Dietary determinants of dental caries and dietary recommendations for preschool children

Objectives: The purpose of this review, commissioned by the Administration for Children and Families, the Health Resources and Services Administration , the Health Care Financing Administration, and the Department of Agricultu re's Food and Nutrition Service, was to update the evidence of the dietary factors that affect dental caries, and subsequently formulate dietary recom mendations for preschool children based on principles of cariology. Methods : Literature on the dental caries process, dietary factors affecting dental caries initiation and progression, and nutrition education and counseling were reviewed and synthesized. Dietary guidelines for children at various a ges were then constructed based on the review. Results: Dental caries in pr eschool children is due to a combination of factors, including colonization of teeth with cariogenic bacteria, type of foods and frequency of exposure of these foods to the cariogenic bacteria, and susceptible teeth. Caries r isk is greatest if sugars are consumed at high frequency and are in a form that is retained in the mouth for long periods. Sucrose is the most carioge nic sugar because if can form glucan that enables firm bacterial adhesion t o teeth and limits diffusion of acid and buffers in the plaque. There is em erging interest in the effects of tooth development and its role in the fut ure dental caries risk of the child. Conclusions: Nutrition education and c ounseling for the purposes of reducing caries in children is aimed at teach ing parents the importance of reducing high frequency exposures to obvious and hidden sugars. Guidelines include: avoiding frequent consumption of jui ce or other sugar-containing drinks in the bottle or sippy cup, discouragin g the behavior of a child sleeping with a bottle, promoting noncariogenic f oods for snacks, fostering eating patterns consistent with the Food Guide P yramid, limiting cariogenic foods to mealtimes, rapidly clearing cariogenic foods from the child's oral cavity either by toothbrushing or by consumpti on of protective foods, and restricting sugar-containing snacks that are sl owly eaten (e.g., candy, cough drops, lollipops, suckers). Along with nutri tional factors, a comprehensive approach to preventing dental caries in pre school children must include improved general dietary habits, good oral hyg iene, appropriate use of fluorides, and access to preventive and restorativ e dental care.