Read the summary and the most important questions on Theory Week 5: Nutritional aspects of dental caries

• 1 Demineralization and Remineralization

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• - How does the process of demineralization go (in 4 steps)- How does a demineralized area first appear?

  1. Bacteria metabolizes carbohydrates and --> make acid
  
  2. Acid moves through enamel tubules
  
  3. It creates --> increased solubility of tooth structure (calcium hydroxyapatite)
  
  4. Calcium leaches from tooth structure 
  
  5. Demineralized area first appears as a white spot

• What is the process of remineralization? (4 steps)

  1. After food clears from the mouth ---> oral pH begins to return to --> more basic 7.0
  
  2. Minerals in saliva (calcium + phosphorus)--> take same pathway as acid through --> tubules to --> replace what was lost 
  
  3. Fluoride in oral cavity --> will incorporate into crystalline surfaces --> that have been partially dissolved
  
  4. Hydroxyapatite coverts into --> fluorapatite --> which fortifies tooth structure --> against future acid attack

• - How long does it take for a dental caries to progress through the enamel for a person of high risk?- Name 4 factors that make someone have a high risk. Explain where needed.

  It takes up to 19-22 months for someone with high risk:
  
  - High carbohydrate diet (= simple carbs = monoschaccaride + disaccharide)
  
  - Poor quality saliva (buffer)
  
  - Poor oral hygiene
  
  - Unavailable fluoride (not going to dentist or no fluoride in toothpaste)

•   - How long does it take for a dental caries to develop for a person of low risk?- Name some factors that determine a low risk for dental caries.

  It takes up to 5 years for a person of low risk:
  
  
  - Sucrose consumption in diet is limited to --> 5% - 10% of daily intake
  
  - Diet is rich in whole unprocessed foods + foods that keep pH around 7
  
  - Ample saliva
  
  - Daily plaque removal
  
  - Use of fluoridated toothpaste

• 2 Six factors that play a role in caries development

• 2.1 Carbohydrates in diet

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• What is shown on the picture and how can you apply that to dental caries?

  = Research by Stephan and Miller that demonstrated that oral pH drops within 2-3 minutes of rinsing with sucrose
  
  
  Critical pH = 5.5 --> level of acid that can demineralize hard tooth structure
  
  
  If you consume food --> it takes 2-3 minutes for the ph to drop
  It takes 35 minutes for it to come up again

•  What is meant by cariogenic foods and what do they do? Give examples of these foods.

  = Fermentable carbohydrates
   --> metabolized by oral bacteria 
  --> + reduces salivary pH below 5.5
  
  Monosaccharide + Disaccharide
  
  Sweeteners used in manufacturing (juice, honey, HFCS, glucose, refined starch) 
  - plaque bacteria can easily break it down to produce acid
  - increase amount plaque biofilm + creates more retention + formation 

• What is the average sugar consumption? 

  113 grams each day
  
  (equivalent to around four cans of regular coca-cola)
  
  (ultra-processed foods contain about 20% sucrose = 57% daily kcal intake)

•   What is meant by cariostatic foods and what do they do? Give examples of these foods.

  = Not contributing to initiation of enamel demineralization
  --> may prevent dental caries even
  (cheese, nuts, portion, sugar-free gum, candy/gum + xylitol)
  
  1. They maintain a more basic oral pH
  - animal protein
  - fats
  - calcium-rich foods
  
  2. Interrupt caries formation
  - cranberries
  - cocoa
  - tea
  - wine
  - coffee
  - probiotics

• What is meant by acidic foods, what do they do (to your enamel) and give examples of foods that are acidic.

  Foods that contain acid --> have a low pH value 
  
  --> will erode enamel (labels: citric, tartaric, lactic, carbonic)
  
  --> Erosive foods soften --> enamel surface
  --> As surface continues to soften + erode --> dentin closer to it
  --> Tooth appears white --> then dark where it erodes
  
  Acidic foods
  - soda
  - citrus fruits
  - yoghurt
  - grapes 

• Why are starchy foods very cariogenic? And what is the danger behind combining a sliced bread with jelly?Give examples if needed.

  Starch is reduced to --> fructose + maltose by --> salivary enzymes
  
  --> They have very retentive factors (bread, rice, snacks)
  when there is already plaque -->more retentive + build up
  
  When combined with a simple sugar --> the combination is worse than either by itself (jelly bread)