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Pediatric Dental Health
October 1, 2002
NUTRITION AND DENTAL HEALTH
Good nutrition is essential for oral and dental health in children. Good eating habits and food
preferences are established early in childhood. Poor nutrition can eventually lead to poor health,
obesity, tooth decay, and periodontal disease.
DIETARY FACTORS THAT CAUSE TOOTH DECAY
Most children crave sugary and other junk food that they see in TV commercials. For this
reason parents should try to control what their children eat as much as possible.
Dietary habits often contribute to the development of dental caries in children. Food
which remains on the teeth provides a substrate for the bacteria which thrive in dental
plaque. These cariogenic (cavity causing) bacteria produce acids which remove essential
minerals from the teeth. This destructive process is called demineralization.
An average person in the United States now consumes 155 pounds of sugar per year.
Unfortunately, processed sugar is not a good nutrient. In fact, only sugar which is in the
form of complex carbohydrates (bread, vegetables) is healthy. The United States
Department of Agriculture’s Food Guide Pyramid clearly shows that sugar should only
be a very small part of a child’s diet!
Sticky, sweet food is very bad for teeth because it maintains high sugar levels in the
mouth, and is very likely to cause tooth decay.
A young child who frequently uses a bottle or sippy cup containing juice or other
sweetened liquid has an increased risk of developing early childhood caries (ECC).
Children should only have water in their bottle or sippy cup between meals!
THE DENTAL CARIES PROCESS
Dental caries is a transmissible and infectious bacterial disease. A child’s diet plays a
central role in the development of dental caries.
The more sugar a child consumes, and the more frequently he/she consumes it, the
greater the risk of developing dental caries (cavities).
Sucrose is the most cariogenic form of sugar because it can form a long molecule called
glucan. This “glue” (glucan) permits bacteria to adhere to tooth enamel, and keeps
bacterial acid close to the surface of the tooth.
Dental caries is caused by a combination of factors:
cariogenic (cavity-causing) bacteria, food (especially refined sugar), susceptible teeth,
and frequency of exposure to sugar (especially sucrose).
The caries process is simple:
Cariogenic bacteria (mutans Streptococci) attach to the teeth and thrive in dental plaque.
The bacteria use sugar to produce acid. When there is enough bacterial acid coating the
tooth surface, demineralization (loss of mineral) of the enamel occurs.
Mutans Streptococci bacteria are usually transferred from the mother’s mouth to the
infant’s mouth during feeding – especially spoon feeding. The earlier a child’s mouth is
colonized (inoculated) with a mother’s oral bacteria the greater the risk for the
development of caries in the child.
Good nutrition during pregnancy is very important for the development of baby teeth.
Mineralization (calcification) of primary (baby) teeth occurs around month 3 to 4 of
pregnancy. When a child is born, the crowns of the baby incisor teeth are almost
Nutritional deficiencies during pregnancy can cause serious problems, including poor
enamel formation (hypoplasia), susceptibility to dental caries, delayed dental eruption,
and small tooth size. Maternal osteomalacia (vitamin D deficiency) can cause hypoplastic
primary tooth enamel.
Fluoride supplementation for pregnant women has not been shown to reduce dental caries
in children. Therefore, fluoride supplements are not recommended for pregnant women.
Breast milk is the best nutrient for an infant. There are many components of breast milk
which benefit the baby.
Immunoglobulins. Secretory IGA is an immunoglobulin which protects against infections
in the baby’s ears, nose, and throat.
Lysosomes. They are a digestive material that influences the type of bacteria which live
in the baby’s digestive tract.
Lactoferrin. This is an iron-binding protein that has a direct antibiotic effect on
staphylococci and E. coli bacteria.
Carnitine. The baby needs this for converting fatty acids into an energy source.
Growth factors. These factors encourage the growth of helpful intestinal bacteria – the
Long-chain fatty acids. These are important structural components in the brain and retina.
THE ROLE OF VITAMINS IN ORAL HEALTH
Function: Needed for gingival health. Important for maintaining mucous membranes of
Source: Milk, carrots, and dark green vegetables.
