1. 1 Sugar- The only Culprit?… have another Coke… Hidden Sugars Coca Cola Sweet Tea Mt. Dew Fermentable Carbohydrates

2. FACTS… Kids and teens are more susceptible to decay because enamel is not mature or fully formed 12- 19 yr old boys who drink soft drinks consume an average of 81 gallons of sugar a year. Girls the same age drink and average of 61 gallons of sugar -- that means 750 cans per year EACH! It takes two hours of moderate walking to burn off the calories in one 20 oz. soft drink Soft drinks have no nutritional value. That’s why they are often referred to as “liquid candy” “sugar water” or “wasted –empty calories” Teens get 13 percent of their calories from carbonated and non- carbonated soft drinks

3. Other Facts Soda does not really quench your thirst; in fact the chemicals present in soda can result in lack of moisture in the body Soda has caffeine & sugar so excessive intake could lead to craving for more Children respond to caffeine in a much more “exaggerated” way than adults and can literally have an overdose reaction

4. How Acidic are the drinks you drink?  The pH of regular and diet pop ranges from 2.47-3.35  The PH in our mouth is normally about 6.2 to 7.0 (slightly more acidic than water)  At a PH of 5.2 to 5.5 or below the acid begins to dissolve the hard enamel of our teeth  http://www.youtube.com/watch?v=SWKB_6lwcx4&f eature=related http://www.youtube.com/watch?v=SWKB_6lwcx4&f eature=related

5. 5 Acidic Alkaline Unsweet no lemon tea (contains fluoride) GERD

6. Acidity of Different Types of Drinks Choc milk PH 7.1!! Diet snapple w/ lemon more acidic than regular 2.5

7. 7 “SIP ALL DAY….. GET DECAY” & EROSION!

8. Hard Facts Diet or "sugar-free" pop STILL contains acid- just not sugar & still stimulates cravings Acid in soft drinks, whether they contain sugar or not, is the primary cause of weakening tooth enamel (also dulls luster) Each acid attack lasts about 20 minutes (before neutralized) The acid attack starts over again with every sip Bacteria in your mouth cause cavities when tooth enamel is damaged If you have a receding gum line, acid does more damage below the gum line than above it. This is particularly a concern for adults– because cementum is weaker than enamel and the acid level does not have to be as “potent” to cause decay Estimated 20% of children <2 years old drink soft drinks regularly

9. 9 “SIP ALL DAY….. GET DECAY” & FATTER Fruit vs. sugary drinks - 60 Minutes - CBS News

10. Soda Substitutes

11. What to do to reduce decay from soft drinks Drink soft drinks on rare occasions Don't sip for extended periods of time – drink all at once (don’t buy ones with re- sealable lids) Use a straw After drinking, swish your mouth out with water (tums?) – not proven technique Avoid before bed Read labels! Use fluoride– if higher acid/sugar intake = need higher fluoride intake/concentrations Drink with a meal instead of alone Eat with neutralizing foods

12. 12 Role of Nutrition in Caries Mutans Streptococci Including Fermentable carbs

13. Simple enough? BIOFILM Food or drink Fermentable carbs EROSION

14. Sugars-- caries potential= YES Monosaccharide- glucose, dextrose (most foods) fructose, corn syrup (candy, soft drinks, fruit drinks, nondairy creamers) Disaccharide- sucrose (fruits/veg/table sugar), brown sugar, turbinado (raw), molasses (breads/waffles), honey, lactose (milk, baked goods, whip top), maltose (beer) Other carbs- polysaccharides (starch- potatoes, grains, breads, rice, bananas, legumes) See Harris p. 317

15. 15 Factors That Hinder or Enhance Caries  Protective minerals-healthy enamel & ACP?  Fluoride  Calcium/phosphorus in saliva  Good home care  Xylitol  Sealants  Good nutrition (especially firm texture foods) Frequency of eating Physical form- consistency/retention/rate of clearance Sequence of foods Type of food Time eaten Do they Hinder or Enhance?

