Introduction

Food habits are one of the most complex aspects of human

behavior, being determined by multiple motives and
directed and controlled by multiple stimuli. Food
acceptance is a complex reaction influenced by biochemical,
physiological, psychological, social and educational factors.
Metabolic conditions play an important role. Age, sex and
mental state are factors of importance. People differ greatly
in their sensory response to foods. The likes and dislikes of
the individual with respect to food move in a framework of
race, tradition, economic status and environmental
conditions1.
For most people food is cultural, not nutritional. A plant or
animal may be considered edible in one society and inedible
in another. Probably one of the most important things to
remember in connection with the cultural factors involved in
food habits is that there are many combination of food
which will give same nutritional results1.
Culture consist of values, attitudes, habits and customs,
acquired by learning which starts with the earliest
experiences of childhood, much of which is not deliberately
taught by anyone. Food habits are among the oldest and
most deeply entrenched aspects of many cultures and
cannot, therefore, be easily changed, or if forcibly changed,
can produce a series of unexpected and unwelcome
reactions. Food and food habits as a basic part of culture
serve as a focus of emotional association, a channel of love,
discrimination and disapproval and usually have symbolic
references. The sharing of food symbolizes a high degree of
social intimacy and acceptance1.
In many cultures food has a social or ceremonial role.
Certain foods are highly prized; others are reserved for
special holidays or religious feasts; still others are a mark of
social position. There are cultural classifications of food
such as ‘inedible’, ‘edible by animals’, ‘edible by human
beings but not by one’s own kind of human being’, ‘edible by
human being such as self’, ‘edible by self’. In different
cultures, certain foods are considered ‘heavy’, some are
‘light’ some as ‘foods for strength’; some as ‘luxury’, etc1.
The challenge to health care provider is to be culturally
adaptable, to display cross-cultural communication skills
and to move toward a trusting interpersonal relationship as
quickly as possible.
John Cassel (1957)3 had illustrated in his review, that it is
possible to derive some guiding principles indicating the
significance of social and cultural factors to health programs
in general. Health workers should have an intimate detailed
knowledge of the people’s beliefs, attitudes, knowledge and
behavior before attempting to introduce any innovation into
an area.
The second principle, which is usually more difficult to
apply, is that the psychologic and social functions of these
practices, beliefs, and attitudes need to be evaluated. As
stated by Benjamin Paul3, “It is relatively easy to perceive
that others have different customs and beliefs, especially if
they are ‘odd’ or ‘curious’. It is generally more difficult to
perceive the pattern or system into which these customs or
beliefs fit.” It is in this area of determining the pattern or
system into which these customs or beliefs fit those social
scientists can probably make their greatest contribution to
health programs. This is the knowledge that will help to
determine why certain practices exist, how difficult it will be
to change them, and give indications of the techniques that
can be expected to be most helpful.
A third principle that should be emphasized was
unfortunately not well illustrated in the example but is of
fundamental importance. The sub cultural groups must be
carefully defined, as programs based on premises, true for
one group, will not necessarily be successful in a
neighboring group. This also is an area in which we as health
workers can receive invaluable assistance from social
scientists.
Anne Burgess (1961)4 stated that health assistants with some
training in the principles of anthropology and education are
indeed an innovation and it appears an effective one. Where
nutrition education has proved disappointing in the past,
could it be that ‘retention of customs’ has been as ‘turbulent
a thing’ as that of the villagers.
Nelson Freimer et al (1983)5. Cultural variation may play an
important role in human nutrition and must be considered
in either clinical or public health intervention particularly in
areas with large immigrant populations. Acculturative and
environmental change influences the food habits and health
of transitional groups. Nutritional assessment may be
complicated by cultural variation. The relationship between
ethnicity and nutrition may be of evolutionary significance.
Food beliefs may have beneficial or detrimental effects on
health status. Appreciation of the interaction of culture and
nutrition may be of benefit to physicians and nutritionists in
clinical practice and to those concerned with the prevention
of nutrition related chronic diseases.
Christine M. Olson (1989)6 had stated that childhood
nutrition education is imperative in health promotion and
disease prevention. The Report concludes ‘that
overconsumption of certain dietary components is now a
major concern for Americans’. While many food factors are
involved, chief among them is the disproportionate
consumption of foods high in fat, often at the expense of
foods high in complex carbohydrates and fiber that may be
more conducive to health.
Two widely recommended strategies for incorporating
nutrition education directed toward children and youth into
health promotion and disease prevention efforts are school-
based nutrition education and the integration of nutritional
care into health care. School based nutrition education
programs targeted toward very specific eating behaviors are
showing very promising results in regard to behavior and
attitude change of children and adolescents. Substantial
changes in health care providers’ attitudes and practices
and in the funding and financing of health care will be
needed if nutrition education is to be delivered in the
context of routine health care.
Puline M Adair, Cynthia M Pine et al (2004)7 had conducted a
study on familial and cultural perceptions and beliefs of oral
hygiene and dietary practices among ethnically and socio-
economically diverse groups. Factor analysis identified
those attitudes, towards tooth brushing, sugar snacking and
childhood caries. Attitudes were significantly different in
families from deprived and non-deprived backgrounds and
in families of children with and without caries. Parents’
perception of their ability to control their children’s tooth
brushing and sugar snacking habits were the most
significant predictors of whether or not favorable habits
were reported. Some differences were found by site and
ethnic group. This study supports the hypothesis that
parental attitudes significantly has an impact on the
establishment of habits favorable to oral health. An
appreciation of the impact of cultural and ethnic diversity is
important in understanding how parental attitudes to oral
health vary. Further research should examine in a
prospective intervention whether enhancing parenting skills
is an effective route to preventing childhood caries.
Abdul Arif Khan et al (2008)8 had conducted a study on
prevalence of dental caries among the population of Gwalior
(India) in relation of different associated factors. They found
that incidence of dental caries was higher in female. High
number of dental caries patients was observed among
vegetarian population. 21-30 year age group was found to be
most infected with dental caries. This study helpful to
analyze respective role of different dietary factors including
protein rich diet, age, gender etc. on the prevalence of
dental caries, which can be helpful to counteract the
potential increase in the cases of dental caries and to design
and plan preventive strategies for the persons at greatest
risk.
Factors influencing standards of nutrition Soil
management.-As an omnivorous animal, man obtains his
food from both animal and vegetable sources. Basically,
however, the nutritive value of his diet is determined by the
nutrients present in the soil upon which his food is grown.
The nutritive elements in the soil and the fertility of the soil
depend not only on its geologic structure but also on the
manner in which the soil is conserved and cultivated. In
many underdeveloped countries the traditional horticultural
and agricultural practices are primitive, but they do
maintain the fertility of the soil. In some countries, however,
an increase in the population and industrialization has
encouraged the growth of a cash-crop economy, the
abandonment of customary practices of soil conservation,
and the impoverishment of the soil. These changes can be
reflected in deterioration in the health of both animals and
man. In Africa, for example, the prevalence of Kwashiorkor is
higher in areas with a cash-crop economy than in less
sophisticated areas where mixed farming is still practiced.

