Reduce food/drink to six times a day?

My three-year-old son has already had early decay removed from several of his molars, and still has more to go. I consider his diet to be good, and we brush his teeth every night. My dentist has recommended we reduce his food and drink intake to six times a day (very hard for a small child). I'm looking for more information about this, especially something I can pass on to his babysitter.


Dear Dot,

Your dentist is probably recommending this reduction because many foods and beverages contain sugars which are implicated as substrates for the bacteria which cause dental caries (cavities). In addition, studies show several factors are involved in sugar intake and caries susceptibility. These factors include the amount of sugar intake, the type of sugar intake, and the number of sugar exposures.

One of the most well-known studies is called the Vipeholm Study. This study was conducted in 1939 at the Vipeholm Mental Hospital in Sweden. Conclusions which resulted from this study are: 1) sugar intake is more likely to cause caries if it is retained on the tooth (e.g. caramels, gummy bears, etc.); 2) caries activity is increased if sugar is consumed between meals; 3) these increases in caries activity can be reduced on withdrawal of these types of foods from the diet; 4) caries can increase with a high concentration of sugar in the saliva and with prolonged sugar clearance from the saliva. In conclusion, the manner of administration of sugar and the frequency of consumption are more responsible for caries susceptibility than the absolute amount of sugar consumed. While physicians, nutritionists, dentists, and other health care providers do not advocate large amounts of sugar consumption, it is definitely better for your oral health to consume it at fewer times during the day rather to constantly consume it throughout the day.

It is important for parents and caregivers to be aware of the "hidden" sugars in foods and to attempt to limit between meal snacks to those foods which contain less sugars. There are many convenience foods and manufactured foods which contain sucrose (one of the most cariogenic components of food). It is helpful to read labels to help determine the amount of sucrose present in these types of foods. Some parents have found it helpful to keep a food diary and seek the help of a nutritionist to provide a more balanced diet. A gradual reduction in the volume and frequency of snacks consumed between meals in addition to obtaining a balanced diet consisting of foods from the four food groups (meats or protein, vegetables-fruits, dairy products, and breads- cereals/grains and carbohydrates) can have a positive effect on oral health.

I do not advocate complete elimination of sucrose-containing snacks as this can lead to feelings of frustration and deprivation. Total elimination is simply not realistic. An analysis of the types of foods your son is eating and the frequency of consumption might help to reduce his susceptibility to dental decay. Good oral hygiene, including brushing at least twice daily and flossing at least once daily, will also help. Rinsing with water after consumption of sucrose can also be helpful if brushing is not convenient. Proper administration of topical fluorides will also reduce his susceptibility to caries. See also Edgar, W.M., et al, "Acid Production in Plaque After Eating Snacks: Modifying Factors in Foods," Journal of the American Dental Association, Vol. 90, 1975, p. 418.

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