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Food constituents and oral health
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Functional dairy products Volume 2

(ISBN 978-1-84569-153-0)
Dairy products already constitute one of the most important types of
functional food and with further knowledge about the health benefits of dairy
becoming available, consumer demand for dairy ingredients will increase.
Together with its companion volume, Functional dairy products: Volume 2
will be an invaluable reference for professionals and researchers in the
development and production of functional dairy products. Part I of this book
reviews how dairy products help to prevent diseases. Parts II and III then
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Functional foods, ageing and degenerative disease
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This important collection reviews the role of functional foods in helping to
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to immune system disorders and cancer. Introductory chapters discuss the
regulation of functional foods in the EU and the role of diet generally in
preventing degenerative disease. Part I examines bone and oral health, the
use of diet to control osteoporosis, the use of functional ingredients to
improve bone strength, and ways of maintaining dental health. Part II
discusses how obesity can be controlled, whilst Part III looks at gut health
and maintaining the immune function using functional ingredients. The book
concludes by reviewing research on functional foods and cancer with chapters
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Functional foods: concept to product
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Functional foods are widely predicted to become one of the biggest dietary
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 Food constituents and
oral health
Current status and future prospects

Edited by
Michael Wilson

Oxford Cambridge New Delhi

Published by Woodhead Publishing Limited, Abington Hall, Granta Park,
Great Abington, Cambridge CB21 6AH, UK
www.woodheadpublishing.com

Woodhead Publishing India Private Limited, G-2, Vardaan House, 7/28 Ansari Road,
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First published 2009, Woodhead Publishing Limited and CRC Press LLC
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Cover image: Electron micrograph of dental plaque kindly supplied by Dr Nicky Mordan,
UCL Eastman Dental Institute, University College London.
Contents

Contributor contact details ......................................................................... xv

Preface .......................................................................................................... xxi

Part I The nature of the problem – oral diseases and the impact
of nutrition

1 Diseases caused by oral bacteria ...................................................... 3

P. D. Marsh, HPA CEPR & Leeds Dental Institute, UK
1.1 The mouth as a microbial habitat .......................................... 3
1.2 The resident oral microbiota .................................................. 6
1.3 Development of the oral microbiota ..................................... 8
1.4 Distribution of the oral microbiota ....................................... 9
1.5 Benefits of the resident oral microbiota ............................... 11
1.6 The oral microbiota and disease ............................................ 11
1.7 Conclusions ............................................................................... 16
1.8 References ................................................................................. 17

2 Viral and fungal infections of the oral cavity .................................. 19

S. Porter, UCL Eastman Dental Institute, UK
2.1 Introduction to viral infections .............................................. 19
2.2 Herpes virus infection ............................................................. 19
2.3 Human papilloma virus ........................................................... 30
2.4 Hepatitis viruses ....................................................................... 32
2.5 Human immunodeficiency virus (HIV) ................................ 33
2.6 Fungal infections ...................................................................... 37
2.7 Paracoccidioidomycosis ........................................................... 40
2.8 Aspergillosis .............................................................................. 41
vi Contents

2.9 Mucormycosis ........................................................................... 42

2.10 References ................................................................................. 42

3 Non-infectious diseases of the oral mucosa .................................... 51

P. M. Speight and P. M. Farthing, University of Sheffield, UK
3.1 Introduction .............................................................................. 51
3.2 White patches of the oral mucosa .......................................... 52
3.3 Oral cancer ................................................................................ 54
3.4 Swellings of the oral mucosa .................................................. 56
3.5 Oral ulceration ......................................................................... 58
3.6 Disorders of the salivary glands ............................................. 61
3.7 Oral lesions associated with systemic disease ...................... 63
3.8 References ................................................................................. 64

4 Dental erosion ..................................................................................... 65

A. Lussi, University of Bern, Switzerland
4.1 Introduction .............................................................................. 65
4.2 Diagnosis ................................................................................... 66
4.3 Risk factors ............................................................................... 68
4.4 Biological factors ...................................................................... 71
4.5 Chemical factors ....................................................................... 72
4.6 Behavioural factors .................................................................. 74
4.7 Summary .................................................................................... 76
4.8 Acknowledgement ................................................................... 76
4.9 References ................................................................................. 76

Part II Food components and oral health

5 Nutrition and its effect on oral health and disease ........................ 83

P. Moynihan, Newcastle University, UK
5.1 Introduction .............................................................................. 83
5.2 Enamel developmental defects .............................................. 84
5.3 The role of diet in dental caries ............................................. 85
5.4 Diet and dental erosion .......................................................... 89
5.5 The impact of nutrition on oral mucosal conditions ........... 90
5.6 The impact of nutrition on periodontal health
and disease ................................................................................ 93
5.7 Diet and general health .......................................................... 94
5.8 Conclusion ................................................................................. 96
5.9 References ................................................................................. 96

