Tinanoff Norman, Palmer Carol A
Dept. of Pediatric Dentistry, Dental School, University of Maryland, Baltimore, USA.
Refuat Hapeh Vehashinayim (1993). 2003 Apr;20(2):8-23, 78.
The purpose of this review, commissioned by the Administration for Children and Families, the Health Resources and Services Administration, the Health Care Financing Administration, and the Department of Agriculture's Food and Nutrition Service, was to update the evidence of the dietary factors that affect dental caries, and subsequently formulate dietary recommendations for preschool children based on principles of cariology.
Literature on the dental caries process, dietary factors affecting dental caries initiation and progression, nutrition education and counseling were reviewed and synthesized. Dietary guidelines for children at various ages were then constructed based on the review.
Dental caries in preschool children is due to a combination of factors, including colonization of teeth with cariogenic bacteria, type of foods and frequency of exposure of these foods to the cariogenic bacteria, and susceptible teeth. Caries risk is greatest if sugars are consumed at high frequency and are in a form that is retained in the mouth for long periods. Sucrose is the most cariogenic sugar because it can form glucan that enables firm bacterial adhesion to teeth and limits diffusion of acid and buffers in the plaque. There is emerging interest in the effects of tooth development and its role in the future dental caries risk of the child.
Nutrition education and counseling for the purposes of reducing caries in children is aimed at teaching parents the importance of reducing high frequency exposures to obvious and hidden sugars. Guidelines include: avoiding frequent consumption of juice or other sugar containing drinks in bottle or sippy cup; discouraging the behavior of a child sleeping with a bottle; promoting non-cariogenic foods for snacks; fostering eating patterns consistent with Food Guide Pyramid; limiting cariogenic foods to mealtimes; rapidly clearing cariogenic foods from the child's oral cavity either by tooth brushing or by consumption of protective foods; and restricting sugar containing snacks that are slowly eaten (e.g., candy, cough drops, lollipops, suckers). Along with nutritional factors, a comprehensive approach to preventing dental caries in preschool children must include improved general dietary habits, good oral hygiene, appropriate use of fluorides, and access to preventive and restorative dental care.
本综述由儿童与家庭管理局、卫生资源与服务管理局、医疗保健财务管理局以及美国农业部食品与营养服务局委托开展，旨在更新影响龋齿的饮食因素的证据，并随后根据龋病学原理为学龄前儿童制定饮食建议。
对有关龋齿形成过程、影响龋齿发生和发展的饮食因素、营养教育与咨询的文献进行了综述和综合分析。然后根据该综述制定了不同年龄段儿童的饮食指南。
学龄前儿童龋齿是多种因素共同作用的结果，包括致龋菌在牙齿上的定植、食物类型以及这些食物与致龋菌接触的频率，还有易感牙齿。如果频繁摄入糖类且糖类以在口腔中长时间留存的形式存在，那么患龋风险就最大。蔗糖是最具致龋性的糖类，因为它能形成葡聚糖，使细菌牢固地黏附在牙齿上，并限制酸和缓冲剂在牙菌斑中的扩散。人们对牙齿发育的影响及其在儿童未来患龋风险中的作用的兴趣正日益增加。
为减少儿童龋齿而开展的营养教育与咨询旨在教导家长减少频繁接触显性和隐性糖类的重要性。指南包括：避免频繁饮用瓶装或吸管杯中的果汁或其他含糖饮料；不鼓励孩子含着奶瓶睡觉；提倡用非致龋性食物作零食；培养符合食物指南金字塔的饮食模式；将致龋性食物限制在进餐时间食用；通过刷牙或食用保护性食物迅速清除儿童口腔中的致龋性食物；以及限制慢慢食用的含糖零食（如糖果、止咳糖、棒棒糖、奶糖）。除了营养因素外，预防学龄前儿童龋齿的综合方法必须包括改善总体饮食习惯、保持良好的口腔卫生、适当使用氟化物以及获得预防性和修复性牙科护理。
