Oulun ammattikorkeakoulu
ePooki 49/2019

Oral Health Promotion for Young People

Metatiedot

Nimeke: Oral Health Promotion for Young People. In A-L. Jussila & M. Oinonen (eds.) Oral Health Promotion

Tekijä: Huhtala Merja; Paasovaara Jonna; Previ Marlene; Riskilä Kreeta; Tikkanen Rinna; Jussila Aino-Liisa

Aihe, asiasanat: suun terveys, terveyskasvatus, oral health, health promotion

Tiivistelmä: Dental caries is the most common disease among children in the world today, so it is good to inform about the different risks that cause caries. Drinking sugared beverages is a main factor caries.

The aim of this article is to clarify, how pH affects to the teeth. Best outcome that we could ask for is that people would drink less sweetened drinks during the day.

A dynamic relation exists between sugar and oral health. Diet affects the integrity of the teeth; quantity, pH, and composition of the saliva; and plague pH. Sugar and other fermentable carbohydrates, after being hydrolyzed by salivary amylase, provide substrate for the action of oral bacteria, which in turn lower plague and salivary pH. The resultant action is the beginning of tooth demineralization.

Since the introduction of fluoride, the incidence of caries worldwide has decreased, despite increases in sugar consumption.

Julkaisija: Oulun ammattikorkeakoulu, Oamk

Aikamääre: Julkaistu 2019-06-28

Pysyvä osoite: http://urn.fi/urn:nbn:fi-fe2019061019848

Kieli: englanti

Suhde: http://urn.fi/URN:ISSN:1798-2022, ePooki - Oulun ammattikorkeakoulun tutkimus- ja kehitystyön julkaisut

Oikeudet: CC BY-NC-ND 4.0

Näin viittaat tähän julkaisuun

Huhtala, M., Paasovaara, J., Previ, M., Riskilä, K., Tikkanen, R. & Jussila, A-L. 2019. Oral Health Promotion for Young People. In A-L. Jussila & M. Oinonen (eds.) Oral Health Promotion. ePooki. Oulun ammattikorkeakoulun tutkimus- ja kehitystyön julkaisut 49. Hakupäivä 24.2.2020. http://urn.fi/urn:nbn:fi-fe2019061019848.

This article contains health promotional material about drinks that includes the following subjects: what are the pH-values of different drinks, how much sugar do different drinks contain and why is it important not to drink sweetened drinks along the day. The aim of this article is to provide new information about these matters to knowledge the risks and decrease the usage of sweetened drinks along the day. 

Introduction

Dental caries is the most common disease among children in the world today so it is good to inform about the different risks that cause caries. Drinking sugared beverages is a risk factor for caries. Guido, JA., Martinez, EA., Soto, A., Eggertsson, H., Sanders, BJ., Jones, JE., Weddell, JA., Villanueva, I. & Antón, JL. 2011. Caries prevalence and its association with brushing habits, water availability and the intake of sugared beverages. International Journal of Paediatric Dentistry 21, 432-440. The aim of this article is also to clarify how pH affects to the teeth. Best outcome that we could ask for is that people would drink less sweetened drinks during the day. 

Caries

A dynamic relation exists between sugars and oral health. Diet affects the integrity of the teeth; quantity, pH, and composition of the saliva; and plaque pH. Sugars and other fermentable carbohydrates, after being hydrolyzed by salivary amylase, provide substrate for the actions of oral bacteria, which in turn lower plaque and salivary pH. The resultant action is the beginning of tooth demineralization. Consumed sugars are naturally occurring or are added. Many factors in addition to sugars affect the caries process, including the form of food or fluid, the duration of exposure, nutrient composition, sequence of eating, salivary flow, presence of buffers, and oral hygiene. Studies (figure 1) have confirmed the direct relation between intake of dietary sugars and dental caries across the life span. Touger-Decker, R. & van Loveren, C. 2003. Sugars and dental caries. Am J Clin Nutr. 78 (4), 881S–892S. Referred 20.3.2018. https://doi.org/10.1093/ajcn/78.4.881S

The Keyes diagram depicts the main factors that are necessary for caries to occur. 

Keyes-Jordan Diagram about Caries Risk Factors

FIGURE 1. Modified Keyes-Jordan Diagram about Caries Risk Factors FIGURE 1. Modified Keyes-Jordan Diagram about Caries Risk Factors. In Hirleman, C. E. 2018. The impact of dental caries on the oral health-related quality of life in children. MS (Master of Science) thesis, University of Iowa. https://ir.uiowa.edu/cgi/viewcontent.cgi?article=7829&context=etd. Originally in Burt and Eklund, 1999 as depicted in Keyes Jordan, 1963.

