Are dietary guidelines conflicting with dental health guidelines?

I have recently been very upset to find my seven year old has caries in one of his teeth. Well I say upset; that’s an understatement. I was shocked. I mean, I am a Dietitian; how the heck could my child have caries? His diet is great, generally, for a seven year old. He never drinks fizzy or sugary drinks (except a bit of lemonade when we go abroad on holidays but that is once in a blue moon), rarely has sweets or lollies (I’m not keen on them and have been very conscious of avoiding them to protect his teeth) and we brush his teeth twice a day. I had to have a long hard think about what was going wrong.

I do allow him the occasional chocolate in moderation- usually after a meal.
I also allow him to graze; and coming from Australia, am very big on “morning tea”. At seven, he does seem to need to go by the small frequent meal pattern as he is always hungry and an active child.

So where am I going wrong with regards to his diet?

Generally, his diet conforms to the dietary guidelines for children and the FSA Eat Well Plate. But what about the guidelines for preventing tooth decay? I had a hunt for the dental guidelines and found Moynihan’s “Dietary advice in dental practice” and was also very pleased to see that a Dietitian was involved in the production of the 2008 “Nutrition and Dental health- guidelines for professionals”.

How does it compare?

Most of the advice for dental health is in line with the general dietary guidelines and the messages reflect that of the Eat Well Plate and the balanced diet recommended for us all. This includes a variety of food every day from the four main food groups (bread/rice/potatoes and starchy foods, fruit and vegetables, milk and dairy foods and meat, fish and protein alternatives) with very occasional treats from the fifth – foods high in fat and sugar. Snacks as well as meals count towards achieving the healthy balance.

There are, however, a few specific recommendations in the guidelines for dental health that aren’t included in general healthy diet messages. The main things seem to be that the amount and the frequency with which sugar containing foods and drinks are consumed is most important and that when sugars are consumed they should be taken as part of a meal rather than between meals.

Dental health recommendations

The main nutrition and dental health recommendations for school aged children include:

• The total consumption of free sugars should not exceed 11% of the total food energy per day.
• The ideal target for sugar frequency is four intakes per day, including mealtimes. Children’s eating patterns should ideally consist of three regular balanced meals a day but it should be recognised that some children will require a snack between each meal. The majority of children do not require more than three daily snacks in addition to meals.
• Recommended snacks between meals for this age group should ideally be sugar-free, low in fat and high in fibre and should take account of the child’s usual diet, likes and dislikes.
• Fresh fruit and vegetables make ideal between-meals snacks
• Dried fruit has a high concentration of sugars and is not regarded as a suitable between-meals snack. However it can safely contribute one of the recommended five portions of fruit and vegetables a day if taken at mealtimes.
• If confectionery or sugar containing foods (e.g., a sweet dessert) are eaten, they are best taken at the end of meals.
• Water and milk are the recommended drink choices, particularly between meals.
• A small piece of cheese (approximately 5g – about the size of a small sugar cube) taken at the end of a meal will help to protect the teeth
• Acidic drinks such as squashes and carbonated drinks, including diet and sports drinks, are not recommended. They should be limited to mealtimes, where possible, rather than between meals, and avoided at bedtime.
• Pure fruit juices should be well diluted and taken at mealtimes only.

The verdict

So I’d say from my end it’s about the frequency of eating and that dreaded grazing.
I may find it difficult to keep my seven year old to three meals a day, as might many parents of a seven year old, so it is also about making sure any snacks he does have are the best choices for protecting his teeth as well as his general health. He can still have his treats, occasionally, as long as they are taken with a meal. I think the best is to minimise snacks as much as possible by trying to offer water first, in case its thirst that’s the problem, and then making sure a snack is a properly planned “one hit” snack rather than a long session of grazing. The chocolate treat will continue to be kept to after a meal.

So what is ok for snacks in between meals?

• Fruit to the guideline amounts– fresh, frozen or tinned in natural juice
• Vegetables – carrot and celery sticks, peppers, cucumber
• Bread or toast (preferably wholegrain)
• Plain rice cakes, bread sticks or crackers
• Hard boiled egg
• Sandwiches with low/non sugar fillings (lean meat, tuna, egg, cheese)
• Homemade popcorn (no sugar or salt)
• Cheese
• Nuts (unsalted) or seeds as appropriate for child’s age
• Unsweetened cereals
• Soup
• Natural yoghurt – with or without fruit added
• Diet or sugar free fromage frais
• Milk
• Water

I think there is plenty there that most children will like as a snack.
So thats my strategy, a good preplanned snack after school when my little fella comes in hungry. Oh and plenty of supervised two minute toothbrushing sessions!

Reference

Nutrition and dental health: guidelines for professionals
Published: 2008- Health Promotion Agency