6 Relating breath malodour to food constituents and

oral health ............................................................................................ 100
J. Greenman and S. Benkara Mostefa Saad, University of the
West of England, UK
6.1 Breath malodour and its measurement ................................ 100
 Contents vii

6.2 The central paradigm for intra-oral generation

by microbes ............................................................................... 113
6.3 Diet, oral health and malodour .............................................. 116
6.4 Salivary flow, substrate and product clearance from
the mouth .................................................................................. 121
6.5 More complex model (quasi-steady states with
perturbations) ........................................................................... 125
6.6 Interventions and management .............................................. 127
6.7 Future trends ............................................................................ 129
6.8 References ................................................................................. 130

7 Sugar alcohols and dental health ...................................................... 134

K. A. Ly and P. Milgrom, University of Washington, USA
7.1 Introduction to sugars and sugar-free sweeteners ............... 134
7.2 Sugar alcohols and cariogenicity ............................................ 135
7.3 Xylitol efficacy in the prevention of tooth decay ................ 137
7.4 Xylitol clinical applications ..................................................... 139
7.5 Deciphering xylitol-containing products for
potential efficacy ....................................................................... 142
7.6 Key points and conclusions ..................................................... 147
7.7 References ................................................................................. 149

8 Dairy products and oral health ......................................................... 152

T. Dietrich, Boston University Goldman School of Dental
Medicine, USA and University of Birmingham, UK;
A. Sheshah, Riyadh Security Forces Hospital, Saudi Arabia;
and M. Nunn, Boston University Goldman School of Dental
Medicine, USA
8.1 Introduction .............................................................................. 152
8.2 Intake of dairy products and risk of dental caries .............. 153
8.3 Intake of dairy products and risk of periodontitis .............. 158
8.4 Future trends ............................................................................. 159
8.5 Acknowledgement.................................................................... 160
8.6 References ................................................................................. 160

9 Impact of food sugars and polysaccharides on dental caries ........ 163

P. Lingström, University of Gothenburg, Sweden
9.1 Fermentable carbohydrates: a key factor in the
caries process ............................................................................ 163
9.2 The different carbohydrates in the diet ................................ 164
9.3 Relative cariogenicity of different sugars ............................. 166
9.4 Starches and dental caries ....................................................... 167
9.5 Impact on caries from a historical perspective .................... 169
9.6 Impact in the modern era ....................................................... 172
9.7 Cariogenic risks of foods and beverages ............................... 173
9.8 Consumption frequency versus amount consumed ............. 174
viii Contents

9.9 Influence of fluoride on the sugars–caries relationship ...... 176

9.10 Individuals at increased risk ................................................... 177
9.11 Impact in the 21st century ...................................................... 180
9.12 References ................................................................................. 181

10 Casein phosphopeptides in oral health ............................................ 185

N. J. Cochrane and E. C. Reynolds, The University of
Melbourne, Australia
10.1 Introduction .............................................................................. 185
10.2 Casein phosphopeptide stabilised amorphous
calcium phosphate nanocomplexes (CPP-ACP)
structure ..................................................................................... 188
10.3 Scientific evidence for casein phosphopeptide-
amorphous calcium phosphate activity in preventing
demineralisation and promoting remineralisation .............. 189
10.4 Mechanism of action ............................................................... 211
10.5 Recommendations for clinical use ......................................... 215
10.6 Future trends ............................................................................ 218
10.7 Conclusions ............................................................................... 219
10.8 References ................................................................................. 219

11 Antioxidants and periodontal disease .............................................. 225

M. M. Grant and I. L. C. Chapple, University of
Birmingham, UK
11.1 The nature of antioxidants ..................................................... 225
11.2 Antioxidants and periodontitis .............................................. 226
11.3 Micronutrients in future therapeutic approaches to
periodontitis .............................................................................. 233
11.4 Sources of further information and advice ........................... 234
11.5 Future trends ............................................................................ 234
11.6 References ................................................................................. 235

12 Anticaries and antiadhesive properties of food constituents

and plant extracts and implications for oral health ........................ 240
C. Signoretto and P. Canepari, Università di Verona, Italy;
C. Pruzzo, Università di Genova, Italy; and G. Gazzani,
Università di Pavia, Italy
12.1 Introduction .............................................................................. 240
12.2 Plaque-dependent oral pathologies ....................................... 241
12.3 Classic approaches for the prevention of tooth and
gum pathologies ....................................................................... 242
12.4 Phenolic content of food and plant extracts ........................ 242
12.5 Main foods and plant extracts with anticaries and
antiplaque activity .................................................................... 245
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 Contents ix