Since the introduction of fluoride Hirleman, C. E. 2018. The impact of dental caries on the oral health-related quality of life in children. MS (Master of Science) thesis, University of Iowa. https://ir.uiowa.edu/cgi/viewcontent.cgi?article=7829&context=etd, the incidence of caries worldwide has decreased, despite increases in sugars consumption. Other dietary factors (eg, the presence of buffers in dairy products; the use of sugarless chewing gum, particularly gum containing xylitol; and the consumption of sugars as part of meals rather than between meals) may reduce the risk of caries. The primary public health measures for reducing caries risk, from a nutrition perspective, are the consumption of a balanced diet and adherence to dietary guidelines and the dietary reference intakes; from a dental perspective, the primary public health measures are the use of topical fluorides and consumption of fluoridated water. (Figure 2.) 

Diagram of the balance between pathologic and protective factors in the caries process

FIGURE 2. Diagram of the balance between pathologic and protective factors in the caries process FIGURE 2. Diagram of the balance between pathologic and protective factors in the caries process. In Hirleman, C. E. 2018. The impact of dental caries on the oral health-related quality of life in children. MS (Master of Science) thesis, University of Iowa. https://ir.uiowa.edu/cgi/viewcontent.cgi?article=7829&context=etd. Originally in Touger-Decker, R. & van Loveren, C. 2003. Sugars and dental caries. Am J Clin Nutr. 78 (4), 881S–892S. Referred 20.3.2018. https://doi.org/10.1093/ajcn/78.4.881S as depicted in Featherstone, 2000

The main indexes used for dentition are: DMFT, DMFS, dmft, and dmfs (decayed, missing, filled, teeth or surfaces); they refer to permanent dentition when written in uppercase letters; and to primary dentition when written in lowercase letters. Touger-Decker, R. & van Loveren, C. 2003. Sugars and dental caries. Am J Clin Nutr. 78 (4), 881S–892S. Referred 20.3.2018. https://doi.org/10.1093/ajcn/78.4.881S. The WHO goal of a mean DMFT for 12-year-olds at 1.5 or below before the year 2020 is already fulfilled in Finland (figure 3). However, it seems there is still work to do to attain the goal of at least 80 % caries free 6-year-olds in 2020. The available data do not distinguish differences between urban and rural areas, nor ethnic and socio-economic differences. It's interesting to see that in Finland 5-year-olds children had higher dmft-scores than 6-year-olds. Johansson, V., Söderfeldt, B. & Axtelius, B. 2008. Oral B's Nordic Report on Oral Health: Caries prevalence among children, adolescents and adults, and periodontal conditions among adults in Denmark, Finland, Norway and Sweden. Malmö University, Reports. Referred 20.03.2018. http://hdl.handle.net/2043/6715

World map on dental caries

FIGURE 3. World map on dental caries: dental caries level FIGURE 3. World map on dental caries: dental caries level. In Nordström, M. 2014. Global burden of caries disease. Malmö University. Referred 14.6.2019. https://www.mah.se/CAPP/Country-Oral-Health-Profiles/Global_burden_of_caries_disease/

Especially, the high content of sugar in sweetened drinks has been associated with the presence of dental caries. It's essential to consider that although bacteria produce acids that are considered to be a cause of caries, the bacteria themselves do not produce sufficient acid to demineralize tooth enamel. Therefore, it is the presence of sugars or cooked foods rich in starch that increase the production of acids. For this reason, it is necessary that the parental figures modify their children’s unhealthy behaviors at an early age. Furthermore, the implementation of public policies to reduce the consumption of sweetened beverages, such as increasing taxes on these products, may help to be prevent tooth decay and tooth loss. López-Gómez, S.A., Villalobos-Rodelo, J.J., Ávila-Burgos, L., Casanova-Rosado, J.F., Vallejos-Sánchez, A.A., Lucas-Rincón, S.E., Patiño-Marín, N. & Medina-Solís, C.E. 2016. Relationship between premature loss of primary teeth with oral hygiene, consumption of soft drinks, dental care, and previous caries experience. Sci Rep. 26 (6), 21147. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768248/

