April 2009 | Modern Hygienist
Patients: Diet

	Photo: Lena Clara/Getty Images

From waistline to gumline

How low-carb diets impact oral health.

by Dianne L. Sefo, RDH, BA, and Lisa Stefanou, RDH, BS, MPH

One of the longest trends in appetite control has been the low-carbohydrate diet.

Many patients, when filling out their medical, dental and personal history, reveal they follow these patterns of eating. Nutrition may have stabilizing or damaging effects on the oral cavity, so as registered dental hygienists, we are in the perfect position to discuss the effects of low-carb dieting on the oral cavity, including the topic people are most embarrassed about: halitosis.

Theoretically, when shrinking your waistline, there should be a reduction in the occurrence of carious lesions. Fermentable carbohydrates, especially sucrose, are absorbed by biofilm. This process causes bacterial plaque to produce acids.¹

Frequent exposure of a susceptible tooth surface to the acid causes demineralization, the initiation of the caries process.² Progressive, intermittent demineralization of the tooth structure may progress into complete destruction of coronal dental tissues and development of pulpal abscesses.

Where caries come from
The etiology of dental caries is multifactorial. The chart to the left offers a visual guide. Streptococcus mutans and lactobacilli are bacteria found in biofilm that are highly cariogenic. Their cariogenic action has four aspects considered as separate effects:³

• Implantation mechanism involving adhesion.

• Colonization through competition with other bacterial components.    

• Metabolic activity of established bacteria under the influence of food residues and oral environment.

• Increased thickness of plaque and its control by oral hygiene.

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