ineedce.com America’s Sweet Tooth Obsession and Its Impact on Oral and Systemic Health Resources ǯƬ Ƭ Karen Davis, RDH, BSDH Sucrose: 50 %Fructose / 50% Glucose High Fructose Corn Syrup: 45% Fructose / 55% Glucose American Heart Association 2009 Dietary Sugar Intake & Cardiovascular Health Scientific Statement: x Worldwide pandemic of obesity & cardiovascular disease warrants new AHA recommendations due to emerging evidence as to the relationship between sugar consumption & cardiovascular health x Sugar consumption liked with metabolic diseases, adverse health conditions, and shortfalls of obtaining essential nutrients x Daily consumption has increased 20% over past 35 years for Americans x Current daily consumption greatly exceeds discretionary calorie allowances from the US Dietary Guidelines Average consumption of Added Sugar daily = 350 Ȃ 470 calories Translates into 22 Ȃ 34 teaspoons daily or 88 Ȃ 136 grams daily 2009 AHA Daily Recommendations: Women 6 ½ tsps or 25 grams & for Men 8 ½ tsps or 38 grams Added Sugars By Other Names: HFCS Brown Sugar Maple Syrup Evaporated Cane Juice Corn Syrup Fructose Agave Syrup Juice Concentrates Sucrose www.ycchololate.com - Xylitol flavored chocolate bars www.dentalantioxidants.com - Clearing house for antioxidant studies www.Periosciences.com - Localized antioxidants for the oral cavity Low Fructose / Low GI Blackberry Grapefruit Lemon / Lime Nectarine Raspberry Wild Strawberry High Fructose / High GI Ripe Banana Grapes Dates Raisins Mango Custard Apples Karen Davis, RDH, BSDH * 646 Goodwin Drive Richardson, TX 75081 * 972.669.1555 * [email protected] * www.karendavis.net 1 1 ineedce.com America’s Sweet Tooth Obsession and Its Impact on Oral and Systemic Health Resources Sugar Alcohols: Dzdz Occur naturally in plants Not completely absorbed Less Glycemic Index than sucrose Fewer calories per gram Do not promote decay Sugar & Sugar Alcohol Comparison Ingredient Sucrose (sugar) Malitol Syrup Malitol Xylitol Isomalt Sorbitol Lactitol Mannitol Erythritol Sweetness 100% 75% 75% 100% 55% 60% 35% 60% 70% GI 60 52 36 7 9 9 6 0 0 Calories / gram 4 3 2.7 2.5 2 2.5 2 1.5 0.2 FDA Approved Sweeteners as Additives SACCHARIN Sweet-n-Low 1879 ͵ͲͲǯ sweeter 100 countries Bitter aftertaste high conc. Heat stable Added to Aspartame in soft drinks Substitute & commercial ASPARTAME NutraSweet Equal 1981 ʹͲͲǯ sweeter Greatest use worldwide Most controversial sweetener Not heat stable Must be avoided by those with PKT Substitute NEOTAME SUCROLOSE Splenda ACELSUFAME POTASSIUM 2002 7000 Ȃ 13,000 sweeter US, AK, UK 1998 ͲͲǯ sweeter 80+ countries 1988 ʹͲͲǯ sweeter 30+ countries Cousin to Aspartame Chemicallyaltered sucrose Heat stable Trichlorination process Bitter aftertaste high conc. Heat stable Blended with other sweeteners Substitute & commercial Mostly commercial Heat stable No amino acid concern for those with PKT Commercial Karen Davis, RDH, BSDH * 646 Goodwin Drive Richardson, TX 75081 * 972.669.1555 * [email protected] * www.karendavis.net 2 2 ineedce.com America’s Sweet Tooth Obsession and Its Impact on Oral and Systemic Health Resources FDA GRAS Sweeteners (Generally Recognized As Safe) ERYTHRITOL Fruits, fermented foods 60-70% STEVIA Natural herb Paraguay 1996 200-͵ͲͲǯ sweeter 2008 0.2 calories/g Heat stable < 50 g/day Absorbed/not metabolized less GI distress Non-caloric Heat stable No daily limit Bitter aftertaste high concentrations ISOMALT Beets Ȃ glucose & mannitol 40-50% SORBITOL Stone