Chemistry Reference
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to be achieved by the turn of the century, including that children aged 12 years on the average should
have a DMFT of below 3 (WHO/FDI 1982).
Controlling the intake of sugars, therefore, remains important for caries prevention. In countries
with a level of sugar consumption of less than 18 kg/person/year, caries experience is consistently
low (Sreebny 1982; Woodward and Walker 1994). Ruxton et al. (1999) used the ecological data from
the studies of Sreebny and of Woodward and Walker to study the relationship between changes in
dental caries and in sugar intake in 67 countries between 1982 and 1994 by drawing up a simple
scatter plot. This scatter plot showed that, in 18 countries where sugar supply declined, DMFT
decreased. In 18 countries where caries level increased, there were increases in sugar supply.
Repeat dietary surveys of English children over three decades indicate that levels of sugar intake
have remained stable while sources of sugars have changed considerably, with the contribution
from soft drinks more than doubling since 1980. Dental caries eventually leads to tooth loss, which
in turn impairs chewing ability, causing the avoidance of hard and ibrous foods, including fruits,
vegetables, and whole grains. It has been found that edentulous subjects have a very low intake (<12
g/day) of nonstarch polysaccharides, fruits, and vegetables. In addition, the provision of prostheses
alone failed to improve the diet. However, initial studies indicated that customized dietary advice at
the time of denture provision resulted in increased consumption of fruits and vegetables, and posi-
tive movement through the stages of change (Moynihan 2005b).
In young children in the U.K., levels of dental caries are increasing (Pitts et al. 2004b). A recent
survey of 5-year-old children conducted by the British Association for the Study of Community
Dentistry has shown that 40% of 5-year-olds in England and Wales have dental caries, with an aver-
age of 1.52 teeth per child affected. The British Association for the Study of Community Dentistry
survey data (Pitts et al. 2004a) shows the mean number of decayed, missing, and illed permanent
teeth in 14-year-old children in England and Wales from 1990 to 2002 and indicates how the trend
for a decline in caries has now stabilized, with an average of 1.5 decayed, missing, and illed perma-
nent teeth per child. Despite a relatively low average number of decayed, missing, and illed perma-
nent teeth, 50% of 14-year-olds in England and Wales (Pitts et al. 2004a) and 50% of 12-year-olds
in the Republic of Ireland are affected by decay (Whelton et al. 2003). Dental caries is a progressive
disease, and levels in European adults are very high. Even in luoridated areas of the Republic of
Ireland, the average number of decayed, missing, and illed permanent teeth for the 35- to 44-year-
old age group is 18.9, and in the U.K., it is 19.0 (the WHO considers a level of ≥14.0 to be very high;
World Health Organization 1996).
Over the past 20 years, the contribution of soft drinks, biscuits and cakes, and breakfast cereals
to total sugar intake has risen signiicantly. In 1980, soft drinks contributed 15% to the total sugars
intake; this percentage has overdoubled in the 20-year period to 37% in 2000. Similarly, the con-
tribution of breakfast cereals to sugar intake has risen from 2% to 7%. The intake of sugars from
confectionery, table sugar, and puddings has declined over the 20-year period. However, confection-
ery has remained a major source, providing 23% of the total sugars in 2000 and, together with soft
drinks, provides approximately 60% of the total sugars. These indings are consistent with other
surveys from industrialized countries, which indicate that children are consuming more sugars than
recommended and the principal dietary sources are confectionery and soft drinks (Rugg-Gunn et
al. 2007; Gregory and Lowe 2000; Guthrie and Morton 2000).
Tooth loss is associated with a reduction in both measured (Krall et al. 1998) and perceived
(Rusen et al. 1993) chewing functions. The chewing function of an individual with dentures is only
one-ifth of that of a dentate individual with 20 or more natural teeth (Michael et al. 1990). Early
studies have reported that the loss of functional dentition results in chewing dificulties and selec-
tive food avoidance, raising concern that this situation may lead to compromised nutritional intake
(Osterberg and Steen 1982; Wayner and Chauncey 1983). Foods avoided include those that are hard
to chew, for example, raw vegetables and wholegrain breads, and foods containing seeds and pips
such as tomatoes, grapes, and raspberries (Wayner and Chauncey 1983).
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