practical everyday advice to our patients as shown in 247HTable 6.5. Advising parents to
completely stop their children from eating sugary foods is not achievable! We should
aim to ensure that our patients eat sensibly and safely. Baby drinks given in baby
bottles led to 'nursing bottle' caries. Plaque pH responses of these drinks showed falls
to below the critical pH of apatite (pH = 5.5). We should advise that only milk or
water is given to children in a baby bottle. Many are not aware that no added sugar
drinks contain natural sugar. We should promote that for young children drinks are
consumed from trainer cups, beakers, and to use straws. 'Safer foods' have been
recommended as alternatives for frequent snackers or nibblers. These alternatives
include cheeses that have been shown to raise plaque pH. In addition to fruit and
vegetables, crisps and peanuts have also been recommended as safer alternatives.
However, citrus fruits have been implicated in the aetiology of dental erosion and
peanuts are associated with inhalation risk in small children. The development of one
'safer' drink has been accredited by the British Dental Association (BDA) and showed
that the plaque pH did not fall below the critical pH for enamel (Toumba and Duggal,
1999).
Frequency of eating
Frequency of eating has an important effect on teeth. However, is this anecdotal or
based on scientific evidence? Eating meals leads to periods of acid attack when tooth
mineral is lost. At the end of the meal or snack the acid is buffered by saliva and the
mineral loss stops and reverses under favourable conditions. Frequent snackers have
predominantly mineral loss and little if any remineralization. Duggal et al. (2001)
demonstrated the importance of fluoride and frequency of sugar consumption in an in
situ study using enamel slabs and transverse microradiography. When volunteers did
not use a fluoride toothpaste mineral demineralization was observed with the
frequency as low as three times per day. However, when fluoride toothpaste was used
twice daily no significant mineral demineralization was observed up to a frequency of
sugar consumption of seven times per day. Therefore, brushing twice per day with a
fluoride toothpaste, subjects should safely be able to have five meal moments per day.
This is a sensible and achievable dietary message for patients.
Non-sugar sweeteners
Those allowed for use in foods and drinks in the United Kingdom are given in 248HTable
6.6. The list is very similar for most countries. There is much evidence that they are
non-cariogenic or virtually so. The intense sweeteners and xylitol are non-cariogenic
while the other bulk sweeteners can be metabolized by plaque bacteria but the rate is
so slow that these sweeteners can be considered safe for teeth. The use of non-sugar
sweeteners is growing rapidly particularly in confectionery and soft drinks.
Confectionery products which have passed a well-established acidogenicity test can
be labelled with the Mr Happy-Tooth logo (249HFig. 6.15) which is a protected trademark,
which informs the purchaser and consumer that these products are dentally safe.
Tooth-friendly sweets are available in about 26 countries; in Switzerland about 20 per
cent of confectionery sold carries the Tooth-friendly (or Mr Happy-Tooth) logo.
There is good evidence that sugarless chewing gums are not only non-cariogenic but
also positively prevent dental caries, by stimulating salivary flow. Indeed, xylitol
gums are used in school-based preventive programmes in Finland. In the United
Kingdom, the BDA accredits products which benefit oral health (250HFig. 6.16). As an