Head Start and Partners Forum on Oral Health:

Paper # 1: Causes of Dental Cavities and the Role of Good Nutrition

We all know that sugar causes cavities, but most of us do not really know why. We also have heard that it is harmful for infants and children to be put to bed with a bottle containing sweetened drinks. A paper by dentist Norman Tinanoff and nutritionist Carol Palmer entitled "Dietary Determinants of Dental Caries and Dietary Recommendations for Preschool Children" (published in the American Journal of Public Health Dentistry, Volume 60, No. 3, Summer 2000) explains how frequently eaten foods containing a lot of sugar promote tooth decay and how a child's diet can be improved so that teeth are protected.

Here is the way it works. Bacteria, or dental plaque, can attach to our teeth, feed on the sugars we eat, and produce acid. A specific bacteria, called Streptococcus mutans, can be transmitted from mothers to their children, and this bacteria is able to produce great quantities of acid from sugar. This acid can erode away the enamel on teeth. If sugar is frequently consumed, acid is formed over and over again and can readily lead to cavities.

Therefore, if children suck on candies, lollipops, or throat lozenges for long periods of time, their risk of tooth decay increases–the sugar is staying in the children's mouths longer, giving the bacteria a longer time to produce acid. Equally harmful to children's teeth is frequently drinking juice from a sippy cup or bottle, especially at nighttime. Of course, many parents frequently give their children juice throughout the day because children like it, it is cheap, and juice is thought to be nutritious. However, these juice drinks, and even "natural juices," have sugar, and just like candies and lollipops, consuming them over a period of time can cause cavities.

The Prenatal Period
Pregnant mothers need to understand that even before their child is born, they are having an effect on their child's future tooth decay. Because children's baby teeth begin forming before birth, pregnant mothers can help prevent future tooth decay in several ways. First, mothers should ensure they are getting adequate nutrition. Develop-mental defects in children's teeth due to poor prenatal nutrition are strongly related to the development of tooth decay later in life. Second, mothers need to pay special attention to their own oral health. Studies have shown that mothers with tooth decay increase the risk of passing cavity-
causing bacteria to their children. For these reasons,
pregnant mothers should make sure to follow the balanced
eating guidelines of the Food Guide Pyramid and maintain proper dental health.

From Birth to One Year
Good nutrition is especially important for oral health during the first year of life. Breast-feeding is good, not only because it is good for the baby's health, but also because it decreases the chance of tooth decay.

As already stated, an important factor for early childhood tooth decay is the prolonged use of baby bottles containing sweet drinks, such as fruit juice or other sweetened drinks. Children on a bottle should be weaned to a cup by age one. As infants make the transition from breast or bottle to cup, it is important that they not be allowed to suck on a sippy cup for long periods of time, and drinks other than milk or water should be limited to meal times. Additionally, pacifiers dipped in sugar, honey, syrups, or other sweets are also a problem.

Children like sweet foods, but parents and caregivers need to have influence over children's food preferences. For example, infants are more likely to accept nutritious food if it is offered several times. Also, children who eat a lot of sugar as infants are more likely to prefer sweet foods when they are toddlers.

From One to Two Years
During the toddler period, children are forming eating habits and are more able to eat on their own. We need to pay attention to food choices that are good for a child's oral health. For example, parents should give their child nutritious finger foods, such as cheese and fruit, as snacks. Studies have shown that children may reject a new food many times before they accept it. Consequently, it is important to continue exposing children to healthy foods by keeping them available. And while parents and caregivers should provide childrenwith healthy foods, let children decide for themselves when and how much to eat. By doing this, you are helping children sense when they are hungry or full.

Also, one should avoid offering children sweet foods as rewards for an action or good behavior, which only reinforces a positive feeling about eating sweets.

From Two to Five Years
In the preschool years, try to reinforce good eating habits, including eating at regular meal times and avoiding snacking throughout the day. As children grow to be more independent, the patterns they were taught earlier in life should help them make healthy food choices. Parents and caregivers can also help children make healthy choices by limiting the availability of sweet and unhealthy foods in the home.

Children with Special Needs
Children with special needs can be at increased risk of tooth decay due to feeding difficulties and the use of sugar-based medications. Such problems can lead to longer feeding times with foods staying in children's mouths for longer periods of time, increasing the risk of tooth decay. Therefore, parents and caregivers need to pay special attention to the oral health concerns of children with special needs. Nutritional counseling can be very helpful in reducing the risk of tooth decay for these children.

Summary
Good eating patterns play a major role in children's oral health, and parents and caregivers have an important role in developing these patterns. They need to understand how frequently consumed sugar-containing food can harm teeth.

This article is a summary of "Dietary Determinants of Dental Caries and Dietary Recommendations for Preschool Children" by Dr. Norman Tinanoff and Carol Palmer. The full text of this article is available in the Summer 2000 edition of the American Journal of Public Health Dentistry as well as on the Web site: http://www.headstartinfo.org.

 

Oral Health Dietary Guidelines
for Expectant Mothers and Preschool Children

Pregnant Women

• Follow the Food Guide Pyramid, taking into account increased needs for pregnancy
• Take prenatal vitamin/mineral supplement as prescribed
• Limit intake of cariogenic foods, especially as between-meal snacks

Birth to One Year

• Avoid allowing infants to sleep or nap with a bottle
• Avoid excessive consumption of juice
• Eliminate dipping pacifiers in sweetened foods

One to Two Years

• Avoid frequent consumption of juice or other sweet drinks in a bottle or sippy cup
• Encourage weaning from a bottle to a cup
• Continue avoidance of taking the bottle to bed
• Promote "tooth-safe" foods for snacks
• Foster routine eating patterns and following the Food Guide Pyramid

Two to Five Years

• Discourage slowly eaten, sweet foods, such as candy, lollipops, or suckers.
• Promote "tooth-safe" foods for snacks
• Encourage eating at meals following the Food Guide Pyramid