Caries-Prone Patients: Prevention, Assessment, and Interventions, 3rd Edition __________________________
Cost The cost of food is a factor that influences dietary choices for many people. Foods with low nutritional value are often more affordable and more easily accessible than foods with high nutritional value. Fresh fruits, vegetables, and lean proteins are more costly per serving than alternatives that are higher in sugar and fermentable carbohydrates [44]. In addition, there is an inverse relationship between calories and cost per serving: Nutritionally deficient foods such as those with high sugar, fermentable carbohydrate, and fat content are among the most affordable dietary choices [45]. When recommending diet modifications to patients, dental professionals need to consider food costs for many reasons. Studies show that persons of low socioeconomic status tend to live in neighborhoods known as food deserts , where good quality, nutritional foods are scarce and transportation and the time needed to get to nutritional food sources factor into the cost of food [46]. Due to the higher costs associated with healthier foods, people with low incomes incur the highest risks of diet-related conditions [47]. Media Media have an impact on diet in two ways. Children ages 8 to 18 spend approximately 7.5 hours every day with media, includ- ing television, the Internet, music, magazines, cell phones, and tablets. Marketing of foods and snacks to children tends to be geared toward low-nutrition foods and beverages [48]. Media influence diet choices, especially those of children, by the sheer number of food-related advertisements found on television, in print, and on cell phones and tablets—which can evade parental monitoring [48]. By realizing the factors that affect patients’ diets, dental profes- sionals are more likely to recommend diet changes to which patients will be willing to adhere. Also, dental professionals can educate patients about these factors to facilitate self-assessment of dietary influences. POPULATIONS AT RISK Certain populations are at increased risk for caries formation due to diet, habits, lack of adequate oral hygiene, and other fac- tors. These populations can especially benefit from nutritional counseling and caries prevention applications and procedures. CHILDREN Because all teeth, once erupted, are susceptible to dental caries, even very young children are vulnerable. Early childhood car- ies (ECC) is defined as the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in the primary dentition of a preschool-age child [49]. This condition is seen throughout the general population but is more common in the poor and near-poor preschool children. In the United States, it is estimated that between 3% and 6% of children have early childhood caries [50]. The National Institute of Dental and
Craniofacial Research (NIDCR) has indicated that between the years of 2011–2016 that 23% of children between the ages of 2 and 5 years had carious lesions in their primary teeth and that children from lower-income families were twice as likely to have decay in their primary teeth compared to children from higher-income families [51]. Among children ages 6 to 11 years, 17% had decay in their permanent teeth [51]. To prevent ECC development, the American Academy of Pediatric Dentistry (AAPD) recommends that children have their first dental appointment soon after their first tooth erupts and no later than their first birthday [49]. Educating the child’s primary caregiver about oral hygiene care for the child and proper use of bottles is one of the main objectives of this appointment. Sodas, juices, and other sugared drinks should not be given to children, or they should be given very sparingly, and they should never be dispensed through a bottle. Children using bottles should not be allowed to go to sleep with them unless the bottle contains water. The AAPD also advises eliminating the use of a baby bottle by age 12 months and avoiding foods and drinks that contain sugar for children under 2 years of age [49]. Parents and primary caregivers need to be reminded about the eruption pattern of teeth and the fact that children have new teeth exposed to the oral environment from age 6 months to approximately age 12 years. The enamel of primary teeth is thin- ner and less organized compared to the enamel of permanent teeth, so the former is more susceptible to demineralization and the formation of carious lesions compared to the latter [50]. Therefore, soda, sugar, and fermentable carbohydrate exposure is more detrimental in youth than in adults. ADOLESCENTS The incidence of caries continues to rise as children grow into teenagers. According to the NIDCR, approximately 57% of adolescents between ages 12 and 19 have had carious lesions in their permanent teeth [52]. Adolescence is a time of increased caries risk because teenagers consume diets that are higher in fermentable carbohydrates and sugars, and they often practice poor oral hygiene. Research shows that this age group responds to health behavior change requests through motivational interviewing (MI) tech- niques, rather than the traditional dissemination of informa- tion and dispensing of advice [53]. Motivational interviewing, a collaborative, goal-oriented form of communicating behavior change, has been shown to positively affect adolescents’ change in diet, exercise, and compliance with medications. MI tech- niques that will help professionals better communicate oral healthcare principles with this age group and the mechanisms by which MI works to instill behavioral changes in adolescents is an area of continued research [54]. Among high school stu- dents between 2019–2021, approximately 16.5% of boys and 12.7% of girls had consumed one or more sugar-sweetened soda beverages each day [55; 88]. Soda is included with other sugary products and those made with solid fats in the category of empty calories. Empty calories account for 30.2% to 34.4%
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