Oral Health Program
 Program Coordinator – All PHC Staff
P: 08 8971 9300 | E: N/A

Diet in relation to oral health

The traditional nomadic diet was low in sugar and contained a healthy balance of nutrients. However,the switch to a ‘European’ diet has meant that large quantities of white flour, sugar and tea are consumed and few fresh fruits and vegetables, having adeleterious impact on both general and oral health.

 

The foods purchased by rural and remote communities tend to be cheaper products containing large amounts of refined carbohydrates, resulting in a diet high in kilojoules but often deficient in vitamins and protein. In 1982, an estimate of the sugar consumption of Groote Eylandters (a remote Aboriginal community) was 90 kg per person per year, which is twice the Australian average. In 1975,a similar estimate at Elcho Island was over 3 kg of sugar per person per week being purchased (some182 kg per year) which, at the time, was almost 3.5 times the national average. The increased consumption of sugar is reflected in increasing dental caries among indigenous people. Examination of Aboriginal skulls predating colonization (in 1788) found that dental caries was the cause of many deaths among aboriginals.

 

The high prevalence of poor nutrition among indigenous communities almost certainly gives rise to a significantly greater susceptibility to periodontal ldisease. Also, deficiencies in vitamin C (due to a lack of fresh fruit) can lead to conditions such as scurvy, with its direct deleterious effects on oral health. Malnutrition has also been suggested as a cause of severe enamel pitting and hypoplasia found on the teeth of some Aboriginal children; hence, an increase in dental caries.

This, combined with poor oral hygiene and a diet high in sugar, has the potential to increase the risk of both periodontal disease and dental caries in rural indigenouspopulations.

 

Role of medical conditions in oral health problems

There are two medical conditions, diabetes mellitus and rheumatic fever, which have a significant impact on oral health and are prevalent among indigenous communities.


1. Diabetes

Diabetes occurs with alarming frequency among rural and remote indigenous communities and has the potential to significantly increase periodontal disease and dental caries. Type II, or non-insulin-dependent diabetes mellitus (NIDDM), is the most common form suffered within indigenous communities. NIDDM has been associated with an increased prevalence of periodontal disease and dental caries among poorly controlled patients. A study in the USA showed significantly more gingival bleeding among type II diabetics than those with impaired glucose tolerance or no metabolicdisorder.24It has also been reported that subjects with NIDDM are up to 3.4 times more likely to have periodontal disease than people without diabetes, and these differences are not related to differences in plaque or calculus levels.25,26Other oral health problems which are thought to be related to NIDDM are oral mucosal lesions and oral dryness, leading to Candida albicans infections.

The length of time an individual has suffered diabetes and the level of control are significantly correlated with the severity of periodontitis and tooth loss. Unfortunately, this is a vicious cycle as the loss of teeth leads to the avoidance of healthy foods in favour of soft, sugary and fatty foods, which in turn encourages obesity and increases the risk of diabetes. There is a dearth of data on this link in the rural and remote indigenous populations and this field requires a sustained research effort. Epidemiological analysis of diabetes among indigenous communities varies, due mainly to the difficulty in determining population sizes in nomadic groups. Cross-sectional analysis found the Current data from Aboriginal communities following a traditional way of life corroborate these earlier findings, with caries incidence being low, while among groups which consume mostly Western foods caries prevalence is significantly higher.

 

2. Malnutrition

In the Kimberley region of Western Australia, 3000 km north of the capital city, Perth, food prices are 40 percent more expensive than those in Perth, encouraging the purchase of cheaper foods with poorer nutritional value.

The high consumption of sugar is not the only dietary-related problem of the indigenous population. Malnutrition is also relatively common in children, making them more susceptible to infections. This susceptibility, combined with poor oral hygiene among the rural and remote indigenous communities, leads to a higher risk of periodontal disease. A 1991 study reported frequent under nutrition among young children in the Kimberley region, due to a diet high in fat and sugar and low in calcium, fresh fruits and vegetables. This same study noted that while the children were often malnourished, obesity became a problem among adults; this was associated with further health problems such as diabetes and hypertension. Another study in the rural south of Western Australia found that inadequate calcium, vitamin C and riboflavin intakes, as well as inadequate kilojoule intakes, were common in rural Aboriginal communities.

Widespread mild to moderate malnutrition in Aboriginal children in the sparsely populated region of northern Western Australia and widespread deficiencies in protein and kilojoule intake in Aboriginal children in rural and remote Queensland have been documented by others.

In one study from the Kimberley region, only 59 per cent of women of child bearing age and 76 per cent of children had adequate nutritional levels. Rural Aboriginal children under three and women of child bearing age had vitamin deficiencies, with growth retardation occurring in 23 per cent of the children surveyed. In this study, detailed analyses of individuals found many to be deficient in kilojoule intake, calcium, iron, and vitamins C, B1, B2, B6, and E.