. For example, studies suggest that pregnant women who have periodontal disease may be more likely to have a baby that is born too early and too small.
Stress and Anxiety
Stress creates a hormone in the body called cortisol. Spikes in this hormone can weaken the immune system and increase susceptibility to developing periodontal disease. Evidence has shown that stress reduces the flow of saliva which in turn can contribute to dental plaque formation.