Educating our patients about the disease-diet relationship

We know that oral health is associated with diet in many ways, and we can track this back to ancient times. Dental palaeopathology or the study of ancient teeth,  reinforces for  us, as oral health professionals, the importance of addressing dietary habits and behaviors  with our patients. In particular, with the prevention of dental caries, since diet plays a critical role in the development and prevention of this disease.

The findings from fossil records show that hunter-gatherers rarely experienced dental caries (Tanga, Viciano, Monza, D’Anastasio, Capasso, 2020). Diet played an important role in plaque prevention and its association with a higher composition of good bacteria (Forshaw, 2014). The shift in our ancestors diets over time, from this hunter-gather style, which consisted  mostly of protein and fats, which are non-cariogenic as oral bacteria cannot ferment them, to an  increase in the intake of carbohydrates, particularly sugars, which are cariogenic, has contributed to the increased rates of dental caries for populations across the globe (Forshaw, 2014).

Although there are several key factors in the aetiology of dental caries, such as oral bacteria,  susceptible tooth surfaces and oral hygiene practices, dental caries is a diet-mediated disease. Sugar, specifically, free sugars are a key dietary factor in the development of this disease (WHO, 2015).

Our responsibility as oral health professionals, is to address our patients’ dietary habits and provide appropriate dietary advice to help prevent oral disease.  Undergraduate dental training can sometimes be limited in the area of nutrition. Therefore up-skilling in this area should be seen as a key part in our professional development. Teaching and educating our patients about diet can assist in  long term benefits to their  oral health and their  general well-being

A dietary assessment is the first step that we can undertake when addressing diet with our patients. This assessment will include discussing their current dietary behaviours such as frequency of snacking, dietary preferences, such as the intake of sugar-sweetened beverages , as well as family or even cultural preferences. This information can then assist in identifying the factors that are contributing to a patient’s current or future risk of oral disease.

Remember, dietary advice doesn’t always  have to be a structured or clinical conversation, for example, asking your patient casually about their favourite food and drink may help to identify and create the opportunity to suggest a dietary change. You could lead on to “did you know that processed foods often have additives, sugar and preservatives that are not good for your teeth or your health”.

By providing a nutritional assessment or dietary advice , we can empower our patients. It is important that they have an understanding of how their dietary behaviors can increase their risk of oral disease.  Along with this advice, we need to offer our patients strategies to address any dietary concerns we are identifying. As with any behaviour change, gradual small changes can make a big difference. Having access to pre-prepared nutritional information can be helpful with this.