Exploring Oral Function, Protein Intake, and Risk of Sarcopenia: A Scoping Review.

INTRODUCTION: Sarcopenia is loss of both muscle mass and function with age and is associated with inadequate protein intake. However, evidence to suggest an association with oral health is less clear. OBJECTIVE: To scope peer-reviewed published evidence (2000-2022) pertaining to oral function in relation to sarcopenia and/or protein intake in older people. METHODS: CINAHL, Embase, PubMed, and Scopus were searched. Included were peer-reviewed studies measuring oral function (e.g., tooth loss, salivary flow masticatory function, strength of muscles of mastication, and tongue pressure) and a measure of protein intake and/or a measure of sarcopenia (appendicular muscle mass and function). Full article screening was conducted by 1 reviewer with a random 10% screened in duplicate by a second reviewer. Relevant content pertaining to study type, country of origin, measures of exposure, and outcomes and key findings was mapped and the balance of data showing a positive versus null association of oral health with outcomes charted. RESULTS: Of 376 studies identified, 126 were screened in full, yielding 32 included texts, of which 29 were original articles. Seven reported intake of protein and 22 reported measures of sarcopenia. Nine distinct oral health exposures were identified, with ≤4 studies relating to any one of these measures. Most data were cross-sectional in nature (27 studies) and from Japan (20 studies). The balance of data showed associations between tooth loss and measures of sarcopenia and protein intake. However, the balance of data pertaining to any association between chewing function, tongue pressure, or indices of oral hypofunction and sarcopenia was mixed. CONCLUSION: A broad range of oral health measures have been studied in relation to sarcopenia. The balance of data suggests that tooth loss is associated with risk, but data pertaining to the oral musculature and indices of oral hypofunction are mixed. KNOWLEDGE TRANSFER STATEMENT: The findings of this research will increase awareness among clinicians of the amount and nature of evidence pertaining to the relationship between oral health and risk of compromised muscle mass and function, including data showing that loss of teeth is associated with increased risk of sarcopenia in older people. The findings highlight to researchers the gaps in the evidence and where further research and clarification of the relationship between oral health and risk of sarcopenia is warranted.

Systematic Review of the Effect on Caries of Sugars Intake: Ten-Year Update.

An update of the systematic review of evidence on the association between amount of sugars intake and dental caries, as well as on the effect of restricting sugars intake to <10% and <5% energy (E) on caries, was conducted, almost 10 y since the review that informed the World Health Organization (WHO) Guideline on Sugars. The aim was to systematically review epidemiological data published from 2011 to 2020 on the amount of sugars consumption and levels of caries and to report the findings for adults and children. Data sources included MEDLINE, EMBASE, Cochrane Database, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences, China National Knowledge Infrastructure, Scopus, and Google Scholar. Eligible studies reported the amount of sugars and caries, measured as prevalence, incidence, or severity. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Risk of bias was assessed using the Office of Health Assessment and Translation tool. Vote counting and harvest plots provided the basis for evidence synthesis. From 488 new papers identified, 23 studies were eligible: 4 cohort, 1 case-controlled, 12 cross-sectional, and 6 ecological. Eleven of 15 studies in children and 6 of 8 studies in adults reported at least 1 positive association between sugars and caries. Six of 7 studies in children and 4 of 4 studies in adults, with data enabling comparison of caries levels with sugars intakes >10%E and <10%E, showed lower caries when sugars intake was <10%E. Amalgamating with original studies yielded 64 of 78 studies showing at least 1 positive association, 20 of 78 a null association, and 3 of 78 a negative association between sugars and caries. GRADE profiles of new and original cohort data confirmed "moderate-quality" evidence that caries is lower when sugars intake is <10%E. Furthermore, new cohort data upgraded the quality of evidence (from "very low" to "low") for lower caries when free sugars are <5%E. The findings support and strengthen original evidence underpinning the WHO recommendations for sugars.

The Impact of Replacement Conventional Dentures on Eating Experience.