Food selection
It has often been demonstrated that, in many areas of the
world, people can live completely healthy lives despite the
fact that, according to Western standards, their nutrition is
inadequate8.
Authorities on the nutrition of people in Southeast Asia have
pointed out that a diet which appears to be deficient is
actually adequate, either because the people eat the most
nutritious parts of plants and animals which elsewhere are
thrown away as waste or because they have achieved an
adaptation to the economical use of the food eaten. It is
therefore; wrong to use standards that are appropriate in
industrialized societies as a measure of the nutritional
adequacy of the diet of underdeveloped or primitive
societies.
The food actually consumed is obviously determined by
what is available. It is not surprising, therefore, to find
considerable differences in food selection between rural and
urban communities. Within both urban and rural
communities, variations in food selection between families
are also influenced by socio-economic status.
The selection of food is often based on religious beliefs. For
example, the attitude toward corn among Mexican Indians is
religious. Often they cannot be persuaded to grow other
crops on land where these would do better than corn,
because they would rather have a poor crop of corn than a
good crop of something that is not corn. Because of the
strong religious feeling against killing or eating cattle, less
than per cent of the population of India eat meat. Moslems
and Jews can eat meat other than pork, but only if it has
been killed in certain ways governed by religious laws.
Many people are strict vegetarians for religious reasons.
Some are vegetarians because they believe in the superior
virtue of plant foods. Others avoid certain foods simply
because they do not like them. Storage and distribution of
food.-In the Middle East and Far East, where the facilities for
refrigeration, preservation, or storage are non-existent, and
any animal slaughtered must be consumed immediately, so
that the supply of first-class protein is irregular8.
In other regions, such as the Arctic and parts of Africa, meat
is preserved by drying. In parts of Europe and the Middle
East, fruits and vegetables are not preserved, so that they
can be eaten only seasonally. Sometimes traditional
methods of preservation have been lost as a result of
outside contact.’ In parts of Africa, poor storage methods
have resulted in the development of toxic elements in rice.
In short, epidemiologists and public health workers who
recognize a need for better nutrition must consider the
traditional methods of growing and storing food. However, it
is not enough merely to arrange to increase the available
food supply. Changes will be acceptable only if they are in
keeping with the established food habits of the people.
Practices related to maternal and infant feeding.-In some
societies an infant is breast-fed or offered other food after
punishment or when it cries. If these people are advised to
breast-feed a child only at scheduled times or if they are
advised that it is harmful to eat between meals, the public
health worker makes the responsible for finding some other
acceptable method by which the mother can give
reassurance to a child who is punished or upset for some
other reason.

