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Educating patients about sugar
EDITORIAL
Educating patients about sugar
A
common concern in orthodontics is the potential development of decalcification, caries, or periodontal problems. These problems can be associated with bonds or bands when combined with an improper diet involving unregulated sugar consumption and inadequate oral hygiene. The relationship between dental caries and the ingestion of fermentable carbohydrates has been known for a long time, as has the fact that various carbohydrates differ in their potential for precipitating caries. Plaque, the forerunner of dental caries and peridontal disease, is a deposit of material on the surface of a tooth. It is composed of mucin from the saliva along with bacteria and their products. According to Covert Bailey’ there are seven biochemical reasons for plaque’s preference for sucrose. People in the United States eat sucrose more often, which affects the caries potential. The frequency of ingestion and adhesiveness of the food are more important than the total quantity of carbohydrate consumed. An oral PI-I of 6 to 7 will drop to 2 in half a second after ingesting a cola or similar drink. The plaque is saturated at this point and can take no more. Twenty minutes of acid is produced each time sugar is taken. Research has shown that it takes 20 minutes before the plaque can absorb any more. Theoretically, then, you can take as much sucrose as you wish over a short period because frequency is more important than quantity. Sucrose penetrates the pellicle of gelatinous material found on teethfuster than fructose or any other sugar. A cola beverage can saturate plaque in one half of a second. No cell can take a disaccharide through the cell membrane without the breakdown of the sugar first. Streptococcus mutuns, the oral bacteria related to dental caries, has an ejicient enzyme near the surface to split the disaccharide. The split of sucrose to glucose and fructose gives the right amount of energy (AF”) needed to form adenosine triphosphate and satisfy the cellular energy needs. Lactose (milk) and maltose (beer) are much slower acting because there is too much energy and it is not efficient with plaque, Thefree energy of the hydrolysis of sucrose equals AF”. After the bacteria’s enzyme system splits the sucrose into fructose and glucose, S. mutans uses fructose faster for the immediate energy needs of the cell and forms acid as a by-product. The acid can then contribute to the decalcification process, which leads to dental caries. The glucose from the split is stored outside the bacterial cell. Stored sugar in plaque is composed of the starches dextrans and levans. This stored glucose becomes interwoven and must be brushed off the teeth or it will become harmful as organized plaque. If an individual stops eating sucrose the bacteria will use the stored glucose. After 332
CGQ2-9416/81/090332+02$M).20/0
0
1981 The C. V. Mosby Co.
Volume 80 Number
Editorial
3
333
depleting the stored glucose, the plaque will not be eliminated because there still will be some in the saliva. As the name “mutans” implies, this Streptococcus can mutate to use fructose or other sugars if necessary, although less efficiently. When the plaque colony dies, it calcifies and becomes calculus. The six reasons cited plus the fact that we eat more sucrose than most countries sets the stage for a high incidence of dental caries. The average U. S. citizen consumes 120 pounds of sugar per year. Upon being metabolized, sugar produces about 120 calories per ounce but no nutrition. You cannot tell patients not to eat sugar but you can suggest what, how, and when to eat as indicated above. Furthermore, many foods contain substances called buffers that neutralize any acids formed. The calcium from milk or the protein from meat can neutralize or absorb acids. Our patients and their mental attitudes range from goal-seeking students to individuals who are apathetic. For this reason we must remain actively flexible in our teaching methods, able to fill the role of a didactic professor at one time and that of an interested friend at another. Those who are apathetic will be far more receptive to information presented by an interested friend. Enthusiasm and freshness are important to the friendship role. The key is to relate that you heard or read something new; it is wise to indicate this without an appeal to authority. Once you have their attention, you may move on to your teaching approach and distribute as much information as feasible. We must learn to relay this information to our patients without alienating them by an authoritarian approach. This can be imparted by either the doctor or staff members. Our patient’s sugar habits can be challenged without lecturing or boring them. Armed with the above information and theories, the task of teaching can be simplified and made interesting for the patient. If a staff member creates a simple drawing to illustrate the process, he or she will get the patient’s attention. Ready-made photographs or drawings do not have the same impact. Patients want to be healthy; they do not have to be motivated toward health. After gaining their attention, we need to give our patients routes to dental health that they can believe in and strive toward. Motivation requires much more than a listing of rewards or consequences. People change only when they believe. Wayne G. Watson REFERENCES 1. Bailey, 2. Bailey,
Covert: Covert:
Sucrose and other carbohydrates. Lecture in San Diego, California, Fit or fat. 1980, P.O. Box 23572, Pleasant Hill, CA 94523.