INTRODUCTION: Despite much research on the impact of edentulism and prosthetic rehabilitation on food and nutrient intake, there is little information on how replacing complete dentures affects social and emotional issues around eating. OBJECTIVES: To investigate, in a cohort study, how replacing conventional complete dentures affects eating-related quality of life (ERQoL). A secondary aim was to test the responsiveness of an Emotional and Social Issues Related to Eating (ESIRE) questionnaire to change in ERQoL. METHODS: Participants, recruited from the Dental Hospital, Newcastle-upon-Tyne, UK, completed the self-administrated ESIRE questionnaire before and after provision of new conventional complete dentures. Paired t test was used to determine any change between pre- and posttreatment ESIRE scores, which can range from 0 (poor) to 100 (excellent). Cohen's d effect size was used to measure the magnitude of change in ERQoL. Standardized response mean (SRM) was used to measure the responsiveness of the ESIRE questionnaire to changes in ERQoL. RESULTS: Fifty-five participants aged 52 to 85 y (mean, 72 y), including 21 males (42%) and 29 females (58%), completed the study. A statistically significant improvement in the total ESIRE scores was found, mean (SE) +20.3 (3.30), P < 0.001. Equally, all domains of the ESIRE questionnaire showed significant improvements: enjoyment of food/eating, +27.3 (3.63), P < 0.001; self-consciousness/embarrassment, +18.1 (3.88), P < 0.001; interruption to meals, +13.3 (5.27), P < 0.05; confidence when eating, +18.7 (4.84), P < 0.001; time for eating/preparation of meals, +18.5 (4.85), P < 0.001); and functional ability to eat, +18.2 (3.67), P < 0.001). Cohen's d was large (0.95) for the total score and ranged from medium (0.37) to large (1.30) for all domains. Value of SRM was large (0.87) for the total score and ranged from medium (0.36) to large (1.1) for all domains. CONCLUSION: Denture replacement can directly improve ERQoL. The ESIRE questionnaire was responsive to clinically important changes in ERQoL. KNOWLEDGE TRANSFER STATEMENT: The results of this study improve the understanding of the impact of denture replacement on eating-related quality of life (ERQoL). Clinicians are encouraged to pay more attention to the impact of wearing conventional complete dentures on social and emotional issues around eating. The findings should motivate clinicians and inspire specialists in prosthodontics and oral rehabilitation to continue providing conventional complete dentures as a suitable treatment option for edentulous patients.

Effects of Starch on Oral Health: Systematic Review to Inform WHO Guideline.

A systematic review was conducted to update evidence on the effect of total dietary starch and of replacing rapidly digestible starches (RDSs) with slowly digestible starches (SDSs) on oral health outcomes to inform updating of World Health Organization guidance on carbohydrate intake. Data sources included MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, LILACS, and Wanfang. Eligible studies were comparative and reported any intervention with a different starch content of diets or foods and data on oral health outcomes relating to dental caries, periodontal disease, or oral cancer. Studies that reported total dietary starch intake or change in starch intake were included or where comparisons or exposure included diets and foods that compared RDSs and/or SDSs. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) statement, and evidence was assessed with the GRADE Working Group guidelines. From 6,080 papers identified, 33 (28 studies) were included in the RDS versus SDS comparison: 15 (14 studies) assessed the relationship between SDS and/or RDS and dental caries; 16 (12 studies) considered oral cancer; and 2 studied periodontal disease. For total starch, 23 papers (22 studies) were included: 22 assessed the effects on dental caries, and 1 considered oral cancer. GRADE assessment indicated low-quality evidence, suggesting no association between total starch intake and caries risk but that RDS intake may significantly increase caries risk. Very low-quality evidence suggested no association between total starch and oral cancer risk, and low-quality evidence suggested that SDS decreases oral cancer risk. Data on RDS and oral cancer risk were inconclusive. Very low-quality data relating to periodontitis suggested a protective effect of whole grain starches (SDS). The best available evidence suggests that only RDS adversely affects oral health.

Fluoride intake of infants living in non-fluoridated and fluoridated areas.

OBJECTIVES: Data on fluoride exposure of infants are sparse. This study aimed to estimate total daily fluoride intake (TDFI) of infants aged 1-12 months, living in non-fluoridated and fluoridated areas in north-east England. METHODS: Daily dietary fluoride intake was assessed using a three-day food diary coupled with analysis of fluoride content of food/drink consumed, using a F-ISE and diffusion method. A questionnaire with an interview was used to collect information on toothbrushing habits. TDFI was estimated from diet, plus fluoride supplements and dentifrice ingestion where used. RESULTS: Thirty-eight infants completed the study; 19 receiving fluoridated water (mean 0.97 mgF/l) and 19 receiving non-fluoridated water (mean 0.19 mgF/l). Mean (SD) TDFI for the infants living in fluoridated and non-fluoridated areas was 0.107 (0.054) and 0.024 (0.015) mg/kg body weight per day, respectively. Diet was the only fluoride source for 87% of infants and none used fluoride supplements. For infants for whom mouth/teeth cleaning was undertaken, dentifrice contribution to TDFI ranged from 24 to 78%. CONCLUSIONS: Infants living in fluoridated areas, in general, may receive a fluoride intake, from diet only, of more than the suggested optimal range for TDFI. This emphasises the importance of estimating TDFI at an individual level when recommendations for fluoride use are being considered.