12.6 Effects of bacterial target inhibition by food and

beverage components .............................................................. 253
12.7 Mode of delivery of polyphenols to the oral cavity ............ 255
12.8 Implications of using natural food components
for oral health ........................................................................... 256
12.9 Future trends ............................................................................ 257
12.10 Acknowledgements .................................................................. 258
12.11 References ................................................................................. 258

13 Food preservatives and dental caries ............................................... 263

W. H. Bowen, University of Rochester, USA
13.1 Introduction .............................................................................. 263
13.2 Spices ......................................................................................... 264
13.3 Clove .......................................................................................... 264
13.4 Antibiotics ................................................................................. 264
13.5 Chelation agents ....................................................................... 265
13.6 Weak acids ................................................................................ 265
13.7 Sulfites ....................................................................................... 269
13.8 Hypersensitivity ........................................................................ 270
13.9 Conclusions ............................................................................... 270
13.10 References ................................................................................. 270

14 Food, nutrition and oral cancer ......................................................... 273

S. Warnakulasuriya, King’s College London Dental Institute,
UK
14.1 Introduction .............................................................................. 273
14.2 The causes of cancer ................................................................ 274
14.3 Food and the risk of cancer .................................................... 274
14.4 Vegetarian diet and oral cancer ............................................. 277
14.5 Animal studies .......................................................................... 278
14.6 Anti-cancer agents in plant foods: mechanisms
of action ..................................................................................... 279
14.7 Carcinogens in foods: additives and preparation ................. 281
14.8 Drinks and the risk of cancer ................................................. 281
14.9 Chemoprevention ..................................................................... 283
14.10 Prevention of second primary tumours ................................ 287
14.11 Summary and conclusions ....................................................... 287
14.12 References ................................................................................. 288

15 Vitamin supplements and oral health .............................................. 296

C. O. Enwonwu, University of Maryland, USA
15.1 Introduction .............................................................................. 296
15.2 Classification of vitamins ........................................................ 297
15.3 Recommended dietary intakes ............................................... 299
15.4 Nutritional supplements .......................................................... 303
x Contents

15.5 Use of vitamin supplements ................................................... 304

15.6 Brief review of the biological functions of vitamins ........... 307
15.7 Oral manifestations of vitamin deficiencies ......................... 314
15.8 Conclusions ............................................................................... 319
15.9 Assessment of vitamin status .................................................. 320
15.10 References ................................................................................. 321

16 Trace elements and oral health ......................................................... 331

M. Faber, Medical Research Council, South Africa;
F. A. M. Wenhold, University of Pretoria, South Africa
16.1 Introduction .............................................................................. 331
16.2 Trace element content of teeth .............................................. 332
16.3 Fluoride ..................................................................................... 333
16.4 Iron ............................................................................................ 337
16.5 Copper ....................................................................................... 338
16.6 Zinc ............................................................................................ 340
16.7 Selenium .................................................................................... 343
16.8 Lead ........................................................................................... 344
16.9 Conclusions ............................................................................... 344
16.10 References ................................................................................. 345

17 Alcohol and oral health ..................................................................... 350

S. Petti, ‘Sapienza’ University, Italy; and C. Scully, UCL
Eastman Dental Institute, UK
17.1 Introduction .............................................................................. 350
17.2 Overall effect of alcohol on general health .......................... 351
17.3 Systemic effects of alcohol, influencing orofacial
health ......................................................................................... 361
17.4 Direct effects of alcohol influencing
orofacial health ......................................................................... 370
17.5 References ................................................................................ 373

18 Malnutrition as an etiological factor in dental

caries disparity ..................................................................................... 381
P. Milgrom, P. Weinstein and S. E. Coldwell, University of
Washington, USA
18.1 Introduction .............................................................................. 381
18.2 Stress and depression .............................................................. 383
18.3 Counseling caregiver about diet ............................................ 384
18.4 Impact of poor diet .................................................................. 385
18.5 Model of caries disparity ......................................................... 385
18.6 Ecological model of what people eat: tooth decay is
part of a larger problem .......................................................... 386
18.7 Family influences on taste preferences ................................. 386
18.8 Food access ............................................................................... 392
 Contents xi

18.9 Food marketing ........................................................................ 392

18.10 Conclusions ............................................................................... 393
18.11 References ................................................................................ 393

19 Tea as a functional food for oral health .......................................... 396

C. D. Wu and G. Wei, University of Illinois at Chicago, USA
19.1 Introduction .............................................................................. 396
19.2 Anticariogenic potential of tea .............................................. 399
19.3 Tea and periodontal diseases .................................................. 404
19.4 Tea and halitosis ....................................................................... 405
19.5 Tea and oral cancer .................................................................. 406
19.6 Antimicrobial activity against fungi associated
with oral infections .................................................................. 408
19.7 Antimicrobial activity against viruses associated
with oral infections .................................................................. 408
19.8 Conclusion ................................................................................ 409
19.9 References ................................................................................ 410

