Influence of other risk factors on diet-related caries – Certain conditions may predispose people to risk for diet-related dental caries.

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). 
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Articles for theme “caries”:
Dietary recommendations for general health promotionGeneral recommendationsGeneral guidelines for energy and nutrient intake are given in the Nordic recommendations from 1989, and in recommendations specific for each Scandinavian country. They give age- and sex-specific recommendations for daily energy and nutrient intake as well as minimal daily required amounts for healthy individuals older than 3 years. It is recommended that energy intake be at a level that does not cause obesity and that there be five or six daily intakes of food at even intervals throughout the day.
Evaluation of dietary factorsThe human longitudinal studies described earlier showed that, in individuals with little or no plaque control and no use of fluoride, frequent intake of sugar-containing products is a significant risk factor or prognostic risk factor for dental caries. In addition, in vivo plaque pH measurements have shown that the drop in pH and sugar clearance time in undisturbed plaque (more than 2 days old) is related to the sugar concentration and consistency of the food item being evaluated (see Figs 63, 64, 65, 66, 67, 68, and 69).
Influence of hydrogen ion concentration (pH) of plaque  It is generally accepted that enamel caries is the result of a disturbance in the equilibrium between enamel hydroxyapatite and the calcium and phosphate ion concentrations of the dental plaque covering the enamel surface. At neutral pH, plaque seems to be supersaturated with these ions. A fall in pH, however, caused by intraplaque bacterial fermentation of carbohydrates, leads to a shift in the equilibrium of concentrations and to dissolution of enamel.
Evidence from human longitudinal, interventional, and experimental studies There are many reasons why there are so few planned interventional human studies of diet and dental caries¾for example, the problem of persuading groups of people to maintain rigid dietary regimens for long periods of time. Although most of such studies involved providing daily sugar supplements to subjects¾a practice that would be considered unethical today¾these studies made an important contribution to dental knowledge.
Evidence from cross-sectional studiesNumerous cross-sectional observational studies in children have used dietary  interview and questionnaire methods to study the relationship between caries prevalence and consumption of sugar and sweets. The results are somewhat conflicting (Rugg-Gunn, 1989): A significant, but not very strong, correlation between caries and the total quantity of sugar consumed has been found in some studies but not in others. A closer relationship has been demonstrated between caries and the quantities of sweets and confectionery consumed, probably because these products are consumed in ways that enhance cariogenicity¾between meals and over long periods¾whereas consumption of even large quantities of sugar at meals seems to do little harm.