Impact of a customised dietary intervention on antioxidant status, dietary intakes and periodontal indices in patients with adult periodontitis.

BACKGROUND: Dietary modification may be important in the prevention and control of chronic adult periodontitis. The role of promoting an adequate consumption of fruits, vegetables and whole grains in chronic periodontitis has not been thoroughly investigated. The main aim of this dietary intervention study was to assess the influence of a customised dietary intervention (aiming to increase the consumption of fruits, vegetables and whole grains) on antioxidant status in adults with chronic periodontitis. METHODS: Fifty-one participants, aged 30-65 years, were recruited from a U.K. Dental Hospital and randomly allocated to an intervention or control group. Both groups received normal clinical treatment but customised dietary advice was delivered to the intervention group by a community nutrition assistant. Dietary intakes, anthropometric parameters and biochemical indices with respect to blood and saliva and periodontal indices were evaluated at baseline, as well as at 3 and 6 months post-dietary intervention. RESULTS: At 3 and 6 months post-intervention, the intervention group showed a significant (P < 0.05) increase in plasma total antioxidant capacity measured by Trolox equivalent antioxidant capacity assay compared to the control group. At 3 and 6 months after dietary intervention, the intervention group had significantly higher intakes of fruits and vegetables compared to the control group. The intake of whole grain was significantly higher in the intervention group than in the control group, 6 months post-intervention. No significant differences were observed with respect to periodontal indices between groups. CONCLUSIONS: It is suggested that dietary advice may help to improve dietary habits and, consequently, the antioxidant status of patients with chronic periodontitis. However, the impact of such intervention on periodontal indices needs further investigation.

Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines.

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to < 10% and < 5% energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption. Data sources included MEDLINE, EMBASE, Cochrane Database, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences, China National Knowledge Infrastructure, Wanfang, and South African Department of Health. Eligible studies reported the absolute amount of sugars and dental caries, measured as prevalence, incidence, or severity. The review was conducted and reported in accordance with the PRISMA statement, and the evidence was assessed according to GRADE Working Group guidelines. From 5,990 papers identified, 55 studies were eligible - 3 intervention, 8 cohort, 20 population, and 24 cross-sectional. Data variability limited meta-analysis. Of the studies, 42 out of 50 of those in children and 5 out of 5 in adults reported at least one positive association between sugars and caries. There is evidence of moderate quality showing that caries is lower when free-sugars intake is < 10% E. With the < 5% E cut-off, a significant relationship was observed, but the evidence was judged to be of very low quality. The findings are relevant to minimizing caries risk throughout the life course.

Compliance with school F-milk and non-F milk intake in 3 to 4 and 6 to 7-year-old children.

BACKGROUND: Fluoridated (F) milk schemes are employed in six countries to reduce dental caries in children. To maximise their benefits considerable uptake is required. Measuring compliance and understanding contributing factors is important in evaluating the effectiveness of schemes since it can be unclear whether reported sub-optimal fluoride (F) intakes, measured through urinary F excretion, are due to sub-optimal F contents of milks or lack of compliance with consumption. OBJECTIVES: To determine compliance with milk consumption for children receiving non-F or F milk (containing 0.5 or 0.9 mgF per 189 ml carton) and rationalise the use of compliance data for clinical observational or intervention studies involving F milk schemes. RESEARCH DESIGN: Partially randomised, partial cross-over study. PARTICIPANTS: 50 children aged 3-4 and 6-7y consuming non-F (n=50) and F milk (0.5 mgF; n=15 children; 0.9mg F; n=16 children) at school. RESULTS: Mean compliance for both non-F and F milk was > or =90% in each of the groups studied and showed no statistically significant difference for children using both milks. The 95% central range of proportions of milk consumed for groups of individuals was wider for 0.9mgF milk (25% to 100%) than for 0.5 mgF milk (81% to 100%) although the greatest range of variation in compliance for within individual observations was seen for non-F milk consumption and in older children. CONCLUSION: Assessment of compliance with consumption should be included when dental efficacy of F milk consumption is being investigated or evaluated to quantify F exposure from milk. This is important, particularly if a change in the F dose of F milk might be under consideration.