fruits, berries MALTITOL Maltose from starches 60% 70-90% 1990 1963 2.1 calories/g Heat stable < 29 g/meal Partially absorbed & metabolized 1986 petition filed 2.5 calories/g 2.7 calories/g Heat stable Heat stable <23 g/meal < 100 g/day *Large amts. Partially Laxative effect absorbed & Caution w/ IBS metabolized Caution regarding prolonged use of sorbitol, isomalt, HSH found in hard candies and mints! XYLITOL Berries, oats, mushrooms, extracted from hardwood trees 100% as sweet as sucrose 1963 4 calories/g Heat stable >50 g/day / Kinder to GI than sorbitol, mannitol Ear & yeast infections, Osteoporosis, Anti-cariogenic, stimulates salivary flow Toxic to dogs www.xylitol.org - Xylitol product guide www.xlear.com - Mints, gum, xylitol crystals toothpaste & nose spray www.xywater.com - Xylitol infused water www.orahealth.com - Xylimelts www.carifree.com - products for infants & children www.3MESPE.com - mints & gum www.xylishield.com - gum, mints, toothpaste, mouth rinse 2005 & 2010 US Dietary Guidelines for Americans x x x Empty calories = SOFAS: Solid Fats & Added Sugars Limit SOFAS after nutrient-dense foods from each category are consumed Age, Gender & Physical Activity determine recommended ranges of 8 Ȃ 20% of empty calories from total calories Karen Davis, RDH, BSDH * 646 Goodwin Drive Richardson, TX 75081 * 972.669.1555 * [email protected] * www.karendavis.net 3 3 ineedce.com America’s Sweet Tooth Obsession and Its Impact on Oral and Systemic Health Resources Example: Females 31 Ȃ 50 / Less than 30 min. moderate exercise daily / 1800 calories / 160 Empty Calories Males 31 Ȃ 50 / Less than 30 min. moderate exercise daily / 2200 calories / 265 Empty Calories x www.ChooseMyPlate.gov - Dzdz upon age, gender and physical activity Obesity by the Stats x >60% of the global disease burden will be associated with obesity by 2020 x US obesity doubled in adults and tripled in children in the last 3 decades x 2/3 of population overweight with BMI: 25, or obese with BMI: 30+ x ͺͷΨ ǣDzdz x Direct & Indirect costs from obesity >$147 billion in 2008 x Obesity associated with metabolic disorders, Type II diabetes, CVD, colon cancer & breast cancer Current Genomics 9:239, 2008 Systemic Impact of High Sugar Consumption x Adverse effects on HDL & Triglyceride levels x May worsen control of diabetes x Compromises intake of dietary vitamin & mineral intake Circulation 106:526, 2002 Systemic Impact of Fructose x Increased Triglyceride levels x Increased visceral fat mass x Decreased insulin sensitivity x Weight gain x Unfavorable lipid metabolism x Non-Alcoholic Fatty Liver Disease NAFLD Journal of Clinical Investigation 119: 1322, 2009 Excessive Sugar Consumption x Increases risk for Type II diabetes x Increases blood pressure levels x Increases risk for heart disease & stroke x Fructose increases proliferation of pancreatic cancer cells Journal of Cancer Research 7: 6368, 2010 Journal of American Society of Nephrology 2010 American Journal of Clinical Nutrition 89: 1037, 2009 Karen Davis, RDH, BSDH * 646 Goodwin Drive Richardson, TX 75081 * 972.669.1555 * [email protected] * www.karendavis.net 4 4 ineedce.com America’s Sweet Tooth Obsession and Its Impact on Oral and Systemic Health Resources Most aggressive dissolution on the enamel: non-cola sodas, energy / sports drinks, commercial lemonades and any drinks that combine fructose & citric acid General Dentistry 53: 28, 2005 Bacterial Testing x CRT® Bacteria by Ivoclar Vivadent