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5. Population nutrient intake goals for preventing diet-related chronic diseases: Previous page | 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27

5.6 Recommendations for preventing dental diseases

5.6.1 Background

Oral health is related to diet in many ways, for example, through nutritional influences on cranio-facial development, oral cancer and oral infectious diseases. The purpose of this review, however, is to focus on the nutritional aspects of dental diseases. Dental diseases include dental caries, developmental defects of enamel, dental erosion and periodontal disease. Dental diseases are a costly burden to health care services, accounting for between 5% and 10% of total health care expenditures and exceeding the cost of treating cardiovascular disease, cancer and osteoporosis in industrialized countries (1). In low-income countries, the cost of traditional restorative treatment of dental disease would probably exceed the available resources for health care. Dental health promotion and preventive strategies are clearly more affordable and sustainable.

Although not life-threatening, dental diseases have a detrimental effect on quality of life in childhood through to old age, having an impact on self-esteem, eating ability, nutrition and health. In modern society, a significant role of teeth is to enhance appearance; facial appearance is very important in determining an individual’s integration into society, and teeth also play an essential role in speech and communication. Oral diseases are associated with considerable pain, anxiety and impaired social functioning (2, 3). Dental decay may result in tooth loss, which reduces the ability to eat a nutritious diet, the enjoyment of food, the confidence to socialize and the quality of life (4-6).

5.6.2 Trends

The amount of dental decay is measured using the dmf/DMF index, a count of the number of teeth or surfaces in a person’s mouth that are decayed, missing or filled as a result of caries in primary dentition/ permanent dentition. An additional dental status indicator is the proportion of the population who are edentulous (have no natural teeth).

In most low-income countries, the prevalence rate of dental caries is relatively low and more than 90% of caries are untreated. Available data (7) show that the mean number of decayed, missing or filled permanent teeth (DMFT) at age 12 years in low-income countries is 1.9, 3.3 in middle-income countries and 2.1 in high-income countries (Table 12).

Data on the level of dental caries in the permanent dentition of 12-yearolds show two distinct trends. First, a fall in the prevalence of dental caries in developed countries, and second an increase in the prevalence of the disease in some developing countries that have increased their consumption of sugars and have not yet been introduced to the presence of adequate amounts of fluoride. Despite the marked overall decline in dental caries over the past 30 years, the prevalence of dental caries remains unacceptably high in many developed countries. Even in countries with low average DMFT scores, a significant proportion of children have relatively high levels of dental caries. Moreover, there is some indication that the favourable trends in levels of dental caries in permanent teeth have come to a halt (8).

Table 12. Trends in levels of dental caries in 12-year-olds (mean DMFT per person aged 12 years)

Country or area

Year

DMFT

Year

DMFT

Year

DMFT

Industrialized countries

Australia

1956

9.3

1982

2.1

1998

0.8

Finland

1975

7.5

1982

4.0

1997

1.1

Japan

1975

5.9

1993

3.6

1999

2.4

Norway

1940

12.0

1979

4.5

1999

1.5

Romania

1985

5.0

1991

4.3

1996

3.8

Switzerland

1961-1963

9.6

1980

1.7

1996

0.8

United Kingdom

1983

3.1

1993

1.4

1996-1997

1.1

United States

1946

7.6

1980

2.6

1998

1.4

Developing countries

Chile

1960

2.8

1978

6.6

1996

4.1

Democratic Republic of the Congo

1971

0.1

1982

0.3

1987

0.4-1.1

French Polynesia

1966

6.5

1986

3.2

1994

3.2

Islamic Republic of Iran

1974

2.4

1976

4.9

1995

2.0

Jordan

1962

0.2

1981

2.7

1995

3.3

Mexico

1975

5.3

1991

2.5-5.1

1997

2.5

Morocco

1970

2.6

1980

4.5

1999

2.5

Philippines

1967

1.4

1981

2.9

1998

4.6

Uganda

1966

0.4

1987

0.5

1993

0.4

DMFT, decayed, missing, filled permanent teeth.

Source: reference 7.

Many developing countries have low decayed, missing, filled primary teeth (dmft) values but a high prevalence of dental caries in the primary dentition. Data on 5-year-old children in Europe suggest that the trend towards reduced prevalence of dental decay has halted (9-11). In children aged 5-7 years, average dmft values of below 2.0 have been reported for Denmark, England, Finland, Italy, Netherlands and Norway (12). Higher dmft values were reported recently for Belarus (4.7) (13), Hungary (4.5) (14), Romania (4.3) (15) and the Russian Federation (4.7) (16).

Being free from caries at age 12 years does not imply being caries-free for life. The mean DMFT in countries of the European Union after 1988 varied between 13.4 and 20.8 at 35-44 years (17). The WHO guidelines on oral health state that at age 35-44 years a DMFT score of 14 or above is considered high. In most developing countries, the level of caries in adults of this age group is lower, for example, 2.1 in China (18) and 5.7 in Niger (19). Few data are available on the prevalence and severity of root caries in older adults, but with the increasingly ageing population and greater retention of teeth, the problem of root caries is likely to become a significant public health concern in the future.

The number of edentulous persons has declined over the past 20-30 years in several industrialized countries (3). Despite overall gains however, there is still a large proportion of older adults who are edentulous or partially dentate and as the population continues to age tooth loss will affect a growing number of persons worldwide. Table 13 summarizes the available information on the prevalence of edentulousness in old-age populations throughout the world.

Dental erosion is a relatively new dental problem in many countries throughout the world, and is related to diet. There is anecdotal evidence that prevalence is increasing in industrialized countries, but there are no data over time to indicate patterns of this disease. There are insufficient data available to comment on worldwide trends; in some populations, however, it is thought that approximately 50% of children are affected (20).

5.6.3 Diet and dental disease

Nutritional status affects the teeth pre-eruptively, although this influence is much less important than the post-eruptive local effect of diet on the teeth (21). Deficiencies of vitamins D and A and protein-energy malnutrition have been associated with enamel hypoplasia and salivary gland atrophy (which reduces the mouth’s ability to buffer plaque acids), which render the teeth more susceptible to decay. In developing countries, in the absence of dietary sugars, undernutrition is not associated with dental caries. Undernutrition coupled with a high intake of sugars may exacerbate the risk of caries.

There is some evidence to suggest that periodontal disease progresses more rapidly in undernourished populations (22); the important role of nutrition in maintaining an adequate host immune response may explain this observation. Apart from severe vitamin C deficiency, which may result in scurvy-related periodontitis, there is little evidence at present for an association between diet and periodontal disease. Current research is investigating the potential role of the antioxidant nutrients in periodontal disease. Poor oral hygiene is the most important risk factor in the development of periodontal disease (21). Undernutrition exacerbates the severity of oral infections (e.g. acute necrotizing ulcerative gingivitis) and may eventually lead to their evolution into life-threatening diseases such as noma, a dehumanizing oro-facial gangrene (23).

5. Population nutrient intake goals for preventing diet-related chronic diseases: 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27 | Next page

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