Americans Are Smiling at Fewer Cavities "What we're seeing is the beginning of the end for a disease that has plagued mankind throughout history." Dr. Harold Loe, Director National Institute of Dental Research From a disease afflicting more than 90 percent of all children less than 50 years ago, tooth decay is well on the way to joining other success stories of modern health care. Based on a new survey of 40,000 children aged 5-17 conducted by the National Institute of Dental Research, it is estimated that one-half of the nation's schoolchildren have no tooth decay at all. This represents a 36 percent reduction in cavities from NIDR studies at the beginning of the 1980s. Experts credit the improvement in dental health to the widespread use of fluoride and improved dental care. Fluoride in community water supplies, toothpastes, rinses and sealants; professional dental care; and good personal oral hygiene were cited as the most effective factors in the decline of tooth decay. Food/Cavity Connection? Dr. James P. Carlos, chief of the NIDR's epidemiology branch, reported that there was no evidence of change in dietary habits over this period of marked dental improvement. What about the role of specific foods? All fermentable carbohydrates have the potential to contribute to the development of dental caries by supplying the "raw materials" necessary for bacteria in the mouth to produce tooth-decaying acid. Fermentable carbohydrates include sugars, such as found in fruits, honey and sweets, and cooked starches, such as found in bread and potatoes. Dr. Mark Jensen, director of the center for Clinical Studies at the University of Iowa College of Dentistry, has studied acid production in the mouth following consumption of snacks such as doughnuts and pastries, as well as following well-balanced meals. Jensen found that both the snacks and meals boosted the acid in the mouth. According to the Princeton Dental Resource Center, the most critical factors in food-related causes of dental caries are the consistency of the food and the frequency of consumption. Frequent consumption of foods containing fermentable carbohydrates and foods that cling to the teeth are of most concern. Natural Defenses Experts point to genetic predisposition and the consumption and flow of saliva as the first line of defense in whether an individual will develop dental caries. The average person produces up to a quart of saliva a day, which serves to protect the teeth from acid. Saliva contains high concentrations of calcium and phosphates, the same minerals that are lost from the teeth following an acid attack. When low concentrations of fluoride are present in the saliva, the calcium and phosphates re-enter the tooth in a healing-like process called remineralization. This process is the main reason fluoridated water and regular use of fluoride toothpastes has been so effective. Saliva also plays a critical role in clearing away foods that, if left on or between the teeth, could contribute to acid formation. Cavity Preventers? Just as bacteria can break down certain foods into tooth-decaying acid, some foods actually have the potential to protect against cavities. In Dr. Jensen's research at the University of Iowa, he also examined the effect of chewing gum on acid levels following snacks and meals. Volunteers were given foods which increased acid in the mouth, followed immediately with sticks of sugarless gum. After just 10 minutes, acid level was back to normal. "The gum stimulates the saliva and then goes one step further," Jensen says. "It physically squeezes the saliva into the spaces between the teeth." He recommends a regular after-meal piece of sugarless gum, especially for adults whose gums have receded, exposing thin, more-susceptible root surfaces. Low-calorie sweeteners such as aspartame, saccharin and acesulfame K are non-cariogenic because they cannot be broken down by bacteria to produce tooth-decaying acid. A recent study by Jensen's colleagues at the University of Iowa concluded that regular gum, if chewed for more than 20 minutes, could have a similar effect as sugarless gum in neutralizing the acids that contribute to tooth decay. Researchers have also identified several other foods that may protect against cavities. In laboratory experiments, licorice displays an ability to retard enamel dissolution, and cheddar cheese increases the flow of protective, acid-lowering saliva while contributing enamel-repairing calcium and phosphate. Cavity-Fighting Chocolate? Studies at the University of Melbourne have recently shown that the milk protein casein may be a cavity fighter. Most chocolate, except fudge and bitter chocolate, contains casein. To study casein's effects, Dr. Eric C. Reynolds used it to replace the other milk solids in chocolate. Fat and sugar levels were unchanged, but the casein content was almost tripled. As a result, rats fed the high-casein product showed no tooth decay. In addition, researchers at the University of Texas Health Science Center at San Antonio are now studying cocoa to isolate particular components that appear to inhibit plaque formation. Gum Disease Is Key Concern Gum disease is the major dental problem facing American adults -- and it's the chief cause of tooth loss. Although gum disease can be slowed or prevented by brushing and flossing, it still affects three out of four persons. Plaque -- the sticky, colorless film of bacteria -- accumulates on the teeth; bacteria thrive, and their by-products irritate the gums, causing bleeding. Eventually, this inflammation may spread to the bone that anchors teeth in the jaw, causing the teeth to become loose. Finally, the teeth may be lost. As with tooth decay, there is good news, however. Tests now enable dentists to detect bacteria that may be indicative of gum disease in its early stages, before any permanent damage has been done. Professional dental care and good personal oral hygiene hold the best promise for achieving similar success in fighting gum disease as that in the war against cavities. Reprinted from Food Insight Fall 1988

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