Do implant-supported dentures facilitate efficacy of eating more healthily?

UNLABELLED: Edentulous persons have poor diet quality demonstrating a need for dietary intervention. Implant-supported mandibular overdentures (IODs) have functional advantages over conventional dentures (CD), but whether they enhance the ability to eat more healthily following dietary advice is unknown. OBJECTIVES: This study aimed to compare the effectiveness of dietary intervention between IODs and CD patients. METHODS: Edentulous adults (28 IOD and 26 CD) received customised dietary advice. The percentage contribution of dietary fats, carbohydrate and protein to energy (kcal) intake, dietary intakes of fibre, fruits, vegetables and antioxidants, and plasma antioxidants were assessed pre- and at 3 and 6 months post-dietary intervention. RESULTS: Both groups increased fruit and vegetable intake at 3 and 6 months following dietary intervention but intakes between groups did not differ. The IOD group had reduced % energy from total fat at 3 and 6 months and from saturated fat at 3 months. The CD group had reduced % energy from saturated by 6 months. The IOD group had a significantly lower % energy intake from saturated fat at 3 months and higher intake of non-starch polysaccharide (NSP) compared with the CD group. Both groups showed improvements in serum antioxidant status but the IOD group had significantly higher plasma antioxidant capacity post intervention compared with the CD group. CONCLUSIONS: Dietary intervention benefits denture patients. IOD patients showed moderately greater dietary improvements compared with conventional denture patients.

Development of a patient-based questionnaire about emotional and social issues related to eating with dentures.

OBJECTIVES: In order to fully assess the impact of prosthetic rehabilitation and to formulate appropriate dietary advice, in-depth information about patients' experiences of eating with dentures is needed. The objective of this study was to develop and validate a questionnaire that accurately reflected the real concerns of patients with dental prostheses about the aspects of their life related to eating, using detailed information derived from qualitative interviews with patients. METHODS: Themes around factors related to eating with dentures were derived from interviews with patients (n=66) with either implant-supported mandibular over-dentures or conventional dentures. The themes were used to design a self-completed questionnaire with questions scored on a visual analogue scale and additionally questions answered using free text. The content and face validity of the questionnaire was tested on a different group of patients (n=10) with implant-supported mandibular over-dentures ('implant-supported') or conventional dentures. Test-retest reliability analysis was conducted on a further group of 30 patients (n=15 implant-supported; n=15 conventional dentures). RESULTS: A questionnaire has been developed with 33 questions scored on a visual analogue scale and 31 open questions designed to collect further information as free text. Themes identified were around social, emotional and practical issues about eating. The instrument has good internal reliability with a Cronbach alpha values of 0.86-0.95 and good test-retest reliability with intra-class correlation coefficients 0.87-0.92 across the domains. CONCLUSIONS: A patient-based instrument has been developed to measure emotional and social issues related to eating with dentures (ESIRE questionnaire). The questionnaire will be a useful tool in future trials of prosthetic rehabilitation.

Dental erosion among 12 year-old Libyan schoolchildren.

OBJECTIVE: As there are limited data on dental erosion in Libya, the aim of this study was to assess the prevalence and severity of dental erosion in a sample of 12 year-old children in Benghazi, Libya. BASIC RESEARCH DESIGN: Cross-sectional observational study. CLINICAL SETTING: Elementary schools in Benghazi, Libya. PARTICIPANTS: A random sample of 791 12 year-old children (397 boys and 394 girls) attending 36 schools. METHODS: Clinical dental examination for erosion using UK National Diet and Nutrition Survey (2000) criteria and self-completion questionnaire. MAIN OUTCOME MEASURES: The area and depth of dental erosion affecting the labial and palatal surfaces of the upper permanent incisors and occlusal surfaces of the first permanent molars. RESULTS: Dental erosion was observed in 40.8% of subjects; into enamel affecting 32.5%, into dentine affecting 8.0% and into pulp affecting 0.3% of subjects. Based on area affected, 323 subjects (40.8%) exhibited dental erosion (code > 0), with 32.6% of these subjects having erosion affecting more than two thirds of one or more surfaces examined. Mean total scores for dental erosion for all surfaces per mouth by area and by depth were both 2.69 (sd 3.81). Of the 9492 tooth surfaces examined, 2128 surfaces (22.4%) had dental erosion. Girls had more experience of erosion than boys at all levels of severity (p = 0.001). CONCLUSIONS: In a cohort of 12 year-old Libyan schoolchildren, more than one third of children examined showed dental erosion, requiring clinical preventive counselling. Significantly more erosion occurred in girls than boys.

