 Hi everyone, welcome back to a new session on dentistry and more. So let's see about something about that and dental caries. So this dental caries is a very cliche topic. So we might have heard about dental caries from childhood with our parents and our teachers and everyone around us will be talking about sugar and dental caries. So if you eat toffee, if you eat sugar, you get caries. So nothing special about it. Everyone knows it that sugar versus dental caries. So what is a very peculiar thing which I am going to talk about is the scientific background and why people are talking sugar is causing dental caries. Because as a research person or as a dentist, we cannot just speak conspiracy theories. We need to stick on to evidence-based medicine. So what are the evidences which support this theory? That is sugar causes dental caries. So whatever a dentist, whatever a doctor speaks about the profession or the facts, there should be a concrete scientific evidence behind it. So in this session, what I am going to talk about is nothing about dental caries that everyone knows sugar causes dental caries. I am not going to talk about the theories of dental caries. I am not going to talk about how caries can be prevented and how what are the treatment regime available for caries. I am going to talk about the scientific evidence, the studies which help the people or studies which help the scientists to say that with confidence that sugar causes dental caries. Okay, let us move on to a topic that is studies which supported studies which proved that causes dental caries. That is sugar causes dental caries. Okay, so we know dental caries basically it is a multifactorial disease. Not just the sugar can cause dental caries. There need to be presence of bacteria. There need to be a host factor that is our immune factors, the saliva, the tooth morphology, many things are there and most importantly the time. Time should be there for these bacteria to act upon the substance. So all these are the tools you are not going in detail about the tools. So I am stressing on the scientific evidence what we have. So these are the experiments which were done in previous years of previous era the last century which proved or which created the substantial scientific evidence for dental caries caused by sugar or sucrose. Ultimately we know sugars are categorized into sucrose, fructose, galactose, lactose. So sugar is sucrose is known as R's sucriminal. It is the most significant sugar type which causes dental caries. Okay, so when we take historical evidences of the skulls, we dig up the skulls from the past years, past million years back. So such evidence were available. So the old Eskimo skulls were completely caries free and the some pominent apes, these are some apes skeleton. Those were also like without any evidence of dental caries. So what we are trying to prove is dental caries is a disease of civilization. Okay, so the man was consuming more and more fine sugars and he is getting more chances of dental caries. So when we were into the raw food or the natural food there was no processed food then there was no caries. So dental caries we can say that it is a disease of civilization. So that was historical evidence. So ophthalmological evidence will be seen in very detail and experimental evidence. This is one of the famous study which was done by Orland. Orland et al means his friends. Orland et al in 1954. It is a very simple study which was done in rats. There were two types of rats or two groups of rats both were exposed to sugary food but one was exposed sugary food by keeping a tube directly to stomach. They were fed directly to stomach. There is no contact to the food which contains sucrose to the teeth oral cavity and the other one were fed directly to the through oral cavity. They were fed orally. So they were eating food by chewing and the other way other group were directly fed into their stomach to the surface that the group of France which were fed directly to the stomach were not produced any caries and the other group produced caries. So even if you eat sucrose it will not create dental caries. It has to be come in contact with your tooth. Okay so the bacteria will act upon the sucrose and produce acids ultimately caries. Okay so let's see what all the evidence we have. The first study which was done in Sweden a wipe home mental institute which was reported by Gustavson and Davis in 1954 and 55. This was a mental institute where residents were given eight different types of carbohydrates. Okay so the all study was divided into eight groups that is one was controlled and sucrose, bread, chocolate, caramel, eight toffee and 24 toffee. So all were given these type of material that is one was given sucrose that is 300 grams of sucrose then bread then one group were given chocolate then caramel then eight toffee and 24 toffee. So we can see that it is going on a increasing manner from control group to this group. Control group means they were not getting any type of carbohydrate or very low carbohydrate. Carbohydrate means sucrose mostly containing sucrose. So the result of the study was you can see the graph here the 1946 to 51 where the period of study and this is carious tooth. Okay this is carious tooth this is zero tooth, carious tooth and this is 15 carious tooth. Okay so over the period of five years what was observed that people who were consuming 24 toffees group were produced highest number of caries then the eight toffees. Okay so the least number were with control group of people without any sucrose diet. So it is obvious that people who are eating more number of of these were getting more number of caries. So it has this proven that the increase in consumption of sugar causes increase in caries and the increase in sugar between meals when we eat along with food along with our lunch along with our dinner it won't create much problem but between lunch and dinner if you eat sugar means it will stick to a tooth and it causes more time to get cleared of from the tooth. So it has more time for the bacteria to act upon. So that's what this study has proven this. This wipe home Sweden study has proven that if you eat more sugar you get more caries. The second