Improve Oral Health With Dairy
Nutritional counseling provided by dental hygienists typically focuses on caries prevention and reduction.
Nutritional counseling provided by dental hygienists typically focuses on caries prevention and reduction. This includes reducing sources of carbohydrates in the diet. Besides eliminating dietary sources that contribute to caries formation, nutritional counseling can include discussion of nutrients for enamel health and remineralization of weakened enamel. The dental benefits of dairy consumption are widely known. Numerous studies have associated consumption of milk and dairy products with decreased caries rates for almost 30 years. Even prominent organizations such as the World Health Organization (WHO) acknowledge that as dairy intake increases, the incidence of dental caries decreases.
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Dairy products include bovine milk and products made from it, such as cheese and yogurt. Calcium-fortified soymilk is considered a dairy product because of its calcium content. Most Americans meet their calcium intake through consumption of dairy products. Other sources of calcium include sardines, salmon with bones, soybeans, soy yogurt, soy tofu, tempeh, collard greens, turnip greens, kale, bok choy, and calcium-fortified products, such as juices, cereals, breads, rice milk, almond milk, or soymilk. Not all dairy products contain an adequate amount of calcium, such as butter, cream, and cream cheese.
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Casein is a protein that recruits calcium phosphate to demineralized enamel surfaces. Casein from milk is rapidly absorbed into the surface of enamel and provides resistance to acid attacks. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is a natural derivative of milk.8 This acronym might sound familiar because it is currently added to dental products. As discussed next, CPP-ACP is a key component in remineralization of enamel. CPP is the digested form of casein after it binds to phosphorus. CPP influences the demineralization and remineralization process by preventing calcium and phosphate from being soluble. CPP stabilizes amorphous calcium phosphate (ACP), which in turn allows ACP to be concentrated in biofilm and to slowly diffuse free calcium into the tooth to promote remineralization and decrease demineralization. ACP buffers the free calcium and phosphate ions, which maintain the saturation of these elements to decrease demineralization and enhance remineralization. CPP-ACP is superior to other forms of calcium in its ability to remineralize enamel. CPP-ACP solutions are efficient at remineralizing enamel because they buffer the acid generated during demineralization through generation of calcium hydrogen phosphate.
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While components in dairy products are related to preventing enamel demineralization and remineralizing enamel, additional uses of milk were recently discovered. Sabir and Alam assessed dentinal hypersensitivity on 31 individuals following nonsurgical periodontal debridement. Those assigned to the intervention group were instructed to rinse with room temperature milk five times a day for 5 minutes each time for 15 days. The control group did the same regimen, but with water. Follow-up assessments were performed at 4 days, 10 days, and 15 days after therapy. A four-point verbal rating scale was used to record the amount of discomfort experienced after drinking water at room temperature and cold water. The numerical values of the scale included 1 as no hypersensitivity, 2 as mild hypersensitivity, 3 as moderate hypersensitivity, and 4 as severe hypersensitivity. In the intervention group, 11% experienced mild hypersensitivity after 15 days, while all individuals in the control group still had mild to moderate hypersensitivity. The remineralizing capabilities of CPP allowed for the retreat of dentinal hypersensitivity in these individuals.
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While research on milk fluoridation dates back to 1959, there has been a resurgence in research related to milk fluoridation. A 2014 publication summarized in situ results from a small study aimed at determining if adding fluoride to milk remineralized enamel more than milk alone. The control group drank 200 ml of nonfluoridated milk and saw the least amount of change in the enamel. The best results were found in the group that drank 100 ml of milk fortified with 3 mg of fluoride. The publication concluded that the dose and concentration of fluoride in milk impacts its cariostatic properties.
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As the consumption of dairy products is proven to positively impact the oral cavity, oral health professionals should share this evidence with patients. The United States Department of Agriculture recommends 2 cups to 3 cups of dairy per day depending on age. Those younger than 9 should consume 2 cups to 2 ½ cups per day, while individuals age 9 or older should consume 3 cups of dairy per day. One cup of dairy is equivalent to 1 cup of milk, 1 cup of yogurt, 1 cup of calcium-fortified soymilk, 1 ½ ounces of natural cheese (1⁄3 cup), 2 ounces of processed cheese (American), 1 cup of pudding made with milk, or 1½ cups of ice cream.