health is directly related to an individual’s
diet. The most common problem affecting dental
health is tooth decay or dental caries, which
can lead to more serious problems to one’s
teeth and health in general.
Sugar has been proven by a number of studies
and research over the years to be the greatest
contributing factor for tooth decay. Thus sugar
intake should be regulated or minimized. This
is rather difficult, considering majority of
the mass population has an affinity to sugary
foods, such as chocolate, ice cream, candies,
and other such foods. To add to that, eating
is a social activity affected by many external
It has been proven from scientific consensus
that diet is more important after the decay
set in, and the influence of diet before the
onset of delay is just minimal.
Before, sugar classification had caused a
lot of confusion among the general public.
Fortunately, the U.K. government has introduced
a new system to simplify sugar classification.
This is now considered as the standard classification
worldwide. COMA, the new classification, is
based on the
location of the sugar in the food or drink.
With this being used as a framework, sugar
is classified into twobasic groups. These are
1. Intrinsic sugars – This type of sugar
is found inside the cell structure of foods
like fruits and vegetables.
2. Extrinsic sugars – This type of sugar
is found outside the cell structure of foods.
Extrinsic sugars are also divided into two.
The first one is called milk extrinsic sugar
which is present in milk and milk products.
The second is non-milk extrinsic sugar or NMES.
This type is present in table sugar, confectionary
and soft drinks.
According to research-evidence showed that
this NMES is very harmful to the teeth. It
is recommended to reduce the amount and the
frequency of NMES consumption. Intake of NMES
is restricted mostly during to mealtimes only,
specifically four times a day for a total of
60g/day for every person. It should also comprise
no more than 10% of total energy intake.
Evidence of dietary intervention
Only few good research studies have been made
on dietary interventions. But the population
showed that sugar consumption can be considerably
reduced if given the right support. The importance
of dietary intervention is meant for good health.
The general health of the individual should
be one of the target priorities. Like for example,
dietary intervention must not lead to an increased
intake of saturated fats. As it has happened
in the past, people increased the intake of
fatty snacks as they reduced their sugar consumption.
Guidelines are made to inform the people on
proper diet. Guidelines for a healthy diet
generally include the following:
- Eating a variety of foods
- Eating more
foods rich in starch and fiber
more fruits and vegetables
- Eating the
right amount of nutritious foods
less fatty foods
- Eating less sugary
foods and drinks
- Enjoy your food
Making and listing down dietary guidelines
are easy to do. The difficult part is putting
these plans into action, as implementing these
guidelines requires real work, especially when
they are so many hindrances and problems to
achieve dietary changes.
For the individuals to be more open and accepting
to the dietary changes, a 6-step counseling
program has been made and is used by some
dentists. Here are the 6 steps:
1. Identification of high-risk patients – Dental
information and education are given orally
or through mass media like advertisements,
posters, and leaflets. These usually provide
prevention of tooth decay and caries. But there
are also a large number of people or patients
that already have dental caries and this group
of people need more support. This group is
composed of pre-school children, adolescents,
and patients on medication.
2. Dietary history – Take the dietary
history of patients. This offers very important
information. The interview would answer questions
of what these people are eating, how often,
and how much. It will identify how much NMES
they consume. Dietary history is also essential
before giving a patient his/her medications.
3. Set goals – The main objective in
these steps is a decrease of NMES consumption.
But for goals to be achieved and attained,
it should have the consent and motivation of
the patient. The patient’s condition
and circumstances should be taken into account,
thus the goals must also be realistic and suitable
with the patient being part of the decision-making.
4. Action plan – These plans are made
to remove the barriers and hindrances for the
person’s needs and goals be achieved.
One should be inventive to be able to conquer
these hindrances. An example would be to encourage
the individual to eat fruits or vegetables
instead of having
sweets such as cake and ice cream for dessert.
Eating is considered as a social activity,
it is important then to promote family and
peer groups support in changing dietary habits.
5. Review – Review and constantly evaluate
counseling made to find out if changes are
needed to accomplish the goal. Regularly visit
and evaluate the patients to identify any progress
made and any further counsel and encouragement
is needed. These visits can be done in a weekly
6. Refer – There are some patients who
follow a specific type of diet because of there
religion, belief, or medical condition. These
patients with specific types of diets need
more specialized advice. Dental professionals
be of little or no help to them. Because of
this, these patients should be referred to
a registered dietician.
These 6 steps are easy and achievable, but
everyone involved – the patient and dental
health care professionals like the dentists – should
work as a team. Dentists play a vital role
as they identify patients who need help. Dentists
should be active in helping and encouraging
these patients to attain one’s goal of
healthy and desired dietary changes.