study was output of study. Okay output of study was a residential type where the children's were deciding and it was done by Sullivan and Harris in 1942 1967 at 13 years up to 13 years they were followed. So it was a residential school where only particular type of diet were provided which were rich in vegetables and milk all weight not soybean and mostly the uncooked food and they are poor in trees sugar and refined car word rate. So they had very low exposure of tender caries. Okay after this they compared with us normal state schools okay and this output house children and normal state school were compared. So what they found out was this DM office is total caries experience decade tooth missing tooth and filled tooth all due to dental caries. Okay you can see that in 10 years the whole good house are only 0.85 compared to 5.2 almost five times greater in the state school children where the normal sugars were readily available. Okay this whole house was with rigid restrictions for car word rate. You can see it is one here it is almost seven seven times in the age group of 11 12 it is 1.8 and 9.3 and all age groups it was almost five to six times more caries. Okay that also proven that the output house study also proven that the diet is causing dental caries and especially the presence of refined car word rate also grows causing more caries. You eat more caries you get more if you sorry if you eat more sugars you get more caries. So the next study was 2 sugar study which was done by Sheenan and McKinnon in 1972 to 1974 in Finland. So it was a three different types of sugars by the time it has proven that the car word rate is causing dental caries and how it differs each other because we have so many types of closed structures cell, xylitol and caractose many types of sugars we had. So they just wanted to know what causes what percentage of caries. So in this study they had three groups one was eating chewing gums with sucrose one was with chewing gums fructose and one was with xylitol and they were observed for two years and they found out was the least caries producing group was xylitol group then the fructose and the highest was with sucrose that is why we are promoting chewing gums with xylitol we know happy dent and orbit orbit with fructose and happy dent with xylitol. So these two are like sugar mimicking sugars they are not actually true car word rate bacterias cannot act upon these car word rates they can act upon only on sucrose and produce lactic acid which causes dental caries they cannot just act on this fructose and xylitol and produce acid they can produce about very very little amount. So it has proven that xylitol has a very good effect on this dental caries resistance so that is why we are promoting the chewing gum with xylitol and fructose so the commonly available chewing gum is a happy dent and fructose with orbit okay. So the difference of car word rate has a different effect on dental caries and this is own landmark study this Trista da gunha is an island which is present in southeast region of Atlantic ocean which is a very remote island so what happened was the study was done by Holloway adult now what happened was in 1963 there was a volcanic eruption and soon all the inhabitants were all the inhabitants were evacuated to England okay. So when they came to England they were checked for dental caries and what they found out after four years because these four years they were staying in England okay the dental caries increases by 50 to 80 percentage in four-year period and before they coming to England the caries exposure was literally zero just they exposed to a civilized world they caries experience or their caries presence was increased almost 80 percentage. So this island was one of the landmarks today which proven that the civilization is a dental caries say this is of civilization okay and this is one another study hereditary fructose intolerance some people are having this problem this fructose and fructose containing dietary fructose they cannot just digest it so they don't eat it commonly in such truth the dental caries found to be very low okay so this is fructose so gross is the most detrimental than fructose so people with fructose problem the caries found to be very low and this world war studies were conducted to found out to and which found out the dental caries and the carbohydrate association because during the world war time the civilians did not get much of the sugar because of this rationing and dental caries was very much low and the civilians but what happened with the soldiers they were given camp for mainly readymade food and processed or refined sugar and the dental caries was much more higher in this particular soldiers because they were given mainly the chocolates for getting instant energy so such food types cost dental caries compared to the civilians civilians were exposed to very low amount of sugar during the world war so this was a world war two study which has proven the association between sugar and dental caries so all these studies has invariably proven that caries is a result of civilization or caries is caused by sucrose or the carbohydrate refined carbohydrate people who are exposed to natural or raw food are not much affected with dental caries people who are exposed to refined or processed food or canned food they are having they are producing much more caries that's why caries was literally absent in era beyond on 1700 or 1600 and it is very much evident after 1800 or 1900 so now caries is almost like a pandemic every person has dental caries one or two because the dietary habit is a lot of change we are nowadays eating not of very much raw food we are mostly eating processed or canned food so all these studies have given the scientific evidence to say that this toffee coaxing caries or eating sugar coaxing caries okay so we must know that what are the scientific evidence so anyone can say that the dental caries is caused by sugar but these were the landmark studies which has proven which has created the evidence to say that dental caries is a product of carbohydrate or dental caries is a product of civilization it is a disease of civilization so I'll come up with a new class thank you