16. 16 Always a “balance” & can change at different periods in life Need susceptible host & biofilm

17. Key Terms to Know…. 17

18. 18 Harris p. 302

19. 19 **Readily lower pH in mouth= predictive to caries Good choices! Harris p.303

20. 20 Cariogenic Foods & Biofilm pH Frequency a HUGE factor in caries (not quantity) 20 minutes a part- see Wilkins p. 513

21. 21

22. Neutralizing the Acid Cheese Nuts/PB Meat, Chicken, and Fish Raw Vegetables Beans Milk, eggs, plain yogurt Water Popcorn Butter/margarine *If consumed with or after sugary food/drinks, these products may help to neutralize the acid produced or accelerate the clearance from the mouth

23. 23 Hidden sugars? Reading food labels

24. MY FITNESS PAL APP 10% Desired weight

25. 25 Other Sweeteners Polyols Sorbitol Mannitol Xylitol

26. 26 What’s all this about? XYLITOL

27. Interferes with MS metabolism Stimulates saliva =reduces decay Helps with clearance & xerostomia *recommend gum with xylitol– should be one of 1 st ingredients -- check the labels!

28. 28 Other Sweeteners Intense “True” artificial sweeteners Saccharin Aspartame Cyclamate Sucralose Others….. FDA Approval? What about PKU? STEVIA

29. Safety concerns? http://www.youtube.com/watch?v=3M2krP3SXNU http://www.youtube.com/watch?v=A-hUyw2lcio Dr OZ

30. Avoiding the “roller coaster ride” effects moods!

31. 31 Purpose & Objectives for the Dental Dietary Assessment & Counseling Allows the patient an opportunity to see own eating & snacking habits (take ownership) Identify whether patient is meeting daily requirements (myplate) (do 1 st ) Find ways to incorporate missing foods (offer specific suggestions- not just “you need more veggies”) 2 nd Identify frequency, consistency of diet, cariogenic potential of diet Provide individual recommendations 3 rd offer general suggestions based on Dietary recommendations **referral if needed

32. 32 We are in NO way an expert! ?????!!!!

33. 33 Forms Used for Assessment Carbohydrate Intake –Short form noted as “Dietary planning” 3 Day Diet (w/instructions and nutritional assessment sheet)- “Nutritional Counseling”

35. 35 Considerations Get some help!

36. 36  Total Carbohydrates 45-65% (<7% sugars)  Protein 10-35%  Fat 20-30% (saturated <10 if possible) From Guidelines 2010

37. 37 Just a Few Basic Dietary Recommendations Limit eating events to 3 a day. Reduce snacking (unless required, such as with diabetes) If patient snacks, recommend fresh fruit, vegetables, popcorn, and dairy (give list of better food choices for caries) Cariogenic foods, such as retentive starches and sugary foods and liquids should be consumed during meals if possible Liquids clear cavity faster than more retentive items When oral hygiene does not follow a meal or snack, end the eating event with a dairy product (cheese or milk) or another food that helps clearance or neutralizes acid (xylitol gum?)

38. 38 Other Possible Suggestions Encourage a variety of foods Stress the importance of eating vegetables, fruits, and whole grains Explain how to read labels and that most sugars end in “ose;” emphasize < sugars/fermentable carbs Explain the relationship between sugar/carbs/erosion & tooth decay Give examples of “hidden sugars” & counsel regarding “sipping” drinks Give examples of ways to add foods that they show deficiencies in Stress using sodium and salt in moderation- “no salt added” does not mean that the product is low in sodium– read labels Emphasize less processed foods versus whole/natural sources Emphasize that alcohol intake should be in moderation; alcohol is high in calorie and contains few nutrients Encourage an active lifestyle and to consult resources or a dietician for more specific recommendations- especially if systemic disease exists

39. Discourage eating snacks before bed, unless followed by thorough OH Drink water (best choice) but if not unsweet tea? Discourage skipping meals Recommend a multi-vitamin daily Look at additional sources of fluoride or Peridex for caries control Provide with resources (websites, color handouts, etc…..) Remember, small changes can make a big impact in the long run Use Dietary Guidelines for general suggestions Don’t take it for granted that “they know already” LISTEN to your patients desires Consider Biotene or other xerostomia aids if needed, rather than sucking on candy Other Possible Suggestions

40. 40 Other Resources http://www.USDA.gov http://www.health.gov/healthypeople http://diabetes.org http://www.ific.org http://www.floss.com http://ada.org/consumer/diet.html http://www.eatright.com/aoral.html http://www.ahrq.gov/clinic/uspstf/uspsdiet.htm www.nat.uiuc.edu