example, they have accredited dentrifices which have proven effectiveness, for many
years. More recently, foods and drinks have been accredited⎯for example, a fruit-
flavoured drink which demonstrated to have negligible cariogenic and erosive
potential. The Tooth-friendly and BDA accreditation schemes help the consumer to
make better choices. The bulk sweeteners can have a laxative effect and should not be
given to children below 3 years of age. People vary in their sensitivity to these polyols
as some adults in the Turku sugar studies were consuming up to 100 g of xylitol per
day without effect.
Dietary advice for the prevention of dental caries
The basic advice is straightforward⎯reduce the frequency and amount of intake of
fermentable carbohydrates. Dietary advice should be at two levels. First, every patient
should receive basic advice. This especially applies to parents of young children who
need to be given the correct advice at the appropriate age of the child. Dietary advice
is often too negative; energy that has been provided by confectionery has to be
replaced and it is very important to emphasize positive eating habits. The variety of
foods available has increased enormously in most countries in recent years; we must
use this increased choice to assist our patients to make better food choices. The
second level of advice is a more thorough analysis of the diet of children with a caries
problem. A well-accepted method is the 3-day diary record. One practical drawback
of this method is that it requires at least three visits⎯an introductory visit where the
patient is motivated and informed about the procedure and the diet diary given out,
the diary collection visit, and a separate visit for advice and to agree targets. Each of
these stages is important. At the first visit it is vital that the patient and parent
appreciate that there is a dental problem and that you are offering your expert advice
to help them overcome this problem. Once motivated they must understand how the
diary is to be completed. Any requests by parents for advice at the first visit should be
parried and delayed until the third visit. At the third visit, advice must be personal,
practical, and positive⎯all three of these are important (251HTable 6.5). Food preference
of children, cooking skills, food availability, and financial considerations vary
enormously⎯advice must be personally tailored and practical for that patient.
Positive advice has a much greater chance of acceptance than negative advice such as
'avoid this', 'don't eat that'⎯nagging is a de-motivator. Dietary changes are difficult,
targets often have to be limited and constant reinforcement of advice and
encouragement is essential. However, health gains can be considerable, to general as
well as dental health and often to other members of the family, so that dietary advice
is an essential part of care of children.