Part III Technology and product development

20 Probiotics and oral health ................................................................. 421

J. H. Meurman, University of Helsinki, Finland
20.1 Probiotics: the concept ............................................................ 421
20.2 Probiotic species ....................................................................... 422
20.3 Putative mechanisms of probiotic action .............................. 422
20.4 Probiotics as support therapy for systemic diseases ............ 423
20.5 Probiotic strains and oral microbiology ................................ 424
20.6 Experimental and clinical studies of the effect
of probiotics on oral and dental diseases ............................. 424
20.7 Safety aspects ............................................................................ 428
20.8 Future trends ............................................................................ 428
20.9 Conclusion ................................................................................ 429
20.10 References ................................................................................. 429

21 Oral care gum products ...................................................................... 433

K. K. Mäkinen, University of Turku, Finland
21.1 Introduction: notes on early history; rationale
for the use of oral care gums .................................................. 433
21.2 Oral care gums in relation to other oral care
adjuvants; advantages and disadvantages ............................. 434
21.3 ‘In sputo veritas’ – gum-chewing stimulates
salivation and the chemical defence of saliva ...................... 435
21.4 Target groups for the administration of oral
care gums ................................................................................... 437
xii Contents

21.5 Examples of special oral care gum products ........................ 438

21.6 Clinical caries trials: school programmes .............................. 443
21.7 Effect after ‘sugar challenge’ .................................................. 444
21.8 Biochemical effects in short-term polyol gum use .............. 445
21.9 Gum products and remineralisation ...................................... 446
21.10 Public endorsement of oral care gum products ................... 447
21.11 Practical instructions for studies on oral care
gums; incompatibilities among gum ingredients .................. 448
21.12 References ................................................................................. 450

22 Novel drug delivery systems for therapeutic intervention in

the oral environment .......................................................................... 455
S. Kalachandra, H. R. Howell, O. M. Patel, J. Li and
D. A. Barrow, University of North Carolina, USA
22.1 Polymeric systems appropriate for oral drug
delivery: history and background ........................................... 455
22.2 Oral diseases that are potential candidates
for local drug delivery ............................................................. 456
22.3 Design goals for modern oral drug delivery
systems ....................................................................................... 459
22.4 Actual devices based on biocompatible
materials .................................................................................... 460
22.5 Use of additives to accelerate release and
solubility of problematic (water-insoluble) drugs ................ 464
22.6 Maintaining and assuring stability of drugs
during device manufacturing .................................................. 464
22.7 Future trends: multi-drug devices .......................................... 465
22.8 Dedication ................................................................................. 466
22.9 Acknowledgements .................................................................. 467
22.10 References ................................................................................ 467

23 Formulating tooth-friendly beverages, confectionery

and oral care products ........................................................................ 470
M. E. Barbour, University of Bristol, UK
23.1 Introduction .............................................................................. 470
23.2 Properties of beverages which may compromise
dental health ............................................................................. 471
23.3 Properties of confectionery which may compromise
dental health ............................................................................. 472
23.4 Properties of oral care products which may
compromise dental health ....................................................... 472
23.5 Acids and dental erosion: approaches to, and
mechanisms of, reducing acid-mediated
tooth dissolution ....................................................................... 473
 Contents xiii

23.6 Sugars and dental caries: approaches to, and

mechanisms of, reducing carious tooth loss .......................... 475
23.7 Formulating tooth-friendly beverages ................................... 478
23.8 Formulating tooth-friendly confectionery ............................. 480
23.9 Formulating tooth-friendly oral care products .................... 482
23.10 Future trends ............................................................................ 483
23.11 References ................................................................................. 483

24 Functional foods and oral health ...................................................... 488

H. Whelton, University College Cork, Ireland
24.1 Introduction .............................................................................. 488
24.2 Foods associated with oral diseases and disorders .............. 490
24.3 Foods which can be used to prevent and treat
oral disease ................................................................................ 492
24.4 Minerals and caries .................................................................. 493
24.5 Minerals and periodontal disease .......................................... 499
24.6 Minerals and tooth surface loss ............................................. 500
24.7 Animal products and caries .................................................... 500
24.8 Animal products and other oral diseases ............................. 506
24.9 Plant products and caries ........................................................ 507
24.10 Plant products and periodontal disease ................................ 512
24.11 Plant products and oral cancer ............................................... 514
24.12 Regulation of functional foods for oral health .................... 514
24.13 References ................................................................................. 519

Index ............................................................................................................. 529

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