We have discussed briefly the development of the teeth so as to point out the importance of planning early for their nutrition. It is clear that this must be provided for before the baby is born, the mother including the necessary elements for this purpose in her diet. In addition to emphasizing the prenatal period as a formative time it seems to us that certain other periods of life in which dental changes are likely to occur, should be singled out for special comment. The present knowledge of dental nutrition leads to the placing of emphasis on calcium, phosphorus and vitamins A, D and C as specific requirements for all ages. It is undoubtedly correct to assume that a well balanced diet in respect to other essential food substances is necessary in the normal growth and development of the teeth.
Diet during Pregnancy and Lactation. The mother needs an adequate diet planned in harmony with the principles already discussed. Proteins and fats should be used in smaller amounts while mineral foods and vitamins should be provided in greater proportions than normally required. Calcium and phosphorus are needed for the proper development of the infant’s bones and teeth. Toward the end of pregnancy when the need for these substances by the growing fetus is at the maxi-mum, they should be provided even more freely. The simplest and most satisfactory way to obtain calcium and phosphorus is to use one quart of milk daily, supplemented with a moderate amount of cereals and liberal amounts of fruits and vegetables. During this period she should not experience an abnormal gain in weight. The fact that the extra whole milk may be fattening need not prevent her from taking milk, for skimmed milk may be used. Very little of the calcium and phosphorus are lost when the cream is removed. If the expectant mother does not like milk, she should be willing to take it in the interest of her child. If she is sensitive to it, then extra attention must be paid to the selection of foods or other substances so as to pro-vide adequate amounts of these minerals.
That vitamins A, D, and C are necessary in the development of sound teeth has been demonstrated in experimental work. Sufficient vitamin A will be provided with a quart of milk in the diet. The mother should be out-of-doors in the sunshine as much as possible so that the sun may make vitamin D in her own skin. -If she could live in the tropics the vitamin D supplied in this way might be adequate, but in temperate zones she should obtain some from other sources. Foods are comparatively poor sources, except when irradiated. Irradiated foods and fish liver oils should therefore be used if necessary. Her diet should contain generous amounts of raw fruits and vegetables, because these contain vita-min C, which has been shown to be necessary for the prevention of scurvy, the earliest manifestations of which are seen in blood vessel changes around the teeth.
The need for minerals and vitamins during lactation is greater than during pregnancy, so the mother must continue a similar program of diet as long as she nurses the baby. We favor mothers nursing their babies when-ever possible, because the calcium and phosphorus in human milk is in a form more easily absorbed than that found in cow’s milk or prepared formulas.
Infancy. The newborn baby is always given milk. As stated above, it should have mother’s milk if possible. If for any reason this is not available, then formulas containing cow’s milk are used. These are planned to furnish calcium and phosphorus in proper proportions. All vitamins are important to the baby. Vitamin A is provided in the milk. Vitamin D, found in sources already mentioned, must be provided. The baby may make some of its own vitamin D if it is allowed plenty of sunshine. Special attention must be given to insure an adequate supply of vitamin C as cooked foods are added to the diet. Often a few drops of orange juice or tomato juice, which are very good sources of vitamin C, are given to the baby before it is two weeks old. There are many vacuum packed preparations of sieved fruits and vegetables on the market suitable for infant feeding. These retain vitamin C, which is destroyed by heat only in the presence of oxygen.
After weaning, the infant should be given one quart of milk daily. While additional cereals, fruits, and vegetables are put into the diet during the second year, care must be taken to see that the necessary food substances are provided which will build the tissues being formed at that time. Milk provides the calcium and some of the phosphorus needed in building bones and teeth. It also supplies vitamin A. Raw fruit juices will insure adequate vitamin C; and generally, vitamin D can be supplied in adequate amounts by using irradiated foods and cod liver oil or similar preparations. Milk from cows fed a diet well supplied with vitamins A and D will probably supply these vitamins in suitable amounts.
Not only are minerals and vitamins needed for the formation of the deciduous teeth which appear in this period, but also for the early development of the permanent teeth which are forming deeper in the jaws at the same time.
Childhood. The greatest loss of teeth from decay occurs between the ages of two and four years. This may be due in part to poor prenatal and infant nutrition. At this age the child is ready to take a fairly generous mixed diet. Too often they are fed according to their size rather than according to their needs. Childhood is a period of rapid growth and tooth development. Calcium, phosphorus and vitamins must be liberally supplied in the diet. Children need, crave, and should have a high carbohydrate diet. This should be provided largely with generous amounts of fruits and vegetables rather than with concentrated sweets, so that in addition to the necessary carbohydrates they will be given the valuable minerals and vitamins. Some raw fruits, fruit juices, or raw vegetables should be included daily to provide vitamin C. Extra vitamin D may be supplied in the form of irradiated foods or fish liver oils.
Adolescence. Children also lose many teeth from decay between the ages of 12 and 15 years. During this period food requirements reach a maximum. Too often unwise food restrictions are self-imposed to achieve an artificial ideal in weight or form. Teeth may share in the damage to health generally by such a course. Tea and coffee are often substituted for milk in the diet because of the erroneous idea that milk is meant only for small children. Fruits and vegetables are often replaced by more refined and tempting articles of food. If glandular changes bear any relation to dental nutrition this is probably the period when an adequate diet should be most carefully followed.
Adult Life. After the growing years, practically every one of the principles mentioned above must continue to apply if good dental nutrition is to continue. This is particularly true with the young adult as tooth decay is very prevalent during the ages of 22 and 25 years. There is a difference of opinion as to whether the adult needs to continue to take an extra supply of vitamin D. Theoretically, if an adequate amount of sunshine is al-ways available after the growing period, the adult may make enough vitamin D to supply the body’s needs, except as stated above, during the gestation and nursing periods. Adults, too frequently stop drinking milk. It is extremely difficult to supply an adequate amount of calcium and phosphorus in the diet without at least one pint of milk per day, and since no possible harm can come from the taking of more milk, a safe general rule would be to use one quart of milk daily from the cradle to the grave. Those who prefer not to use sweet milk may supply the same minerals very satisfactorily by using sour milk or cheese.
Briefly summing up our knowledge of dental nutrition, we would recommend that the elements necessary in producing strong sound teeth be provided long before the child is born, and that a liberal supply of the same elements be planned for throughout life. Ample mineral foods must always be included in the diet. Special attention is necessary to insure sufficient calcium and phosphorus. Adequate vitamins must always be supplied, especially A, D, and C, to insure the most favorable states for the growth and maintenance of sound sturdy teeth.