Dental erosion and its association with diet in Libyan schoolchildren.

AIM: To investigate any association between dental erosion and its potential dietary risk factors in a group of schoolchildren in Benghazi, Libya. STUDY DESIGN: A cross-sectional observational study. METHODS: A random sample of 12-year-old schoolchildren in 36 randomly selected schools completed a questionnaire to provide dietary data and underwent dental examination. Dental erosion was assessed using UK National Diet and Nutrition Survey (2000) criteria. Associations between erosion and dietary variables under study were investigated through processes of bivariate and multivariate analyses. RESULTS: Of 791 schoolchildren dentally examined, 40.8% had dental erosion; erosion into enamel affecting 32.5%, into dentine affecting 8% and into pulp affecting 0.3% of subjects. Bivariate analysis showed frequency of fruit-based sugary drink intake was statistically significantly and positively associated with erosion (p=0.006, Odds Ratio; 1.498, 95% CI; 1.124, 1.996) as was the length of time taken to consume acidic drinks (p≠0.005, Odds Ratio; 1.593, 95%CI; 1.161, 2.186). Additionally, multivariate analysis showed frequency of consumption of fruit other than bananas, sugared tea with milk and flavoured milk to also be positively associated with erosion (p=<0.05). CONCLUSIONS: In this group of Libyan 12-year-olds, frequency of consumption of fruit-based sugary drinks and length of time taken to consume acidic drinks were the primary statistically significant positive risk factors for dental erosion.

Association of removable partial denture use with oral and systemic health.

OBJECTIVES: This narrative literature review aims to consider the impact of removable partial dentures (RPDs) on oral and systemic health. DATA AND SOURCES: A review of the literature was performed using Medline/PubMed database resources up to July 2011 to identify appropriate articles that addressed the objectives of this review. This was followed by extensive hand searching using reference lists from relevant articles. CONCLUSIONS: The proportion of partially dentate adults who wear RPDs is increasing in many populations. A major public health challenge is to plan oral healthcare for this group of patients in whom avoidance of further tooth loss is of particular importance. RPDs have the potential to negatively impact on different aspects of oral health. There is clear evidence that RPDs increase plaque and gingivitis. However, RPDs have not clearly been shown to increase the risk for periodontitis. The risk for caries, particularly root caries, appears to be higher in wearers of RPDs. Regular recall is therefore essential to minimise the risk for dental caries, as well as periodontitis. There is no evidence to support a negative impact on nutritional status, though research in this area is particularly deficient. Furthermore, there are very few studies that have investigated whether RPDs have any impact on general health. From the limited literature available, it appears that RPDs can possibly improve quality of life, and this is relevant in the era of patient-centred care. Overall, further research is required to investigate the impact of RPDs on all aspects of oral and general health, nutritional status and quality of life.

Perceived chewing ability and intake of fruit and vegetables.

Edentulous individuals have reduced chewing ability and lower fruit and vegetable consumption compared with dentate individuals. It has been suggested that the two are causally related. However, psychosocial factors such as attitude, self-identity, and knowledge of recommendations are predictive of intake in non-edentulous persons. The aims of this study were to: determine if perceived chewing ability was predictive of fruit and vegetable intake; explore the predictive ability of knowledge, attitude, and self-identity; and compare intake between edentulous and dentate individuals. Full denture-wearing (N = 79) and dentate persons (N = 52) completed a three-day food diary. Perceived chewing ability, sociodemographic, and psychosocial factors were assessed via self-administered questionnaire. The dentate persons consumed significantly more fruit and vegetables, but differences were not significant when juices were excluded. Perceived chewing ability explained approximately 4% variance in intake. Attitude, self-identity, and knowledge explained a further approximately 20%. If the diet of denture-wearers is to be improved, psychosocial factors, as well as perceived chewing ability, must be addressed.

Attitudes and practices of dentists with respect to nutrition and periodontal health.