Tooth erosion

Low pH and high buffer capacity of drinks are the major risk factors, while calcium is the main protective factor. Reduction of frequency of consumption and contact time of erosive drinks with teeth and consumption of dairy products are advisable. Tooth erosion is a chemical-mechanical process that results in a cumulative loss of dental hard tissue. Its ultimate causative factors are non-bacterial acids and mechanical abrasive forces. Frequent consumption of soft drinks and fruit juices significantly increases the prevalence of tooth erosion. Some weak acids can have high buffer capacity at a specific pH and so they can keep tooth dissolution during long periods of contacts. There is no critical pH value for erosion. The critical pH value depends on the tooth tissue and on the concentrations of calcium and phosphate in the solution. Yogurt is a good example of this, since it's pH is around 4, but it's not erosive since it has high calcium concentration. (Table 1.) Buzalaf, M. A. R., Magalhães, A. C. & Rios, D. 2018. Prevention of erosive tooth wear: target-ing nutritional and patient-related risk factors. BDJ 224, 371–378. Referred 19.3.2018. https://www.nature.com/articles/sj.bdj.2018.173

TABLE 1. pH values of different drinks TABLE 1. pH values of different drinks. In Keskinen, H. 2015. Juomat ja suun terveys. Duodecim Terveyskirjasto. Referred 18.3.2018. https://www.terveyskirjasto.fi/terveyskirjasto/tk.koti?p_artikkeli=trv00017

pH values of different drinks

The pH scale measures how basic or acidic a substance is. The pH scale ranges from 0 to 14. A pH of 7 is neutral. A pH greater than 7 is basic and a pH less than 7 is acidic. Virtual Chembook. 2003. pH Scale. Referred 22.3.2018. http://chemistry.elmhurst.edu/vchembook/184ph.html There is risk of dental erosion when a pH is below 5.5 and drink contains harmful acids, most commonly citric acid (E 330) Keskinen, H. 2015. Juomat ja suun terveys. Duodecim Terveyskirjasto. Referred 18.3.2018. https://www.terveyskirjasto.fi/terveyskirjasto/tk.koti?p_artikkeli=trv00017

Tooth development

As in other aspects of human growth and development, nutrition has an effect on the develop-ing tooth. Essential nutrients for a healthy tooth include calcium, phosphorus, and vitamins A, C, and D. Calcium and phosphorus are needed to properly form the hydroxyapatite crystals, and their levels in the blood are maintained by vitamin D. Vitamin A is necessary for the formation of keratin, as vitamin C is for collagen. Fluoride, although not a nutrient, is incorporated into the hydroxyapatite crystal of a developing tooth and bones. Moynihan, P. & Petersen, P. 2004. Diet, nutrition and the prevention of dental diseases. Public Health Nutrition 7 (1A), 201–226. Referred 22.3.2018. http://www.who.int/nutrition/publications/public_health_nut7.pdf At the age of thirteen to sixteen, after teething, teeth are still developing. At the developing phase teeth are fragile to any kind of damage. Ash, M. M. & Nelson, S. J. 2003. Wheeler’s dental anatomy, physiology, and occlusion. Phila-delphia: W.B. Saunders. That’s why good oral health and nutrition in so important in that phase of life. (Table 2.)

TABLE 2. The development timeline of human permanent teeth TABLE 2. The development timeline of human permanent teeth. In Ash, M. M. & Nelson, S. J. 2003. Wheeler's dental anatomy, physiology, and occlusion. Philadelphia: W.B. Saunders.

The development timeline of human permanent teeth

Discussion

For our stand (photo 1) we wanted to do something that would be interesting and exciting for the students. We wanted that the students had an opportunity to take part in our stand. We achieved this by organizing some tasks for our stand. First task was to match the correct drink and pH-value. One of the pH-values was extra, as seen in the picture (pH 9,6), that we added in as a joker. The second task was to match the correct drink and the amount of sugar it had. Some of the drinks didn’t have any sugar, for example unsweetened tea and coffee or water. After the students were done with the tasks, we checked whether their answers were correct and told them the right answers if some of their answers were wrong. We then proceeded to tell more about how pH affects one’s teeth by showing a short video about the effects of tooth erosion. We also discussed what should be drank when you’re thirsty and how many acid attacks can teeth withstand during the day. 

Our stand at the event

PHOTO 1. Our stand at the event (photo: Paasovaara Jonna)

The event in over all went really well. At first we had some difficulties with time consumption and had to take out some minor things that we planned to discuss at our stand. The students were really excited and participated well at our stand. They told us about their own experiences and whether they liked to drink soft drinks or not. Most of the students didn't like drinking soft drinks, but there were some that would drink them a bit too often. We were surprised how some of the students didn't know what pH means but at the same time there were students in class that knew. We weren't exactly prepared for this, but luckily we knew how to quickly explain the basis of pH and what it means. We could have prepared ourselves better with our stand by, for example, practicing what we were going to talk about and check how much time it would take. If we had practiced a bit more, we wouldn’t have had problem with our usage of time. 

References

    Picture References

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