Diet, Fluoride, and Dental Caries

1. Diet, Fluoride, and Dental Caries Wendell Evans BDS MDS DDSc FICD Population Oral Health The University of Sydney

2. Dental caries was ranked as the highest diet-related disease in Australia in terms of both total costs and health care costs (Crowley et al 1992). Crowley S, Antioch K, Carter R, Waters AM, Conway L, Mathers C (1992). The cost of diet related disease in Australia. Canberra: AIHW and NHMRC.

3. Annual sugar use (kg) Age 11-12 years DMF* Teeth *Decayed, Missing, Filled FAO (Food and Agriculture Organsiation - United Nations 1960

4. 10% glucose rinse Dental plaque pH Critical pH for tooth enamel dissolution Minutes Jenkins GN. The physiology and biochemistry of the mouth, 4th Edition. Oxford: Blackwell Scientific Publications, 1978. Page 388.

5. Jenkins GN. The physiology and biochemistry of the mouth, 4th Edition. Oxford: Blackwell Scientific Publications, 1978. Page 389.

6. The Vipeholm Study of Diet and Dental Caries Gustafsson et al. (1954). The Vipeholm dental caries study. Acta Odontlogica Scandinavica 11:232-364.

7. Gustafsson et al. (1954). The Vipeholm dental caries study. Acta Odontlogica Scandinavica 11:232-364.

8. 4 300 3 200 New DMFT per year Sugar consumed gm per day 100 1 0 0 Liquid 24 toffees Gustafsson et al. (1954). The Vipeholm dental caries study. Acta Odontlogica Scandinavica 11:232-364.

9. The Dental Caries Experience of the Children of Hopewood House Bowral, NSW Lilienthal et al Med J Aust, June 1953

10. Hopewood House 82 Children aged 4-9 years • Findings • well nourished • healthy • very poor oral hygiene • no dental caries Investigators Paediatricians Dental scientists Lilienthal et al Med J Aust, June 1953

11. 12 10 HOPEWOOD HOUSE BOWRAL, NSW DMFT of children aged 6 – 9 years 8 6 4 2 0 New Zealand Sydney Bowral Lilienthal et al Med J Aust, June 1953

12. Lilienthal et al Med J Aust, June 1953

13. The Tennessee Study Weiss RL, Trithart. Between meal eating habits and dental caries experience in preschool children. American Journal of Public Health 50:1097-1104, 1960.

14. Weiss RL, Trithart. Between meal eating habits and dental caries experience in preschool children. American Journal of Public Health 50:1097-1104, 1960.

15. Weiss RL, Trithart. Between meal eating habits and dental caries experience in preschool children. American Journal of Public Health 50:1097-1104, 1960.

16. The cariogenicity of refined carbohydrates

17. Beck DJ, Bibby BG. Acid production during the fermentation of starches by saliva. Journal of Dental Research 40:486-491, 1961.

18. Calcium sucrose phosphate Harris et al. Observations on the cariostatic effect on a group of children aged 5-17 years. Australian Dental Journal 12:105-113, 1967.

19. Harris et al. Observations on the cariostatic effect on a group of children aged 5-17 years. Australian Dental Journal 12:105-113, 1967.

20. Relationship between dietary habits and caries increment assessed over two years in 405 adolescent school children in Northeast England. Rugg-Gunn et al (1984). Archives of Oral Biology 29:983-992. .

21. 2 year study • children initially aged 11.5 years • 3 day diet diary on 5 occasions • annual bitewings • non-fluoridated environment Rugg-Gunn et al. Archives of Oral Biology 29:983-992, 1884.

22. Rugg-Gunn et al. Archives of Oral Biology 29:983-992, 1884.

23. Rugg-Gunn et al. Archives of Oral Biology 29:983-992, 1884.

24. Rugg-Gunn et al. Archives of Oral Biology 29:983-992, 1884.

25. The effects of sugars intake and frequency of ingestion of dental caries increment in a three-year longitudinal study – Michigan, USA Burt et al. Journal of Dental Research 67:1422-1429, 1988.

26. Michigan, USA • 3 year study of 499 children • initially aged 11-15 years • 24 hour diet interviews on 3-4 occasions • non-fluoridated environment • annual bitewings Burt et al. Journal of Dental Research 67:1422-1429, 1988.

