Dental caries is a dynamic process that involves susceptible tooth surfaces, cariogenic bacteria like Streptococcus mutans or Lactobacillus and a fermentable carbohydrate source. Fermentable carbohydrates are primarily sucrose, but all carbohydrates are generally considered cariogenic.[1] Other factors such as salivary gland hypofunction, lack of motivation for maintaining oral hygiene, socioeconomic and cultural differences, parenting practices, genetics, among other factors, play a major role in the development of dental disease. Frequent consumption of carbohydrates in the form of simple sugars increases the risk of dental caries.[2][3]

The first few years after birth are very important since there is a massive dietary shift from an exclusively milk and liquid diet to a modified adult diet. Human milk is recommended strongly in the first year of life because it provides superior nutrition and immunity in the first year of life. Breast milk has found to be insignificant in the development of early childhood caries as compared to nighttime bottle feeding which can lead to early childhood caries.

Parenting plays an important role in the transition from milk to solid foods. Parents influence what the child likes or dislikes, the quality of diet, and overall weight status.[4]

Malnutrition (over and undernutrition), especially in children, is a result of improper dietary behaviors and feeding practices in infancy and childhood. It is usually related to limited access to fresh, nutritiously dense foods that parents replace with high-energy, low-cost, nutrient-poor, fatty, and sugary foods.[2] There is a lack of quality food stores in rural areas and poor neighborhoods. Diets also change according to traditional ethnic eating behavioral changes and hence, increase the risk of dental disease in childhood and infancy.

Nutrition affects oral hygiene, and proper nutrition is also important during tooth development. It may increase the risk of dental and periodontal disease.

Developmental diseases develop due to nutritional deficiencies like:

• Delayed tooth eruption, decreased enamel solubility, salivary gland dysfunction are due to protein deficiencies.
• Vitamin A deficiency leads to impaired epithelial tissue development, tooth formation, and enamel hypoplasia.
• Vitamin D and calcium deficiency causes hypo-mineralisation, delayed eruption, the absence of lamina dura, abnormal alveolar bone patterns.
• Delayed wound healing, dentin malformations, bleeding gums, pulpal alterations, defective collagen formation are due to vitamin C deficiency.
• Angular cheilosis and periodontal diseases are due to deficiency of vitamin B.[5][6]

Understanding how diet, eating behaviors, demographics, and environmental factors contribute to caries rates in children and adults is essential to improve the oral component of general health. Since dental caries is assumed to be a multifactorial disease, the role of dietary sugar in controlling the disease is underestimated. Dietary sugars are the substrate for cariogenic bacteria to flourish and generate enamel-demineralizing acids. Dental erosion is one of the concerning factors which is on the rise. It is associated with dietary acids which are consumed through beverages and soft drinks. There is a strong correlation between the amount and the frequency of free sugar intake and dental caries. Refined foods and fermentable carbohydrates increase the risk of dental disease. On the other hand, starchy staple food and fresh fruits have shown to be associated with low levels of caries activity.[3]

Dental diet and nutrition play a crucial role in childhood caries.[7] The best way to prevent disease is to take early precautions like using fluoride, eating nutritional foods, and properly brushing teeth. Fluorides reduce the risk of caries but do not eliminate them. They cause remineralization and demineralization of tooth enamel. Fluorides are consumed in small quantities by humans and occur naturally in the environment. Apart from dietary, respiratory and supplemental fluorides, the most important source of fluoride is fluoridated water.[3] During pregnancy, the placenta acts as a barrier, but fluorides can cross the placenta, and low concentrations are available to the fetus. Low concentrations of fluoride are also transmitted through the plasma of the mother's milk. The most important fluoride action is through the saliva in appropriate concentrations. The only disadvantage of fluoride doses and application is possible toxicity. The application should be well supervised. Overexposure to fluorides can cause dental fluorosis.[8] Pregnant women must be encouraged to breastfeeding to restrict nighttime bottle feeding to decrease the risk of developing nursing bottle caries. Parents and families need to be counseled to promote healthy eating behaviors and habits.

For poor neighborhoods, affordable healthy foods should be made available to promote the general health of growing children. The frequency of consuming free sugars should be limited and should not exceed 4 times a day. Diet soda and energy drinks include citric and phosphoric acids which may lead to demineralization of tooth enamel. Regular brushing and rinsing of mouth, using straws and sugar-free chewing gums may help to prevent the harmful effects of liquid fermentable carbohydrates. Other foodstuffs that counter the harmful effects and destructive of fermentable carbohydrates should be used to their best abilities. Fats and proteins in the diet help to protect the teeth from sugars that become adherent to the teeth. Dairy products rich in calcium and phosphorous help in remineralization by preventing the pH of the mouth from falling below 5.5 Good nutrition helps to prevent periodontal infection and diseases. Crunchy and fibrous food increases the flow of the saliva which has antibacterial properties.[3]

Primary health care providers should be observant of obesity in children because early intervention can improve children's health status.[9]

The other issues healthcare professionals should be aware of are the ever increasing fast food chains that provide the foods which are responsible for the excessive calories and obesity issues amongst children and adolescents.

Closing the gap between the racial, ethnic, and demographic minorities is very important and must be done with multiple partners including healthcare providers like pediatricians, physicians, dentists, dieticians, and allied health professionals and also local community leaders, government agencies, educators, legislators, media, industry, and related fields.[9]