Function: Essential for healthy bones, teeth and growth of the jaws.
Source: Sunshine, fortified milk, and oily fish.
Function: An important part of the “extrinsic” clotting system.
Source: Dark green leafy vegetables.
Function: Needed for periodontal and gingival health. Aids in wound healing. Necessary
for collagen production. Prevents bleeding gums.
Source: Fresh fruit, potatoes, and green vegetables.
Function: Deficiency leads to changes in oral mucous membranes – such as angular
chelitis and glossitis.
Source: Green vegetables, milk, liver, yogurt, and cheese.
Folic acid, folate.
Function: Helps the structures of the face develop correctly. Pregnant women need to
Source: Dark green vegetables, liver, and whole-meal bread.
THE ROLE OF MINERALS IN ORAL HEALTH
Function: Helps in the formation of teeth and bones.
Source: Milk, cheese, seafood, and yogurt.
Function: Needed for energy production, metabolism, and healthy bone development.
Source: Milk, cheese, meats, whole grains, eggs, and legumes.
Function: Needed for muscle contractions and nerve function.
Source: Milk, cheese, whole grains, and vegetables.
Function: Needed for tissue repair, normal metabolism, and wound healing.
Source: Seafood, liver, meats, and whole grain cereals.
Function: Required for glucose metabolism and the release of energy.
Source: Cheese, whole grain cereals, and meats.
Function: Keeps bones and teeth strong.
Source: Tea, broccoli, chicken, and fluoridated water.
Function: Required for the production of blood and nerve fibers.
Source: Seafood, liver, and nuts.
Function: Needed for blood production and energy production. A deficiency in iron
results in glossitis, which is a red, painful tongue.
Source: Liver, leafy green vegetables, and meats.
THE EFFECTS OF JUICE ON CHILDREN’S TEETH
Children are the single largest group of juice consumers. By the age of one, almost 90%
of infants in the U.S. are drinking fruit juice. One percent of infants consume more than
21 ounces of juice per day!
Fruit juice is not a substitute for natural fruit, and it has fewer nutrients. Water and
carbohydrates are the main ingredients in juice. The major carbohydrate components of
juice are: sucrose, glucose, fructose, and sorbitol. Fruit juice also lacks the fiber in whole
Malnutrition, short stature, and dental caries in children have been associated with
excessive juice consumption. Excessive consumption of juice by infants can also cause
diarrhea due to poor absorption of the carbohydrates in juice. Abdominal pain is also
common in heavy juice drinkers.
The American Academy of Pediatric Dentistry and the American Academy of Pediatrics
both recommend that juice be offered to infants in a cup – not in a bottle or sippy cup.
Infants should not be put to bed with a juice bottle or sippy cup.
It is recommended that fuit juice be consumed during meal time. Juice should not be used
to pacify a child, and should not be sipped all day.
THE EFFECTS OF SOFT DRINKS ON CHILDREN’S TEETH
Soft drinks and soda are the biggest single source of refined sugar in the American diet.
Carbonated beverages have absolutely no nutritional value, however. Heavy soft drink
consumption is correlated with low intake of ascorbic acid, magnesium, vitamin A, and
By 1998, American were consuming 15 billion gallons of soft drinks per year. Today,
Americans consume more than 53 gallons of carbonated beverages per person, per year.
Even more alarming… twenty percent of one- and two-year- old children in the U.S.
consume soft drinks with an average consumption of seven ounces per day! Fifty-six
percent of U.S. 8-year-olds consume soft drinks every day!
High soft drink consumption leads to excessive caloric intake and high consumption of
sugar. There is a positive correlation between soft drink consumption and dental decay.
In many carbonated beverages, the sugar content can equal 10 teaspoons per 12 ounces!
Most carbonated beverages contain phosphoric acid, citric acid, and carbonic acid.
Tragically, this leads to chemical erosion of teeth.
Carbonated beverages are aggressively marketed at the teen market. Consumption of soft
drinks among 12- to 19-year-old males approached 81 gallons per year in 1998.
