Influence of other risk factors on diet-related caries
Certain conditions may predispose people to risk for diet-related dental caries.
Systemic diseases and regular medication may affect caries risk. The disease or medication per se might increase caries risk, but sometimes the increased risk is related to treatment. The increased need for energy and nutrients during a disease episode is often not met, and the patient may be undernourished. Intake of medicines containing sucrose must be noted, eg, fiber supplements for constipation, cough mixtures, and antibiotics.
Further, the intake of soft drinks and sweets is found to be high in hospitalized patients. In some diseases, dietary treatment relieves disease symptoms. Thus, a reduced-fat diet eases diarrhea associated with Crohn's disease or irradiation of the abdominal tract. A low-protein diet defers the need for dialysis in patients with uremia. To compensate for the reduced fat or protein intake, carbohydrate intake is increased, and this increases caries risk. Monosaccharides and disaccharides are used generously; otherwise, the meals would be too large.
Dental caries in patients with psychiatric disorders may be complex to explain.
Carbohydrates favor the uptake of tryptophan to the brain, and serotonin production is enhanced. Thus, carbohydrates can have a sedative effect, and frequent eating may induce relaxation. Caries resistance may be lowered by concurrent medication with
psychiatric drugs which often impair salivary secretion, as will be discussed in chapter 3.
Abuse of recreational drugs, such as hashish, may be associated with a craving for sweets. These patients frequently have high caries activity, typically with smoothsurface lesions.
A few decades ago, pregnancy was regarded as a cause of tooth loss resulting from dental caries. Although this is no longer the case, pregnancy may be associated with increased caries risk in some women. During the first trimester, problems with oral hygiene may result from nausea. Pregnancy is often associated with cravings for sweets and more frequent eating. Hormonal changes will also reduce the amount and quality of saliva during the final months of pregnancy.
Studies have shown an association between obesity and caries prevalence. However, the association with diet has not been clear. Several studies have shown that the obese underreport total energy, fat, and sucrose intake, but overreport vitamin C and fiber. It could, therefore, be assumed that the sucrose intake in obese individuals with a caries problem is higher than is disclosed by the patient during the dietary registration.
Occupations in which frequent food sampling is possible, or even a necessary aspect of work, are associated with an increased risk for dental caries. Examples of such occupations are workers in the confectionery industry and restaurant personnel.
Bakery workers were also once considered to be at higher risk for caries (for reviews on dietary factors related to dental caries, see Imfeld, 1983; Rugg-Gunn, 1989, in Murray, 1989; Edgar and Higham, 1991, Geddes, 1991, Bowen, 1994, Geddes, 1994, Imfeld, 1994a,b, Marsh, 1994, Johansson and Birkhed, 1994, Nyvad and Fejerskov, 1994, Carlsson and Hamilton, 1994, Rugg-Gunn, 1994).
