Nutritional Factors Associated with Dental Caries: Comparison
Please note this is a comparison between Version 2 by Catherine Yang and Version 3 by Maria Antoniadou.

Nutrition and dietetic care span various life stages, addressing nutritional needs and exploring factors that shape dietary habits. Globally, an alarming disproportion in food resource distribution, coupled with substandard nutritional intake, underscores profound implications for oral health. 

  • diet
  • dental caries
  • oral health
  • dentists
  • dentistry
  • sustainability

1. Introduction

The prevalence of dental caries and periodontitis, acknowledged as the most pervasive oral diseases, has necessitated a reevaluation of societal objectives concerning oral health [1]. This reassessment is prominently centered on primary dental care and has been effectively instituted in multiple nations, yielding notable achievements [2][3]. The adoption of this novel approach by various governments stems from the realization that despite considerable advancements in scientific knowledge and technology in recent years, a commensurate enhancement in oral health has not materialized [4]. Extensive and protracted investigations have consistently established a correlation between periodontal diseases, tooth decay, and the presence of dental plaque, the etiological factors of which are both specific and preventable [5][6]. Notably, restorative dentistry remains financially prohibitive for significant segments of the population in many countries, primarily being accessible to the more affluent socioeconomic strata [7]. Concurrently, the financial implications of dental care are large, consuming over 15% of overall health expenditure. This underscores an impending fiscal challenge for public health systems as the trajectory of escalating costs associated with dental care appears unsustainable [8].
This circumstance has led to the development of a novel strategic approach to address oral diseases, compelling the World Health Organization (WHO) to delineate specific objectives for oral health in 2023 [1]. The initial objective stipulates that by 2030, 50% of children aged 5–6 years should exhibit a state of dental cavity absence, commencing from the baseline year of 2020. The second goal pertains to a target caries index of 3- to 12-year-olds [9]. The third objective aims at the preservation of complete dentition in 85% of 18-year-olds [1]. Additionally, for adults aged 35–45 years, a consequential ambition is the achievement of a 50% reduction in the incidence of extractions relative to historical levels. Concurrently, there is a pressing need for the establishment and integration of sustained data collection systems within health frameworks specifically designed to monitor and assess the evolving landscape of oral health [10].

2. Effects of Poor Nutrition on Oral Health and Dental Caries

Nutrition exerts a profound impact on oral health, with malnutrition notably exacerbating periodontal and oral infectious diseases during this phase [11]. However, the most prominent influence of nutrition on dental health manifests through the local effects of the diet within the oral cavity, specifically concerning the development of dental caries and enamel erosion [12]. A suboptimal diet can significantly contribute to the onset of tooth decay and gum disease [11][13]. Consumption of foods rich in starch, sugars, and carbohydrates can elevate plaque acid levels, precipitating cariogenic attacks. Beyond dental caries, nutritional factors may also play a role in the development of various dental and oral mucosal pathologies [14]. Protein deficiencies, for instance, may be associated with delayed tooth eruption and salivary gland dysfunction. Additionally, a deficiency in vitamin A may lead to impaired epithelial tissue development, tooth formation, and enamel hypoplasia, thereby laying the groundwork for the prevalence of caries [15]. Vitamin C is also a pivotal player in gingival well-being and is essential for collagen production, a protein crucial in maintaining gum integrity. A dietary regimen rich in vitamin C is therefore integral in averting gum disease [16]. Calcium, another essential mineral, assumes responsibility for fortifying teeth and bones, fostering enamel strength, and mitigating the risk of tooth decay. Calcium deficiency not only weakens tooth enamel but also precipitates other oral health issues, including periodontal disease and tooth loss. Nutrient inadequacies, especially those pivotal to bone health, increase the susceptibility to bone loss and subsequent osteoporosis. The intricate process of bone formation demands a consistent supply of nutrients, such as calcium, protein, magnesium, phosphorus, vitamin D, potassium, and fluoride [17][18]. Concurrently, the role of natural and free sugars, encompassing sucrose, glucose, and fructose, assumes prominence as primary contributors to caries development. Sucrose, a disaccharide comprising glucose and fructose, stands out for its heightened cariogenic potential [19]. An array of nutrients, including calcium, vitamin D, protein, magnesium, phosphorus, and potassium, actively contribute to bone and hard dental tissues health. A healthy and balanced diet, characterized by the inclusion of fruits, vegetables, legumes, nuts, seeds, and lean proteins, inherently provides the essential nutrients indispensable for maintaining robust and functional bones and teeth [12][18]. Moreover, phosphorus has emerged as a critical element in caries inhibition, acting as a natural protector and remineralizer of tooth enamel, while zinc, an essential mineral, plays a vital role in gum health. A diminished uptake of zinc may escalate the risk of periodontal disease and subsequent tooth loss [20]. Thus, persistent poor dietary quality is linked to the emergence of oral health issues later in life. Notably, oral health problems, such as tooth loss, periodontal disease, and dry mouth, are pervasive conditions among older individuals (≥65 years) and exert a substantial impact on both oral and general health [15][18][19]. The intricate interplay of micronutrients in dental caries, encompassing their nutritional sources and deficiency effects, is systematically presented in Table 1.
Table 1. Micronutrients and their role, nutrition source, deficiency effect, and supplements.

