External

Food
Factor
 Ex. Breads,
Carbohydrate Biscuits, cake,
grain

Ex. Fish, meat,

Protein
eggs

Ex. Butter,
Fat
margarine
The contain
Ex. Fruits,
Vitamins
vegetables

Ex. Milk, cheese,

Minerals
eggs
Food
Ex. Fruits,
Fiber
vegetables, grains

To clean teeth Ex. Apple, guava

The function
To destruction Ex. Chocolate,
process cake, cookies
 Carbohydrate

Monosaccharide Dissacharide Polysaccharide Other name Added sweeteners

Glycogen Ribose Simple carbohydrate

Glucose/ Dextrose Sucrose
Ex. The convertion Ex. Derived from Ex. Breads,
Ex. Honey Ex. cane
form of glucose fruit pentosans cake,ccookies, cane

Sorbitol
Fructose/ Levulose Lactose Strach
Ex. Fruits,
Ex. fruits Ex. milk Ex. Grain products
vegetables

Galactose Maltose Dextrin Glucosamine

Ex. The digestion of Ex. Digestion of Ex. the digestion of Ex. Amino sugar in
lactose strach starch body tissue
 The sources of
plaque bacteria =
cariogenic Carbohydrate

Monosaccharide Dissacharide Polysaccharide Other name Added sweeteners

Glycogen Simple carbohydrate

Glucose/ Dextrose
Ex. Honey
Sucrose
Ex. cane
SUCROSE
SUCROSEEx. onions
Ex. The convertion
Insulin
Ex. Breads,
form of glucose cake,ccookies, cane
IsIsthe
themost
most
Fructose/ Levulose Lactose cariogenic
cariogenicEx.Sorbitol
Strach
Fruits,
Ex. fruits Ex. milk Ex. Grain products
sugars
sugars vegetables
Galactose Maltose because
becauseGlucosamine
Dextrin
Ex. The digestion of Ex. Digestion of Ex. the digestion of Ex. Amino sugar in
lactose strach starch body tissue

Cariogenic is foods or beverages that contain fermentable carbohydrates that can

be metabolized by oral bacteria to cause a decrease in plaque pH to <5,5 and result
in demineralization of tooth enamel and ultimately caries in animals and/or
humans (palmer, 2007).
 Because..
• it can be reserve source for cariogenic bacteria,
• it is found on almost all food and the frequency
of consuming is greater than others,
• it provide only calories compared with other
sugars that found primarily in more nutrient-
rich foods,
• sintesis of extracell polysaccharide of sucrose is
more faster that other sugars (glucose,
fructose, and lactose).
 Carbohydrate

Added
Monosaccharide Dissacharide Polysaccharide Other name
sweeteners

Glycogen Simple carbohydrate

Glucose/ Dextrose Sucrose Insulin
Ex. The convertion Ex. Breads,
Ex. Honey Ex. cane Ex. onions
form of glucose cake,ccookies

Sorbitol
Fructose/ Levulose Lactose Strach
Ex. Fruits,
Ex. fruits Ex. milk Ex. Grain products
STRACH
vegetables
Low
Galactose Maltose Dextrin cariogenic
Glucosamine
Ex. The digestion of Ex. Digestion of Ex. the digestion of sugar but sugar in
Ex. Amino
lactose strach starch body tissue
because of salivary amylase, it can change to
more cariogenic sugars
HOW ???
This can happend when poor oral hyigiene
habits allow starches to remain in the mouth for
prolonged periods. Many of the most cariogenic
sugars containing in cookies and cake is starches.
So, it contributes to the retentiveness of
nutrient in increasing cariogenic potential.
Carbihydrate Role in Caries Incidence
• Kidd and Joyston-Bechal (1991) suggest that
Carbohydrate serve substrate to fermentation
process that produce acid for bacteria and extracell
polysaccharide. But for different carbohydrate have
also different cariogenic level.
• Kidd and Joyston-Bechal (1991) suggest that sucrose
is the most cariogenic sugar because sintesis of
extracell polysaccharide of sucrose is more faster
that other sugars (glucose, fructose, and lactose).
• Steele (1974,p. 210) argues that sugar clearly heads
the list of cariogenic foods, and sucrose is the most
cariogenic sugar.
 Index of the caries occuring by several food
(Tarigan, 1990)

Food
30

25

20

15
Food
10

0
Limonade Apple Ice Cream Bread Chocolate Bon Bon
Fig.1 Four Circle that figure the combination of four
factors causing caries (Kidd & Joyston-Bechal, 1991)

Microorganism

No No
Caries Caries

Host & Caries Substrate

teeth
No No
Caries Caries

Time
 The process of Dental Caries
Saliva’s protein Enamel pellicle allows
Form the enamel
The cleaned teeth adsorb to the cleaned bacteria to start
pellicle
teeth collonizing

A bound between
Some of these Plaque formed,
Fermentation process bacteria and enamel
bacteria can use contain of oral
produce organic acids pellicle by the
dietary sugars as an bacteria in a matrix of
in dental plaque fluid interaction of protein
energy source extracellular material
between them

Cause pH plaque Demineralization

decrease process
 •Sucrose → Dextrose → Lactic
Step 1 acid

•Lactic acid + Hydroxyapatite →

Step 2 Calcium phosphate + water

•Tooth organic material +

Step 3 proteolytic bacteria → decay
Food that sometimes eaten by the fifteen-girl
student on scenario