27. (3 years) Burt et al. Journal of Dental Research 67:1422-1429, 1988.

28. (3 years) Burt et al. Journal of Dental Research 67:1422-1429, 1988.

29. Summary of findings Caries incidence was not related to total sugar intake nor to frequency of eating occasions. Rugg-Gunn et al. Archives of Oral Biology 29:983-992, 1884.

30. The Melbourne Study

32. Pit and fissure surface caries risk estimates

34. Effect of cheese Eating cheese following consumption of a sugary snack (pears in sugary syrup) prevented the depression of plaque pH whereas drinking sugared coffee following pears consumption further depressed pH.

35. Rugg-Gunn et al. The effect of different meal patterns upon plaque pH n human subjects. British Dental Journal 139:151-156, 1975.

36. Effect of war time diet During WW2, severe rationing of sugar occurred. Caries incidence in both Scandinavia and Japan was correlated with sugar consumption. Most recently, United Nations imposed sanctions against Iraq was associated with a dramatic decline in caries incidence. These data show the potential for health promotion (at the population level) to target dietary sugar restriction. The common risk factor approach.

37. Toverud G (1957). The influence of war and post-war conditions on the teeth of Norwegian children. In: Rugg-Gunn AJ. Nutrition and Dental Health. Oxford: Oxford University Press, 1993, 129.

39. DMFT in Iraq before and after United Nations Sanctions (UNS) Jamel H, Plasschaert A, Sheiham A. Dental caries experience and availabilit of sugars in Iraqi children before and after the United Nations sanction. International Dental Journal 54: 21-25, 2004

40. Fluorine • 13th most abundant element in the earths crust (WHO,1984) • most electronegative of the elements • emitted from volcanoes as gaseous fluorine which reacts immediately with water to form HF • mainly found in rock and soil in various forms of barely soluble calcium fluorides • concentration in seawater about 1.2 mg/L (ppm) • concentration in fresh water ranges from near zero to 25 ppm (in the Rift Valley, Tanzania) • world-wide fresh water fluoride concentrations are generally less than 0.1 ppmbut commonly up to 2 ppm in some areas

42. 0.0 ppm 0.0 ppm 1.2 ppm Source: McClure FJ. Water fluoridation: The search and the victory. Bethesda: National Institute of Dental Research, 1970.

43. 0.1 ppm 1.0 ppm 1.2 ppm Permanent teeth DMF reductions at Grand Rapids after 10 and 15 years of fluoridation. Source: McClure FJ. Water fluoridation: The search and the victory. Bethesda: National Institute of Dental Research, 1970.

44. Percent caries reduction in 113 studies into the effectiveness of water fluoridation in 23 countries. Source: Murray JJ, Naylor MN. Fluorides and dental caries. In: Murray JJ (Editor). Prevention of oral disease 3rd edition. Oxford: Oxford University Press, 38, 1996.

45. Australian 12-year-olds

46. The effect of water fluoridation The combined effect of water fluoridation and fluoridated toothpaste Victorian 12-year-olds

47. Source: Spencer AJ, Slade GD, Davies M. Water fluoridation in Australia. Community Dental Health 46:188-198,1986

48. Water fluoridation in the Blue Mountains reduces risk of tooth decay RW Evans1, A Hsiau1, PJ Dennison1, A Paterson2, and B.Jalaludin2 Australian Dental Journal 54: 368-373, 2009

49. Primary teeth Caries experience oflifelong residents aged 6 – 8 years Blue Mountains 2.58a Hawkesbury Mean dmft 1.10 0.71 0.69b 2003 1993 a = 135% more than Hawkesbury at baseline b = 73% less than Hawkesbury at baseline A = RW Evans1, A Hsiau1, PJ Dennison1, A Paterson2, and B.Jalaludin2 1Community Oral Health and Epidemiology, 2Formerly NSW Health

50. Primary teeth Percent oflifelongresidents aged 6 – 8 years with no decay 72% 71% 62% 38% 1993 2003 Blue Mountains Hawkesbury RW Evans1, A Hsiau1, PJ Dennison1, A Paterson2, and B.Jalaludin2 1Community Oral Health and Epidemiology, 2Formerly NSW Health