3. Current Food Technology and Its Influence in the Formation of Caries

The prevailing trend in the food and beverage industry is to meticulously design products to maximize their appeal to consumers. Sugar-sweetened beverages, exemplified by soft drinks, fruit juices, chocolate milk, and energy drinks, epitomize products strategically crafted for consumer allure. The heightened attractiveness of these beverages is primarily attributed to their elevated carbohydrate content, which, by elevating blood glucose levels, induces a pleasurable mood [27]. Furthermore, the caffeine present in many beverages serves to stimulate the trigeminal nerve in the brain, acting synergistically with carbonic acid [28]. Despite the euphoric symptoms associated with their consumption, it is imperative to acknowledge that such drinks may precipitate bone loss, likely attributable to their high caffeine and phosphorus content [27][29]. A similar concern arises with “energy drinks”, wherein the carbonate they contain poses a substantial risk, though the precise mechanism through which they exert their detrimental effects remains incompletely elucidated [30]. Contemporarily, there is a discernible trend among younger demographics to substitute traditional beverages, such as water, milk, and juice, with these enticing alternatives [27][31]. Encouragingly, tea, a beverage commonly consumed by young adults, possesses a notable concentration of polyphenols, which contribute significantly to the prevention of dental caries [32][33][34]. Routine consumption of energy drinks is characterized by elevated sugar content and extreme acidity. With a pH range falling between 2.4 and 3.5, these beverages harbor high concentrations of carbonic acid, phosphoric acid, malic acid, and citric acid [35]. Both the sugars and acids in these drinks significantly contribute to the development of dental caries. Prolonged and frequent consumption of energy drinks has been associated with the induction of dental caries, substantiated by established positive correlations between caries and the intake of soft drinks [19][36][37]. The acidity of these beverages plays a dual role in the development of dental caries. Firstly, it augments the acidic pH initiated by cariogenic attacks, thereby intensifying the deleterious impact of the carious process [35]. Secondly, it imposes selective pressure that fosters the proliferation of a more acidogenic and aciduric microbiota in the oral cavity, creating conditions conducive to cariogenic processes [38]. The frequency of consumption of such beverages directly correlates with the magnitude of their detrimental effects on dental health. The ascendancy of green marketing in the food industry over recent years has yielded positive nutritional shifts, particularly for infants and young children. The adoption of green chemical technology has enhanced the bioavailability of products with high nutrient value, facilitating the absorption of nutrients that might otherwise be overlooked [39]. An illustrative instance is the enriched pasta with vegetables, designed to facilitate children in meeting daily vegetable recommendations [40]. Such applications bear the potential to confer significant benefits to oral health, particularly when increased bioavailability of essential nutrients like magnesium and calcium through dietary means is anticipated to exert a positive influence on oral health and caries prevention [26]. Despite the commendable strides in formulating food products for children aged 4–7 and 7–10 years, with sugar content generally limited to less than 5 or 6 teaspoons, overconsumption remains a pertinent concern associated with both obesity and dental caries [41]. The crux of fostering proper infant growth lies in ensuring the right balance of essential and supplemented nutrients, either through breastfeeding or alternative nutrition formulas [42]. Notably, formula manufacturers have already heeded recommendations by reducing sugar content and adhering to guidelines for carbohydrate and corn syrup restrictions [43]. The incorporation of fructo-oligosaccharides and galactic-oligosaccharides in infant formula, with specified content limits, underscores their potential impact on dental health given the pivotal role played by calcium and phosphorus [44]. To mitigate the potential misunderstanding of nutrient labels, health professionals advocate for color-coded labeling on the front of food packages. The rationale behind this system is to categorize products as “red” for cautious and infrequent consumption while encouraging the selection of more “green”- and “amber”-labeled products to minimize the risk of caries and enhance overall oral health (Table 2) [45].
Table 2. Color indication on the food label indicating the sugar content per 100 g of product and/or per portion adapted with permission from Ref. [46].
Low (Green) Medium (Amber) High (Red) High Per Portion If More Than 100 g/150 mL (Red)
Sugar in food (per 100 g) 5 g or less Between 5 g and 22.5 g More than 22.5 g 27 g
Sugar in drink (per 100 mL) 2.5 g or less Between 2.5 g and 11.25 g More than 11.25 g 13.5 g


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