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The Report of the British Nutrition Foundation's Task Force, edited by Ursula Arens, 1998, 240 pages, hardcover, $139.50. Elsevier for the British Nutrition Foundation, Amsterdam.
This book is a product of a British Nutrition Foundation Task Force on Oral Health. Thus, the text is a literature review concluding with recommendations for alleviating the widespread incidence of oral disease.
Beginning with a synopsis of oral and craniofacial anatomy and a description of oral microflora, the book documents the role of food and food components that are relevant to oral health. Although terse, the treatment of specific dietary factors and their relation to oral health is credible and represents the state of the science. One of the strengths of the book is the description of dental caries, including epidemiology and the physiologic and dietary factors that can affect the caries process. It would have been more instructive to compare the epidemiologic data on dental caries from the United Kingdom with those of other countries. The conclusion regarding dental caries is that it remains "unacceptably high" in the United Kingdom, although there is some evidence of decline over the past 25 y, primarily as a result of increased use of fluoride products and, to a more limited extent, a national reduction in sugar consumption. The Task Force's conclusions regarding diet and dental caries posteruptively are sound.
The book's attempt to be comprehensive falls short of expectations and results in some glaring omissions. For example, in the section on periodontal disease, there is little mention of the relation among calcium intake, osteoporosis, and periodontal disease. There is a "new" literature in this area that is shedding some light on these complex interactions and that may be worthy of consideration for dietary recommendations. Indeed, the literature concerning the influence of diet on periodontal disease is classic and may not be descriptive of today's understanding of the interactions of nutrition, infection, and the immune system. As a consequence, the book does not provide any substantive recommendations on diet and periodontal disease.
In the same way, the text does not discuss the interesting literature on craniofacial birth defects, including clefts of the lip and palate. The current data suggest a role of folate for at-risk women, similar to that discovered for neural tube defects. There is also a lack of attention paid to the potential influence of oral infections on systemic health and well-being, such as cardiovascular disease, stroke, low birth weight, pulmonary disease, and diabetes mellitus. This is an exciting area of contemporary research that could provide an opportunity for the Task Force to reinforce not only the continuing prevalence of the oral diseases themselves, but also the fact that oral health is intimately linked to systemic health. Frankly, the section on ill health and disease is too cursory to be meaningful.
The book does have a fine section on oral cancer and adequately covers the effects of multiple deprivations, culture, religion, and socioeconomic status on oral health behaviors. The general conclusions and recommendations made by the Task Force are reasonable, with the exceptions noted above. The recommendations for food manufacturers and pharmaceutical companies are concerned only with dental caries; it appears as though there was a missed opportunity to enlighten the pharmaceutical industry as to the advantages of developing gene-related "smart" diagnostics and therapeutics aimed at preventing and managing the neglected epidemic of oral, dental, and craniofacial diseases and disorders.
On balance, the book could be a valuable adjunct to professionals and policymakers who are concerned with improving oral health.