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The impact of diet and nutrition on oral health is discussed in Chapters 7–13, and the impact of oral health on diet and nutrition in Chapter 14.
Nutrition influences the teeth primarily during their formation; whereas bone and the soft tissues of the mouth respond promptly to nutritional imbalance, as they are continuously being renewed [21]. At the pre-eruptive stage, deficiencies of energy, protein, calcium, phosphorus, iodine, iron and vitamins A, C, and D can affect tooth development. Diet and intake of nutrients continue to influence tooth development and mineralisation after tooth eruption. In addition, due to the rapid rate of tissue turnover of the oral mucosa, deficiencies of some nutrients such as vitamins B2, B12, C, and folate as well as iron and zinc may initially be reflected in the mouth.
Primary dietary factors and eating patterns associated with dental caries risk include the form of the food (e.g., solid, liquid), the frequency of consumption of fermentable foods such as sugars/starch-based diets and the duration of exposure of the teeth to these fermentable products. On the other hand, dental caries, tooth loss (edentulism) and removable prostheses (dentures) can have a major impact on dietary habits and diet composition, thereby impacting the general health and quality of life of the affected individuals. An inability to chew certain foods, such as steak, whole grains, fruit and vegetables, due to untreated painful dental caries and tooth loss, may lead to inadequate intake of protein, dietary fibre, vitamins and minerals [22].
Dental erosion is associated with acids of intrinsic (gastrointestinal) and extrinsic (dietary and environmental) origin. Acidic foods may contain one or more of: acetic, ascorbic, carbonic, citric, malic, oxalic, phosphoric and tartaric acids. An important factor influencing the erosive potential of acidic foods and drinks is eating habits, such as the length of time that an acidic drink remains in the mouth (e.g., swishing the drink around the mouth, night-time bottle feeding). Individuals with a healthier lifestyle that includes diets high in acidic fruits and vegetables may have higher incidences of dental erosion [23]. Consumption of soft drinks and chewing vitamin C tablets have been reported to be significantly associated with the development of dental erosion, with approximately 2.4- and 1.2-fold increased risk, respectively [24]. On the other hand, milk and yogurt provide important sources of dietary calcium, phosphate and casein, which are known to protect enamel [24]. The relationship between diet and dental erosion is discussed in Chapter 9.
Table 3. Daily requirements of specific elements
Periodontal disease is not initiated by poor nutrition; however, susceptibility to the disease may increase as a result of deficiencies in vitamin C, folate and zinc, as these nutrients increase the permeability of the gingival barrier at the gingival sulcus. Other nutrients such as calcium, phosphate, vitamin A, vitamin E and ß-carotene are also reported to maintain gingival and immune system integrity. Due to the anti-inflammatory properties of omega-3 PUFAs, they may be useful in managing periodontitis [25]. As part of a periodontal prevention and treatment regime, reducing the consumption of refined sugars and increasing the consumption of fish oils, fibre, fruit and vegetables are recommended by the 2011 European Workshop on Periodontology [26].
Diet, after tobacco and alcohol, has been recognised as an important risk factor for oral cancer; although the relationship between oral cancer and diet is complex. Consumption of cereals, dairy products, olive oil and raw fruit and vegetables, independent of tobacco and alcohol use, as well as ingestion of some micronutrients such as riboflavin, selenium, magnesium and iron have been reported to be inversely associated with the risk of oral cancer [27]. A 50% reduction in the risk of oral cancer with daily fruit and vegetable consumption has also been suggested following a systematic review [28].
Oral manifestation of some acute diseases (e.g., head and neck cancer, infections) and chronic diseases (e.g., diabetes, HIV AIDS) may have a profound effect on the diet and the nutritional status of individuals. HIV is associated with some oral manifestations such as viral/fungal infections, stomatitis, xerostomia, periodontal disease, and Kaposi’s sarcoma. Burning mouth syndrome, periodontal disease, candidiasis, dental caries, and xerostomia are oral manifestations of uncontrolled diabetes. All these conditions affect eating ability, limiting the intake of nutrients, and consequently compromise the nutrition status of individuals.
References
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3Australian National Health and Medical Research Council (NHMRC), Australian Government Department of Health and Ageing and the New Zealand Ministry of Health (NZ MoH). Nutrient reference values for Australia and New Zealand https://www.nrv.gov.au/introduction (accessed September 18, 2017).
4British Nutrition Foundation. Nutrition requirements. 2016 https://www.nutrition.org.uk/attachments/article/234/Nutrition%20Requirements_Revised%20Oct%202016.pdf (accessed September 18, 2017).
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8Mahan LK, Escott-Stump S: Krause’s Food and Nutrition Therapy, ed 12. Canada, Saunders Elsevier, 2008.
9Cummings