Dental Health

For children, the most common chronic infectious disease is dental caries—tooth decay. Among 6-year-olds, at least 40% experience dental caries in their primary teeth. By adolescence, 85% of 17-year-olds will have dental caries. Prevention hinges on keeping the oral cavity free of cariogenic microbes and reducing exposure to sticky carbohydrate foods and carbonated beverages. Not surprisingly, children who consume a diet high in simple carbohydrates and who are late to initiate oral hygiene practices or who are not monitored in caring for their teeth are at a greater risk for tooth decay. The prevalence of dental caries is greatest among special population groups that include the following: children from families who have a low socioeconomic status, homes where parents do not have a high school education, and certain ethnic groups—African Americans, Hispanics, and Native Americans. In modern society, dental caries is becoming a disease of the poor.

Low-Caries Diet

The "stickiness" of snack foods and the length of time taken for the saliva to remove the snack from the teeth should be considered when providing nutritious snacks. Of the following foods studied by dental researchers, some barely stick to the teeth while others are rated "stickiest."

Barely sticky: apples, bananas, hot fudge sundaes, milk chocolate bar

Moderately sticky: chocolate caramel bars, white bread, caramels, creme-filled sponge cake

Stickier: dried figs, jelly beans, plain doughnuts, chocolate-caramel-peanut bars, raisins

Stickiest: granola bars, oatmeal cookies, sugared cereal flakes, potato chips, corn chips, pretzels, salted crackers, puffed oat cereal, creme sandwich cookies, peanut butter crackers, french fries

Sticky snacks leave particles on the teeth for longer periods of time, which makes the teeth susceptible to attacks from the enamel-eroding acids produced by bacteria. Typical snack foods—cereals, crackers, and cookies (even plain, low-fat/sugar)—are stickiest. According to research, some foods like cheese, nuts, milk, and chocolate appear to have an anticariogenic effect.

In addition, carbonated beverages are highly cariogenic. In fact, drinking soda is of increasing concern. Drinking sodas prolongs the exposure of teeth to carbohydrates, producing a new attack on the teeth with every sip. The sugar in the soda combines with bacteria in the mouth to form acid that degrades the tooth enamel. Even diet sodas have acid that tears down the tooth enamel. Each acid attack may last up to 20 minutes. The Missouri Dental Association has developed a new media campaign aimed at reducing soda consumption by children. For educational materials go to their Web page: http://www.modental.org/Stop_The_Pop.html.

Snack Foods

Emphasizing snacks that are less sticky may help reduce dental problems seen in this group. However, any snack can be eaten if the teeth are cleaned after eating.

Oral Health Care

Children should have a regular routine established for care of teeth and gums at home and brush after meals at school. They should be familiar with the dentist, participating in regular visits at least once a year. Many dentists apply sealants as new permanent teeth emerge to deter the development of caries. This can be an effective treatment for children with high risk of dental caries.

Centers should encourage oral health screening and promote sound dental health by (1) providing nutritious low-caries-risk diet, (2) restricting sweets to mealtimes when salivary flow is greater, (3) promoting follow-up on dental screenings, and (4) promoting oral health practices such as teeth-brushing and flossing.