As teens in the United States have increased their consumption of soft drinks, their
consumption of milk has decreased by 40%, which contributes to a decrease in their bone
density. In fact, carbonated beverage consumption in teenage girls is associated with
osteoporosis later in life. Girls build 92% of their bone mass before the age of 18.
Unfortunately, only 10% of teenage girls consume the recommended amounts of milk
and dairy foods.
AGE-APPROPRIATE NUTRITION GUIDELINES
From birth to four months of age:
The American Academy of Pediatrics recommends that breast milk be the only nutrient
fed to infants until 4 to 6 months of age.
For mothers who do not breastfeed, infant formula can be used. Formula-fed babies may
need to eat 6 to 8 times per day for a total of 16 – 35 ounces per day.
Four to six months of age:
At this age, the baby should be consuming 28 to 45 ounces of formula per day.
Six to eight months of age:
Solid foods can be introduced into the infant’s diet. Mother should wait until the baby has
good control of the head an neck. At that point, start with a thin consistency mixture of
baby rice cereal. Later, try offering strained fruits and vegetables. Infants should not be
allowed to use a sippy cup for prolonged periods of time. Drinking fruit juice for a
prolonged period of time will likely lead to the development of dental caries.
Eight to twelve months of age:
By the age of one, most children should be “off the bottle.” Offer the baby strained meats
at this age.
Remember, infants should not be put to sleep with a bottle containing any liquid other
One year of age:
Whole milk or 4% milk may now replace breast milk or formula. Children under the age
of 2 should not be given low-fat (2% or skim) milk.
Parents should encourage their infants to drink from a cup as they approach their first
Toddlers and older children:
Do not give food that may cause your toddler to choke – such as nuts, popcorn, raisins,
hot dogs, grapes, or berries.
Infants should not be put to bed with a bottle containing juice or milk. Only water should
be in the bottle at bedtime!
One to two years of age:
Toddlers should be discouraged from carrying a sippy cup. Toddlers who drink more than
12 fluid ounces of juice per day may develop dental caries and “toddlers’ diarrhea.”
Toddlers should be introduced to healthy food and snacks.
Yogurt and cheese are good calcium alternatives for children who cannot tolerated milk.
Two years of age and up:
Aged cheese contains calcium lactate and fatty acids which help fight cavities. The
calcium and phosphates in aged cheese are slow-release components which are needed
for tooth remineralization. In addition, the physical form of cheese promotes salivary
flow – which increases food clearance and decreases the acidic environment surrounding
NUTRITION TIPS FOR PARENTS
Do not put an infant or toddler to bed with a bottle or sippy cup which contains juice or
milk. Only water should be in the container. In addition, do not let your youngster drink
or sip juice throughout the day. Frequent use of a sippy cup containing juice is likely to
cause dental caries. Put only water in sippy cups!
Keep only healthy foods in the house. Buy “whole-wheat” products and bread. Avid
buying sweet snacks or soda, as these are very destructive to teeth. Do not buy sticky,
sweet foods such as candy, raisins, and fruit roll-ups.
Teach your children the importance of healthy eating habits. Do not let sugars dominate
your child’s diet!
Make healthy foods fun by providing a variety of healthy snacks, fruit, and vegetables.
Snacking on cheese can help prevent tooth decay. Aged cheddar, Monterey Jack, and
Swiss cheese are best for this purpose.
Let your children know that soda and junk food causes cavities. Offer your children milk
or water instead of juice. Teenage girls especially should drink plenty of milk and avoid
soda to prevent osteoporosis in the bones.
Help your young child brush after every meal.
An article in Pediatrics reports on 2 cases of severe nutritional deficiency caused by
consumption of health food beverages by infants. Case #1 was a 22-month-old male who
was admitted to the hospital with severe kwashiorkor – a protein deficiency. Case #2 was
a 17-month-old black male who was diagnosed with rickets – a vitamin D deficiency. In
both cases, taking a thorough diet history was crucial for arriving at a diagnosis.