It goes without saying that in every dental practice, the prevention of dental disease should receive as much attention as the treatment we provide. This principle is especially important when it comes to a child patient, where an ounce of prevention is most certainly worth a pound of cure.
We’re pretty good at toothbrush instruction and cleaning teeth. But most dental practitioners are at a loss when it comes to implementing an organized system for dispensing relevant diet and nutrition advice, which can play an essential role in caries prevention as well as the overall health and development of a child.
Parents are looking for guidance when it comes to the feeding and nourishment of their children, beginning with breast and bottle feeding for the newborn and later dealing with issues like picky eating, frequent snacking, food allergies, swallowing difficulties, excessive weight gain or loss, or even early onset juvenile diabetes.
The Terminology and Planning
Let’s get some facts straight. Diet refers to the food we consume: good or bad. Nutrition refers to the nourishment: the substances in the food that promote growth and health to sustain life and allow us to thrive. These substances include carbohydrates, proteins, fats, minerals, vitamins, and more.
When we speak of a balanced diet, we are referring to a diet that contains all of these elements in their natural state, not supplements. That’s why most practical nutritionists and dietitians use the word moderation when it comes to dispensing dietary advice—a little bit of everything and nothing in excess, which is easy to say and harder to do.
So, allow me to give you some insight into my diet and nutrition protocol. Let’s assume you have a 3-year-old patient with a couple of carious lesions in the primary molars. You inform the parents and make your recommendations in regard to restoring the affected teeth.
Then, you initiate a discussion about the child’s eating habits: Is the child a good eater at mealtime? Is he or she a frequent snacker? What are the child’s favorite foods? Does the family eat together or on the run? Do you cook most of the time, or do you tend to buy prepared dinners?
Next, have a short conversation about the role that different kinds of foods play in causing dental decay and why we need to get a better handle on the child’s eating habits. Provide a small pad of paper with blank pages for the parents to keep in their kitchen where they can write down everything and anything the child eats for the next week. It needs to be an honest log that doesn’t try to make the child’s diet look better than it is.
At the following visit, look at the list the parents have returned and try to help them see some alterations that can be made without burdening the family financially or being judgmental. Also remember that cultural and ethnic differences shouldn’t be tampered with. The alterations we recommend will be geared to finding opportunities where we can limit between meal carbohydrates, frequent sugary beverages, and bedtime snacks.
We do not talk about eliminating candy and cookies, because we are believers in “everything in moderation,” though candy and other sticky sweets should be avoided at bedtime. It’s also preferable to eat 3 Oreo cookies at one sitting and then brush the teeth rather than 3 Oreo cookies one at a time spread out over the day.
And when it comes to caries prevention, it’s not the total amount of carbohydrates that’s important, but rather the frequency with which they’re eaten and the consistency. For example, grapes contain natural fructose and glucose sugars. They also are high in vitamin C and antioxidants. Raisins (dried grapes) contain at least 3 times the amounts of those sugars. One 42.5-gram box of raisins will have 26 grams of sugar, but raisins are very healthy because of the antioxidants. So, what’s better for your child? Which are more convenient to pack in a lunch box?
Beyond the influence of heredity, which we cannot control, it’s important for parents to understand that proper diet and nutrition, rational eating habits, and diligent oral hygiene all play a part in maximizing the chances of our children having healthy teeth.
Dr. Berman is an internationally recognized pediatric dentist with a career as a successful practitioner and as a popular world-class lecturer spanning more than 5 decades. He’s still one of the principal dentists in a thriving practice in Chicago. He has been an ambassador for dentistry as a health reporter on CBS (News Radio 78) and via media appearances as a consumer advisor for the ADA, the Chicago Dental Society, and the Academy of Pediatric Dentistry and as co-author of Essentials of Modern Dental Practice. He has published numerous articles and is a member of many professional and service organizations including honorary membership in the Hinman Dental Society.