Dental considerations for dietary counselling

A decline in the prevalence of dental caries over three decades has occurred without a significant change in the consumption of fermentable carbohydrates, indicating that good dental health is achievable with the presence of cariogenic factors in the diet. Since, in many countries 80% of the caries is present in only 20% of the population, 'targeted intervention' would seem a better preventive option, stressing the judicious use of fluoride, plaque control, fissure sealants and a sensible diet. Dietary modification is notoriously difficult to achieve, being incumbent upon the subject's willingness to effect a change in behaviour. Many texts refer to the frequency of consumption of carbohydrates as being all-important, recommending a reduction in the frequency. However, recent evidence suggests it is the frequency of toothbrushing with a fluoride containing dentifrice which is of fundamental importance in promoting remineralisation of enamel. Dietary advice should be formulated which is both realistic and positive. Trying to dissuade children from consuming products, which they perceive to be tasty and pleasurable is counter productive and more emphasis should be given to tooth brushing using a fluoride toothpaste. Also, a fundamental shift away from the idea of 'good foods versus bad foods' is required and more emphasis laid on good diets as opposed to bad diets. Children should be able to enjoy foods traditionally considered 'bad' from a dental viewpoint, as long as they brush their teeth with a fluoride containing dentifrice and have a sensible approach to their consumption.