• Biscuits
• Chocolate
• Cakes
• Candies
 Reference List
1. Howe. 1980. Basic Nutrition in Health and Disease. Philadelphia:W. B. Saunders
Company.
2. Tarigan, Rasinta. 1990. Karies Gigi. Jakarta: HIPOKRATES.
3. Kidd, Edwina A. M. Joyston-Bechal, Sally. 1991. Dasar-dasar karies. Jakarta:EGC
4. Steele, Pauline F. 1974. Dimension of Dental Hygiene, Ed. 2. London: Henry
Kimpton Publishers.
5. Palmer, Carole A. 2007. Diet and Nutrition in Oral Health. Ed. 2. New Jersey:
Pearson Education.inc
6. Gibney, Mike 2011, ‘ Scientific Basis for Opinion: an Journal of the Irish Dental
Association; Aug/Sep2011, Vol. 57 Issue 4, p192-194, 3p Retrived November 13,
2012, from EBSOHOST database.
7. Ismail, Amid I.; Tanzer, Jason M.; Dingle, Jennifer L. 1997, ‘Current Trends of
Sugar Conumption in Developing Societies: an Academic Journal Community
Dentistry & Oral Epidemiology; Dec1997, Vol. 25 Issue 6, p438-443, 6p Retrived
November 13, 2012, from EBSCOHOST database.
Table 1. Nutrients According to Body Use (Howe, 1980)
Body Use Nutrient Group Food Sources

Nutrients that produce energy Carbohydrates Sugar, strach, syrup, cereals,

(kilocalories)
Nutrients that build or repair
tisssues
Nutrients that regulate and
coordinate life processes
-Sugar candy, honey, jam, jelly, fruits,
- strach vegetables, most dessert.
Fats Butter, margarine, cream, lard,
-Saturated cooking oils, vegetable
- unsaturated shortenings, meat fat, olives,
nuts, chocolate, dough.
Proteins Eggs, meat, fish, cheese, legumes,
-Complete nuts, cereals, grain cereals.
- incomplete
Minerals Milk, cheese, meat, egg, fruits,
vegetables, cereals.
Water Water, milk, beverages.
Vitamins Milk, fruits, vegetables, meat,
egg, cereals
Fibers (cellulose) Fruits, vegetables, grain cereals
Table 2. Carbohydrate content of 100 grams of common foods
(Howe, 1980)

Sugar Grams Starches Grams

Sugars – white 90 – 99,5 Starches – 85 – 90
brown, maple arrowroot, corn,
potato, tapioca
Honey > 80 Crackers, cookies 70 – 85
Candies 60 – 95 Desert 10 – 65
Cake with icing ± 60
Pies ± 40
puddings 10 – 45
Breads 45 – 60
Carbohydrate
• Howe (1980, p. 44) Charbohydrate Is chemical
compund of carbon, hydrogen and oxygen.
• Kind of Carbohydrate :
– Monosaccharides. glucose, fructose, galactose.
Obtained from corn syrup, vegetables, honey.
– Disaccharides. Sucrose, lactose, maltose. Obtained
from cane, beet, maple sugars and syrups, fruits,
vegetables, milk.
– Polysaccarides. Glycogen, strach, cellulose, lignin.
Obtained from grain product, glycogen, cereals, nuts,
fruits.
– Other saccharide name. Insulin, sorbitol,
glucosamine, ribose.
 Table 3. Classification and Nutrient Sources of Carbohydrates
(Palmer, 2007)

Complex Carbohydrates Breads, whole grains, muffins, biscuits, cakes,

waffles.
Starch Breakfast cereals, crackers, snacks, grits

Dietary Fiber Whole grain breads, cereals, whole fruits, unpeeled

vegetable
Simple Carbohydrate

Dissaccharides Sucrose : cane, beet, maple sugar, fruits, and

vegetable.
Maltose : cereals, maling of cereal grain by hydrolysis,
beer.
Lactose : milk only.
Monosaccharides Glucose : (dextrose, grape sugar, corn sugar) fruits,
vegetables, corn syrup, honey.
Fructose : fruits, vegetables, honey.
Galactose : only occurs from lactose hydrolisis
Added Sweeteners Simple carbohydrate such as cane sugar, corn sugar,
corn syrup.
Softdrink, bakery items, jams, jellies, gelatin dessert,
cakes, cookies, donuts, pies.
Some vitamins and medications
• Rasinta Tarigan (1990) suggest that mouth and teeth
can be influenced by nutrient. Those influenced is
consist of two type:
– The contain of nutrient. Consist of carbohydrate, protein,
fat, vitamin and mineral.
– The function of nutrient. Devided to two: nutrient that can
clean teeth, example apple, guava. Nutrient that can
destructive teeth, example chocolate, cake, cookies.
• Ismail, Tanzer, Dingle (1997) suggest that bacterial
collonization,demineralization and reminalization of teeth are
determinated by the interaction among the risk factors,
included cariogenic bacteria, fermentable carbohydrate,
saliva, and fluoride in oral environment.
• Palmer (2007) suggest that both monosaccharides and
disaccharides can be the source for plaque bacteria called
cariogenic. The most cariogenic of sugars consider as sucrose
because it can be reserve source for cariogenic bacteria, it is
found on almost all food and the frequency of consuming is
greater than others, and it provide only calories compared
with other sugars are found primarily in more nutrient-rich
foods.
• Palmer (2007) suggest that although starches are considered
low cariogenic but because of salivary amylase, it can change
to more cariogenic sugars. This can happend when poor oral
hyigiene habits allow starches to remain in the mouth for
prolonged periods espesially. Many of the most cariogenic
sugars containing in cookies and cake is starches. So, it
contributes to the retentiveness of nutrient in increasing
cariogenic potential.
• Table sugar, preserve, biscuits and cake are
not an issue in population level relating to
dental caries on children and teenagers, but
those food have strong association with the
main risk factor for caries in adult, named
frequency of added sugar intake (Gibney,
2011).