Dietary recommendations for general health promotion
General recommendations
General guidelines for energy and nutrient intake are given in the Nordic recommendations from 1989, and in recommendations specific for each Scandinavian country. They give age- and sex-specific recommendations for daily energy and nutrient intake as well as minimal daily required amounts for healthy individuals older than 3 years. It is recommended that energy intake be at a level that does not cause obesity and that there be five or six daily intakes of food at even intervals throughout the day. Recent studies indicate that a more frequent eating schedule would offer
physiologic benefits, for example, a decrease in total serum cholesterol concentration.
However, other aspects of such recommendations must be considered before they are generally adopted.
The daily recommended energy intake originates mainly from carbohydrates (55% to 60% of the total energy). Fat should provide a minimum of 20% and a maximum of 30% of the energy. A fat intake below 20% to 25% of total energy may lead to deficiency of essential fatty acids. Protein provides the remaining 10% to 15% of daily energy. Specific recommendations are also given for fiber, salt, alcohol, and micronutrients.
To fulfill these recommendations, the average diet in all Scandinavian countries would need modifications described in Box 5. These recommendations are useful guidelines for medical as well as dental practice and can also be applied to reduce caries risk. The dietary recommendations for diabetics are also in general agreement with these guidelines.
Individual recommendations
After assessment of the dietary information, the advised plan for the individual is formulated. A useful tool may be “sugar clocks,” demonstrating the high caries risk associated with frequent eating (Fig 74).
In some patients, carious activity may be attributable to a single habit, eg, frequent consumption of sugar-containing lozenges or snacking or drinking soft drinks at night.
Such habits are readily identified and usually easily rectified. In other patients, eating
habits may be more complex, comprising snacks only and no main meals. In such
cases, a change in basic behavior is required.
This process is complicated by the fact that humans dislike change. Therefore,
enforced dietary changes will not succeed unless the benefit accrues rapidly and is of
demonstrable advantage. This can be seen in some weight-reducing programs or, for
example, when uremic patients adopt a protein-reduced diet. Otherwise, a successful
change in dietary behavior requires a program of repeated, small steps. This applies to
the introduction of new food items and habits in small children as well as in adults.
It is also important that the advice be compatible with possible disease conditions or
medication in the individual patient and that the proposed changes be acceptable to
the patient. Of further importance is that dietary counseling take into account the
patient’s social situation. The basis for designing advice sheets on proper energy and
nutrient intake is beyond the scope of this book. For further information the reader is
referred to textbooks on nutrition.
The objective of dietary evaluations and recommendations related to dental caries
should be to reduce the total sugar clearance time per day. However, because root
caries can develop at a pH as high as 6, the intake of sticky, starch-containing
products must also be regarded as a powerful modifying risk factor in elderly people
with exposed root surfaces and impaired salivary function. High salivary levels of
lactobacilli indicate a high sugar intake and low intraoral pH. The Lactobacillus test is
therefore a valuable objective supplement to the dietary questionnaire.
For caries prevention and control, compliance with the following dietary
recommendations is essential (Box 6).
