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Cheese: A continuing ally in the battle against tooth decay

Research continues to demonstrate that cheese is a heavyweight contender in the fight against tooth decay. What's more, studies by the Forsyth Specialized Caries Center in Boston indicate that the carie-promoting effect of sugar and the carie-protective effect of cheese - both long noted in coronal caries - have been extended to root caries as well (see Table 1).¹ Various mechanisms of action may be responsible for cheese's anticariogenic effects - from its high mineral content to its ability to stimulate saliva. Read on…

Table 1. Adult risk of root caries (odds ratio) upon exposure to sugar and cheese¹ (95% CI)

Exposures	Sugar (daily)	Cheese (weekly)
2	1.26	0.74
3	1.42	0.64
4	1.60	0.55
5	1.79	0.47

Calcium and Phosphate
Cheese^2-5 and milk, whether skim, 2%, whole or chocolate,³ promote the incorporation of high levels of calcium and phosphate into human dental plaque. When these foods are eaten, their minerals are retained as a calcium-phosphate-casein reservoir that creates an effective 'sustained-release' system for these minerals which inhibit demineralization and enhance remineralization.³ This action - release of calcium from cheese and its diffusion into plaque - may be regarded as cheese's most important anticariogenic effect.²

Cheese makes your mouth water
Eating cheese - during and for some minutes thereafter - not only increases salivary secretion but also alters its composition, buffering plaque pH and increasing the rate of sugar clearance.^{2, 4} This may be one reason why cheese has been shown to significantly reduce the caries response to experimental sucrose challenges.^{2, 4}

Experiments have shown that cheese stimulates saliva, releases calcium and reduces the phosphate in oral fluids.^{2, 5} (This pertains to all cheeses studied, including processed.⁶ The only exception is cream cheese,^{2, 5} a poor calcium source.) However, research conducted with xerostomic patients indicates that even a reduced saliva flow is sufficient to release the calcium and phosphate in cheese.⁷
Not just a bite of calcium
Milk protein (casein), and the substances which promote its digestion, appear to protect tooth enamel by buffering the acids derived from the consumption of sugars.^{8, 9} In addition, milk contains other minor protein fractions which are ever more powerful, protective factors against demineralization.¹⁰ Recent research indicates that the anticariogenic effect of milk casein may result primarily from its ability to prevent oral colonization of Streptococcus sobrinus.⁹ Investigators suggest that this is "the first example of a food component other than dietary sugars selectively modifying the composition of the dental plaque microbiota of rats in such a way as to reduce its pathogenic potential."⁹

The fat in dairy products coats the teeth, inhibiting the amount of fermentable carbohydrate retained in the mouth and preventing acid from reaching the plaque.¹¹

Cheese makes a great dessert
As little as five grams of cheese eaten at the end of a meal not only protects against the formation of cavities, but appears to reverse early signs of tooth decay.^{5, 6, 12} Cheese-containing meals increase plaque calcium. The latest research shows that eating cheese immediately after a sweet meal reduces acid production. Both likely protect against dental caries.^{13, 14}

Cheese: A fitting conclusion

If you didn't know it before, you do now… Cheese has properties that could benefit your patients, young and old. Not only are there more elderly people, but they are also more likely to retain their teeth longer. In addition, prevalence of root caries in seniors is high, magnifying the importance of adopting measures that prevent caries development. Increasing the amount of cheese in a balanced diet - and eating it at the optimum time - could be important steps toward the prevention of tooth decay.

References

1. Papas A et al. 1995. Dietary models for root caries. Am J Clin Nutr 61(suppl):417S-422S.

2. Jenkins GN. 1989. Cheese as a protection against dental caries. Nutr Quarterly 13(2):33-39.

3. Jensen ME et al. 2000. Assessment of the effect of selected snack foods on the remineralization/demineralization of enamel and dentin. J Contemp Dent Pract 1:1-17.

4. Burgess RC et Burgess NE. 1989. Diet and dental caries. NIN Review No. 9, Supplement to Rapport 4(2):1-4.

5. Jenkins GN et Hargreaves JA. 1989. Effect of eating cheese on Ca and P concentrations of whole mouth saliva and plaque. Caries Res 23:159-164.

6. Drummond BK et al. 2002. Comparison of the cariogenecity of some processed cheeses. Eur J Paediatr Dent 3:188-194.

7. Sela M et al. 1994. Enamel rehardening with cheese in irradiated patients. Am J Dent 7:134-136.

8. Reynolds EC. 1987. The prevention of sub-surface demineralization of bovine enamel and change in plaque composition by casein in an intra-oral model. J Dent Res 66:1120-1127.

9. Guggenheim B et al. 1999. Powdered milk micellar casein prevents oral colonization by Streptococcus sobrinus and dental caries in rats: A basis for the carie-protective effect of dairy products. Caries Res 33:446-454.

10. Grenby TH et al. 2001. Dental carie-protective agents in milk and milk products: investigations in vitro. J Dent 29:83-92.

11. Jensen ME. 1984. Diet, nutrition and oral health. J Am Dent Assoc 109:29-32.

12. Gedalia I et al. 1994. Dental caries protection with hard cheese consumption. Am J Dent 7:331-332.

13. Moynihan PJ et al. 1999. The cariostatic potential of cheese: cooked cheese-containing meals increase plaque calcium concentration. Br Dent J 187:664-667.

14. Linke HA et Riba HK. 2001. Oral clearance and acid production of dairy products during interaction with sweet foods. Ann Nutr Metab 45:202-208.

15. 320:576.