www.ivoclarvivadent.us x Tests for Strep Mutans & Lactobacilli to identify risk & implement intervention before lesions appear x Culture results in 2 days x CariScreen Susceptibility Testing Meter by CariFree® www.carifree.com x 1 minute chairside detection of Streptococci bacterial load x ATP bioluminescence x Assigns risk of caries between 0 Ȃ 9999. (1500 of lower considered healthy) Salivary Testing x Saliva Check ® by GC America x Measures salivary production x Resting & chewing pH x Measures buffering capacity of saliva to minimize acidic challenges Remineralization Reality Remineralization is the natural repair process where calcium and phosphate form a new sub-surface mineral coating, which is less soluble than the original surface, especially in the presence of fluoride. Dimensions of Dental Hygiene April 2010, 4 print Remineralization Opportunities AMORPHOUS CALCIUM PHOSPATE Ȉ Ȉ 2 bioavailability Ȉ TRI-CALCIUM PHOSPHATE Ȉ Ƭ Ȉ Ȉ surface & subsurface mineralization NOVAMIN Ȉε ȈƬ Ȉ Karen Davis, RDH, BSDH * 646 Goodwin Drive Richardson, TX 75081 * 972.669.1555 * [email protected] * www.karendavis.net 5 5 ineedce.com America’s Sweet Tooth Obsession and Its Impact on Oral and Systemic Health Resources CALCIUM PHOSPHOPEPTITE & AMORPHOUS CALCIUM PHOSPHATE Ȃ RECALDENT® ȈƬ Ȉs sub-surface lesions Ȉ FLUORIDE Ȉ Ȉ Ƭ ȈAntimicrobial effect CAMBRA www.cdafoundation.org/journal - Part I October 2011 & Part II November 2011 www.ada.org Remineralization Realtity for the MODERATE Caries Risk Patient ƕXylitol 6-8g daily (2 pieces of gum or 2 mints 4 times/day) ƕOTC Fluoride-containing toothpaste twice/daily ƕ.05% fluoride rinse daily ƕCalcium Phosphate paste for exposed roots or sensitivity ƕSealants on pits and fissures at risk ƕ1-2 applications of Fluoride varnish ƕRecare exam every 4Ȃ6 months to evaluate risk ƕBitewings 18Ȃ24 months ƕPower toothbrush for daily plaque removal Adapted from Dimensions of Dental Hygiene April 2010, 7 print Remineralization Reality for the HIGH Risk Caries Patient ƕXylitol 6-8g daily (2 pieces of gum or 2 mints 4 times/day) ƕChlorhexidine rinse 0.12% 10 ml daily for 1 week/month ƕ1.1% fluoride toothpaste twice daily ƕCalcium Phosphate paste several times per day ƕSealants on pits and fissures at risk ƕ1-3 applications of Fluoride varnish ƕRecare exam every 3-4 months to evaluate risk ƕBitewings 6Ȃ18 months ƕPower toothbrush for daily plaque removal Adapted from Dimensions of Dental Hygiene April 2010, 7 print Karen Davis, RDH, BSDH * 646 Goodwin Drive Richardson, TX 75081 * 972.669.1555 * [email protected] * www.karendavis.net 6 6 ineedce.com America’s Sweet Tooth Obsession and Its Impact on Oral and Systemic Health Resources www.brushdj.com Tips for Gaining Control of the Sugar Binge for Improved Health 1. Read labels and decide wisely! 2. Set limits for empty calories daily ƕReduce sugar-sweetened drinks and foods 3. Substitute sugar alcohols for sugar in foods & beverages 4. Count sugar grams throughout the day 5. Use Xylitol gum or mints following meals 6. Reduce cravings with substitution ƕSnack on almonds, walnuts & cheese & substitute fresh fruit for desserts 7. Prepare foods with fresh herbs to increase satisfaction with meals 8. Enjoy the delectable in moderation, on occasion 9. Increase physical activity 10. Drink more water! Karen Davis, RDH, BSDH * 646 Goodwin Drive Richardson, TX 75081 * 972.669.1555 * [email protected] * www.karendavis.net 7 7
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