CE0941: Is a Diet Good for Oral Health, Good for Systemic Health?

Philippe Hujoel, DDS, MS, MSD, PhD

Course Description:

Uniform agreement exists that fermentable carbohydrates are the primary cause of dental caries. This knowledge has an important clinical implication. Caries – still the most common chronic disease affecting mankind – is an eminently preventable disease. As was shown in a pivotal cohort studies in the 1960s, a low-carbohydrate diet reduces caries activity to practically nil even in the absence of fluoride and oral hygiene. So why has the dietary prevention of caries through carbohydrate restriction been largely forgotten? Why was the World Health Organization on record stating that "frequent consumption of candy did not seem to be a significant determinant of caries"?

Blame the low-fat mania. The dietary prevention of dental caries became unpalatable from the 1970s on because fermentable carbohydrates became advocated as the principal dietary staple for improved general health. A healthy diet became a cariogenic diet. This medical dietary advice had profound dental consequences. A dental professional was in a difficult spot to recommend a low-carbohydrate diet and instead had to focus on fluoride, oral hygiene, and antimicrobials. The low-fat mania squelched the promising research on the role of fermentable carbohydrates in periodontal disease and other oral diseases such as leukoplakia.

But what if the high-carbohydrate diet recommendation was a major medical mistake? What if dental researchers were correct all along in claiming that a diet that is good for the teeth is also good for the body? The emerging medical evidence suggests that such a scenario is plausible. Pivotal randomized trials such as the Women’s Health Initiative Study demonstrated that a low-fat diet failed to prevent coronary heart disease, breast cancer, and colon cancer. Randomized trials published in leading mainstream journals such as JAMA, Lancet, and NEJM suggest that a low-carbohydrate diet improves markers of diabetes and coronary heart disease. These studies are leading to a shift in perceptions of what constitutes a healthy diet. Headlines such as "US cracks down on 'liquid candy' drinks" illustrate the increased focus on the harmful consequences of dietary carbohydrates. This shift in perspectives on dietary carbohydrates opens opportunities for the dental profession in terms of patient care which will be reviewed in this course

Course Objectives - As a result of attending this course, the participant should be able to:

• Discuss the Paleolithic diet and historical perspectives on the causes of the diseases of civilizations.
• Explain how most dietary advice is based on weak evidence such as expert opinion, biological plausibility, or ecological studies
• Evaluate the results of large dietary randomized controlled trials.
• Review the available evidence on fermentable carbohydrates in oral health (caries, periodontal disease, leukoplakia).
• Recognize how medical beliefs on a healthy diet influence dental practice
• Explore why fermentable carbohydrates may explain why Alzheimer, pancreatic cancer, and diabetes are more common among people with tooth loss.

Instructor:

PHILIPPE HUJOEL is a Professor in the School of Dentistry at the University of Washington. He was the recent recipient of Distinguished Scientist Award from the International Association of Dental Research and is involved in the development of evidence-based guidelines for professional and governmental organizations such as the American Dental Association. In 2009, he authored a critical review on the role of dietary carbohydrates in dental-systemic health in the Journal of Dental Research. His educational background includes specialty training in periodontics (MSD from the UW), biostatistics (MS from UM), and epidemiology (PhD from the UW). He spends one day per week in a periodontal practice.

Need a hotel in the area?

University of Washington is an ADA CERP Recognized Provider.	The University of Washington is an ACDE member.
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
University of Washington designates this activity for 7 continuing education credits.