March
7, 1981.
Educating patients about sugar
A
common concern in orthodontics is the potential development of decalcification, caries, or periodontal problems. These problems can be associated with bonds or bands when combined with an improper diet involving unregulated sugar consumption and inadequate oral hygiene. The relationship between dental caries and the ingestion of fermentable carbohydrates has been known for a long time, as has the fact that various carbohydrates differ in their potential for precipitating caries. Plaque, the forerunner of dental caries and peridontal disease, is a deposit of material on the surface of a tooth. It is composed of mucin from the saliva along with bacteria and their products. According to Covert Bailey’ there are seven biochemical reasons for plaque’s preference for sucrose. People in the United States eat sucrose more often, which affects the caries potential. The frequency of ingestion and adhesiveness of the food are more important than the total quantity of carbohydrate consumed. An oral PI-I of 6 to 7 will drop to 2 in half a second after ingesting a cola or similar drink. The plaque is saturated at this point and can take no more. Twenty minutes of acid is produced each time sugar is taken. Research has shown that it takes 20 minutes before the plaque can absorb any more. Theoretically, then, you can take as much sucrose as you wish over a short period because frequency is more important than quantity. Sucrose penetrates the pellicle of gelatinous material found on teethfuster than fructose or any other sugar. A cola beverage can saturate plaque in one half of a second. No cell can take a disaccharide through the cell membrane without the breakdown of the sugar first. Streptococcus mutuns, the oral bacteria related to dental caries, has an ejicient enzyme near the surface to split the disaccharide. The split of sucrose to glucose and fructose gives the right amount of energy (AF”) needed to form adenosine triphosphate and satisfy the cellular energy needs. Lactose (milk) and maltose (beer) are much slower acting because there is too much energy and it is not efficient with plaque, Thefree energy of the hydrolysis of sucrose equals AF”. After the bacteria’s enzyme system splits the sucrose into fructose and glucose, S. mutans uses fructose faster for the immediate energy needs of the cell and forms acid as a by-product. The acid can then contribute to the decalcification process, which leads to dental caries. The glucose from the split is stored outside the bacterial cell. Stored sugar in plaque is composed of the starches dextrans and levans. This stored glucose becomes interwoven and must be brushed off the teeth or it will become harmful as organized plaque. If an individual stops eating sucrose the bacteria will use the stored glucose. After 332
CGQ2-9416/81/090332+02$M).20/0
0
1981 The C. V. Mosby Co.
Volume 80 Number
Editorial
3
333
depleting the stored glucose, the plaque will not be eliminated because there still will be some in the saliva. As the name “mutans” implies, this Streptococcus can mutate to use fructose or other sugars if necessary, although less efficiently. When the plaque colony dies, it calcifies and becomes calculus. The six reasons cited plus the fact that we eat more sucrose than most countries sets the stage for a high incidence of dental caries. The average U. S. citizen consumes 120 pounds of sugar per year. Upon being metabolized, sugar produces about 120 calories per ounce but no nutrition. You cannot tell patients not to eat sugar but you can suggest what, how, and when to eat as indicated above. Furthermore, many foods contain substances called buffers that neutralize any acids formed. The calcium from milk or the protein from meat can neutralize or absorb acids. Our patients and their mental attitudes range from goal-seeking students to individuals who are apathetic. For this reason we must remain actively flexible in our teaching methods, able to fill the role of a didactic professor at one time and that of an interested friend at another. Those who are apathetic will be far more receptive to information presented by an interested friend. Enthusiasm and freshness are important to the friendship role. The key is to relate that you heard or read something new; it is wise to indicate this without an appeal to authority. Once you have their attention, you may move on to your teaching approach and distribute as much information as feasible. We must learn to relay this information to our patients without alienating them by an authoritarian approach. This can be imparted by either the doctor or staff members. Our patient’s sugar habits can be challenged without lecturing or boring them. Armed with the above information and theories, the task of teaching can be simplified and made interesting for the patient. If a staff member creates a simple drawing to illustrate the process, he or she will get the patient’s attention. Ready-made photographs or drawings do not have the same impact. Patients want to be healthy; they do not have to be motivated toward health. After gaining their attention, we need to give our patients routes to dental health that they can believe in and strive toward. Motivation requires much more than a listing of rewards or consequences. People change only when they believe. Wayne G. Watson REFERENCES 1. Bailey, 2. Bailey,
Covert: Covert:
Sucrose and other carbohydrates. Lecture in San Diego, California, Fit or fat. 1980, P.O. Box 23572, Pleasant Hill, CA 94523.
March
7, 1981.