OBJECTIVE: To determine the opinions and attitudes of general dental practitioners and hygienists towards the role of nutrition in periodontal health. SETTING: The study was completed by general dental practitioners and dental hygienists throughout the UK. METHOD: A questionnaire was sent out with the British Dental Journal and BDA News together with explanatory information about the study. Postage was pre-paid for replies. RESULTS: Eight hundred and seventy-nine questionnaires were completed. Sixty-six percent of respondents believed nutrition plays a role in periodontal health. Dietary factors that were considered most important were vitamin C (70%), fruit and vegetables (64%) and antioxidant vitamins (45%). Forty-four percent had recommended nutrition supplements to their patients, with multivitamin and mineral supplements (37%) and vitamin C (30%) the most popular. Eighty-two percent of respondents sourced information from dental journals. Qualitative data highlighted uncertainty amongst respondents about the evidence base around nutrition and periodontal health and a lack of training opportunities. CONCLUSIONS: A majority of dentists consider that nutrition and dietary factors play a role in maintaining periodontal health. However, there was a need to increase awareness of the current state of the evidence for a role of nutrition in maintaining periodontal health. Concern regarding lack of an evidence base for the role of nutrition in the treatment of periodontal diseases suggests a need for further research into the therapeutic role of nutrition in periodontal disease management.

Fluoride intake and urinary excretion in 6- to 7-year-old children living in optimally, sub-optimally and non-fluoridated areas.

OBJECTIVES: This study was designed to measure total intake, urinary excretion and estimated retention of fluoride in children under customary fluoride intake conditions, living in either fluoridated or low-fluoride areas of north-east England. Subsidiary aims were to investigate the relationships between the variables measured. METHODS: Using a randomized cluster design with schools as the sampling units, four schools from a non-fluoridated area and two from a fluoridated area were selected from the schools chosen to participate in the study. Fluoride intake from diet and toothbrushing was assessed using a 3-day food diary and fluoride analysis of expectorated saliva during toothbrushing. Samples of all foods and drinks consumed were measured for fluoride content using direct and indirect silicon-facilitated diffusion methods as appropriate. Urinary fluoride excretion and urine volume were measured over 24 h and estimation of fractional urinary fluoride excretion (FUFE) and fluoride retention made from collected data. Following descriptive analysis of variables, Pearson's correlations investigated relationships between fluoride content of home tap water, daily fluoride intake, excretion and retention. RESULTS: Thirty-three children completed the study: 18 receiving non-fluoridated water [mean = 0.08 (+/-0.03) mg F/l], nine sub-optimally fluoridated water [mean = 0.47 (+/-0.09) mg F/l] and six optimally fluoridated water [mean = 0.82 (+/-0.13) mg F/l] at the time of the study. Complete data on F intake, excretion and retention were available for 29 children. Mean fluoride intake from diet and toothpaste ranged from 0.031 (+/-0.025) mg/kg body weight (bw)/day for the low-fluoride area to 0.038 (+/-0.038) and 0.047(+/-0.008) mg/kg bw/day for sub-optimally and optimally fluoridated areas respectively. Contribution of toothpaste to total fluoride intake ranged from 3% to 93% with mean values of 57%, 35% and 47% for children receiving low, sub-optimally and optimally fluoridated water respectively. FUFE ranged from a mean of 32% (+/-13%) for the optimally fluoridated area to 44% (+/-33%) for the low-fluoride area. Fluoride retention was not correlated with the fluoride concentration of home water supply, but was strongly positively correlated (P < 0.001) with total daily fluoride intake. CONCLUSIONS: In an industrialized country, total fluoride intake, urinary excretion and consequently fluoride retention no longer reflect residence in a community with a non-fluoridated or fluoridated water supply. Fluoride toothpaste contributes a significant proportion of total ingested fluoride in children, particularly in low-fluoride areas.

The nutrition knowledge of older adults living in sheltered housing accommodation.

BACKGROUND: Nutrition knowledge enables informed dietary choices. This paper reports on the nutrition knowledge of older adults residing in sheltered housing accommodation in socially deprived areas of north-east England. METHOD: As part of a cluster randomized dietary intervention trial, a validated questionnaire measured the knowledge of current dietary recommendations, nutrient sources, ability to select healthy meal options and knowledge of associations between diet and diseases of older adults aged 60 years and over residing in sheltered accommodation. RESULTS: Completed questionnaires were obtained from 177 (59%) subjects (147 female, 30 male), of whom 76% were overweight/obese and 2% underweight. The mean (SD) age was 76.4 (8.0) years. Of a possible score of 47, the mean score was 23.2, indicating that approximately 50% of questions were answered incorrectly. Knowledge of associations between diet and diseases was particularly poor; 90% of subjects being unaware of the benefits of high fruit and vegetable consumption. Respondents in the highest 10% of the nutrition knowledge score had a significantly higher intake of fruit and vegetables compared with those in the lowest 10%. CONCLUSION: A high proportion of older adults had little basic nutrition knowledge; this presents a barrier to healthier eating that should be addressed.