Refined carbohydrate

This is the most common and significant cariogenic factor. If acid ions are persistently produced in plaque from an excess of refined carbohydrate, they will exhaust the buffering capacity of the saliva, and the remineralising process will no longer effectively counteract the demineralising factors. Assessment of the diet requires a motivated, cooperative patient prepared to record detailed dietary routines on each day of a three day diet chart. The most fermentable carbohydrates are the mono and disaccharides, though highly processed starches have been shown also to be major contributors. In excess of four exposures of fermentable carbohydrates per day is considered potentially cariogenic. However, this is a relative concept and it must always be considered alongside all other demineralisation promoting factors before its full significance can be determined.

Measures to improve diet

It is necessary to carefully assess the contents of the diet to determine the most cariogenic item/s so that alternatives can be recommended. Sugar substitutes are available or it may be sufficient to just reduce the frequency of inclusion of the most fermentable carbohydrates. Long term modification of the diet is difficult to achieve and frequent monitoring of the outcome will be required for success in achieving change in both the short and long term. Assistance of the entire dental team, will make success more achievable.