Diet and dental caries - The psychological perspective!

“Do not focus on how much you eat. Focus on what you eat.” A child’s diet has the profound ability to influence cognition, behavior, and emotional development in addition to physical growth and development. However, the same diet, if not managed with care, can become one of the main causative factors for dental caries. The amount of sugar consumed, the frequency of intake, the physical properties, and the retentiveness of food are some of the dietary factors commonly discussed. However, the psychological aspects associated with diet and dental caries have been less explored. Parents, the primary promoters of oral hygiene practices in children, have a major influence on the dietary habits and food choices of children. It is important for every pediatric dentist to be aware of the impact of the psychological factors associated with diet and apply it in diet counseling. Infancy The newborns are dependent on parents/primary caregivers for their existence. Food provides an opportunity to create a strong bond between infants and their caregivers. It is never just about the food and it is always about the love, warmth, and care that come along with the food. Periodic and adequate nutrition provided with care helps establish a secure emotional attachment between the child and the parent. Disruption in this process can lead to impaired bonding and/or an inappropriate relationship with food. Insecure attachment relationships can also intensify feeding problems. Weaning and the time of transition from an exclusive milk diet to a variety of foods exert a positive influence on eating habits. Children prefer sweet and salty foods to sour or bitter foods. Patterns of sugar consumption are established during infancy and sugar consumption increases from infancy to 2 years of age. It has been shown infants who were given sugars early in life preferred sugary food when they became toddlers. Parental influence can shape their preferences. Delayed or abnormal transition in weaning, excessive intake of high-sugared beverages, delayed acceptance of solid food, continued nocturnal bottle-feeding, and ad-libitum breastfeeding with an added note on secured attachment must be addressed to the parents during diet counseling. Positive changes in infant feeding practices have shown considerable improvement in the oral health of children. Toddlers and Preschoolers In the transition stage of nutrition, there is exposure to new textures, flavors, and smells. According to Erikson, children in this stage are in the initial attempts at “autonomy.” When the caregiver tries to control the type and quantity of food consumed, it can lead to mealtime struggles. The provision of adequate food at regular intervals allows the child to develop a secure relationship with food. Repeated exposure is required for acceptance of new and healthy foods, and this needs to be done with care. It is also important to remember that every demand of the child (“id”) should not be answered with food and beverages. Food should not be used as a reinforcer. Chocolates, biscuits, and sweetened beverages come in different shapes and colors that attract children. A child watching a television show is subconsciously attracted to all the advertisements shown between programs. The actors of the ads are also children of the same age that a child can relate to. The desire to try these attractive goodies gradually becomes deep-seated. Most caregivers, who do not want to upset their children, end up buying these treats and the “desire and demand” cycle continues. A team of researchers at the University of Bonn studied the effect of packaging on children’s perception of food. Kids such as cute cartoon characters and a fun product name (Tony the Tiger inspired children to Frosted Flakes). Children also liked yogurt and cereal treats better when come in attractive packages than in plain packages. Cornell University’s Food and Brand Laboratory found words used to describe food can also affect its taste. Preschool-aged children ate up their entire broccoli portion when they imagined themselves to be dinosaurs consuming a “dinosaur tree.” Packaging healthy food, presenting them well, and the use of euphemisms can make children eat better food. Middle Years Child and Adolescents Food choices and dietary habits are largely influenced by accessibility to food and marketing strategies. These influences can be both positive and negative. Parents have to be extremely careful of the access children have toward sugar-based food. The trade pundits know how to market and sell their products. The parents, a child’s first role model, should encourage the acceptance of novel and healthy foods by eating them with the child. If the bribe is used as a means of making the child accept the undesirable food, it places undue emphasis on the bribe rather than the acceptance of the healthy food. Peer acceptance becomes increasingly important through the school-going years and especially during adolescence. Even the choice of eating is influenced by peer pressure. Parental guidance regarding food choices is not well received by teenagers. Food companies sell their products through television advertising. Indirect advertisement through sponsorship of youth activities and school contracts has a strong impact on the food choices of adolescents. More economical combo packs and super-sized foods high on sugar often attract these older children. Excessive consumption and prolonged sipping of beverages/soda pop are associated with rampant caries in children and adults. Sports drinks are acidic sweetened beverages, with the potential to increase caries risk. There are four levels of influence seen in adolescents: individual or intrapersonal influences (e.g., psychosocial and biological); social environmental or interpersonal (e.g., family and peers); physical environmental or community settings (e.g., schools, fast food outlets, and convenience stores); and macrosystem or societal (e.g., mass media, marketing and advertising, and social and cultural norms). Adolescents have to be dealt with care as there can be an interplay of all these levels. Simple tips for diet counseling Give children choices, not rules – Get them involved in their meal choices and meal preparation! Educate, do not preach – Be enthusiastic, a good role model, and not a lecturer! Small exposures when trying new/healthy food repetition is the key! As preventive pediatric dentists, we are responsible for making children relish healthy food, not (just) eat healthy food. Toward eating right,