Risks to oral health and intervention
Diet and nutrition
Today the world faces two kinds of malnutrition, one associated with hunger or nutritional deficiency and the other with dietary excess. Urbanization and economic development result in rapid changes in diets and lifestyles. Market globalization has a significant and worldwide impact on dietary excess leading to chronic diseases such as obesity, diabetes, cardiovascular diseases, cancer, osteoporosis and oral diseases. Diet and nutrition affects oral health in many ways. Nutrition, for example, influences cranio-facial development, oral cancer and oral infectious diseases. Dental diseases related to diet include dental caries, developmental defects of enamel, dental erosion and periodontal disease.
The nutrition transition is a relevant example on how common risks influence public health, including oral health. The public health community involved with oral health should gain an understanding of the health effects of these complex developments in order to prevent or control oral diseases.
The major challenges are:
- To implement nutritional counselling, covering not only the general health aspects of having good nutritional behaviour but also emphasizing the aspects directly linked with oral health. The post-eruptive effect of diet in terms of sugar consumption is one of the aetiologic factors for dental caries.
- To facilitate awareness-raising activities to promote breastfeeding. Among other important health benefits, breastmilk prevents the occurrence of rampant early childhood caries. Early childhood caries is caused by frequent and prolonged exposure of the teeth to sugar and is often the result of a child going to bed with a bottle of a sweetened drink or drinking at will from a bottle during the day.
- To advise on decreasing the consumption of sugary soft drinks which is a major risk factor in dental caries. Also, dental erosion seems to be a growing problem and in some countries an increase in erosion of teeth is associated with an increase in consumption of beverages containing acids.
- To promote a rational and healthy diet among people living in deprived and more remote areas of low- and middle-income countries by encouraging the use of natural products with good nutritional values instead of refined, industrialized food.
- To advocate a healthy diet which can also help prevent oral cancer. Fresh yellow-green fruits and vegetables have been identified as beneficial as are vitamin A, C and E supplements. Excessive consumption of alcohol is an important risk factor in the aetiology of oral precancerous and neoplastic lesions and such habits should be modified.
WHO/FAO recently published a Global Strategy on Diet, Physical Activity and Health, based on the analysis of the best available evidence on relationship between diet and physical activity patterns and the major nutrition-related chronic diseases. The strategy aims at reducing the growing burden of noncommunicable diseases in both developing and developed countries. Recommendations are made to facilitate formulate regional strategies and national guidelines to reduce the burden of nutrition-related chronic diseases. Among other recommendations, free (added) sugars should remain below 10% of energy intake and the consumption of foods/drinks containing free sugars should be limited to a maximum of four times per day.
In order to minimize the occurrence of dental erosion which particularly seems related to consumption of acidic beverages, the amount and frequency of intake of soft drinks and juices should be limited. Elimination of undernutrition prevents enamel hypoplasia and other potential effects of undernutrition on oral health (e.g. salivary gland atrophy, periodontal disease, oral infectious disease).
The WHO Oral Health Programme contributes to the implementation of the Global Strategy on Diet, Physical Activity and Health. The intervention activities at national level are multiple but the following areas should be addressed:
- Oral health services
- Schools: Curricula, school lunches and school health
- Food industry, supermarkets
- Restaurants, catering, etc.
- NGO's (health related and others)
- Legislation and policy
- Monitoring, surveillance and research
The Ministry of Health should ensure that the mechanisms for intersectorial collaboration are carefully considered. Strategies include taxation and pricing, food labelling, school lunch policies and support to nutrition programmes.