Figure 1: Shows habits influence on standard of

nutrition
Click here to view full figure

In some of the Pacific Islands where the people have a bare

subsistence intake of total nutrients, pregnancy, which
increases nutritional requirements, may result in frank
inadequacy states. This can be aggravated by taboos or
customs which prohibit the consumption of certain nutrient-
rich foods by pregnant or postpartum women.
This combination of factors may be responsible for the
defects in both matrix formation and calcification of the
enamel of deciduous teeth found in Fiji, Pukapuka, New
Guinea, Hawaii, and Niue (New Zealand).
Methods of cooking
Methods of cooking have a marked effect not only on the
physical character of the food as consumed but also on the
nutritive value of the diet.
The relation of nutrition to dental health
The manner in which nutritional factors may affect dental
health is shown in Figure2.3. Attempts to compare the
prevalence of dental diseases and conditions with the
nutritional value of traditional diets have produced
conflicting results-“No consistent association of dental
caries with a deficiency of any known nutrient has been
established. The prevalence of caries may be high or low in
people whose general nutritional standard is high, and it
may be high or low in people whose nutritional standard is
low. Since dental caries begins on the outside of a tooth, it is
generally conceded that nutritional factors could affect the
resistance or predisposition of teeth to dental caries. The
role of major nutrients in this respect is still debatable, but
since the discovery of the fluoride-caries relationship the
interest in trace elements and micronutrients has been
heightened.
According to Kreshover (1956)9, the incidence of oral
manifestations of nutritional deficiencies is probably much
less than commonly thought. In Italy,
Massler.M (1951)10 has found gingivitis is frequently
associated with lower nutritional status, and Roth.H
(1957)11 has claimed that, once started, periodontal disease
progresses more rapidly in patients whose nutrition is poor.
The World Health Organization’s Expert Committee
(1961)12 on periodontal diseases has said that surveys of
gingivitis in areas where nutritional deficiencies are evident
in the population have not shown any consistent association
between the deficiencies and gingivitis. However, they have
also stated: “These findings do not prove that total nutrition
and periodontal disease are unrelated; before any progress
can be made towards answering this question, thorough
dietary and nutritional surveys are needed, both in groups
with a low prevalence of periodontal disease and in groups
with a very high prevalence.”
Evidence from surveys of isolated communities suggests
that a relationship exists between poor maternal and infant
nutrition and defects in the structure of the enamel of
deciduous teeth. However, the actual nutrients involved
have not been determined. According to Balendra.W(1949)13,
a low intake of vitamin A increases the predisposition of
betel-nut chewers to oral carcinoma.
Dietary Factors
The relationship of some dietary factors to dental health is
shown in Figure 2.3.

Figure 2:Shows dietary habits and dental condit

Click here to view full figure
Numerous dental and dietary surveys have established that
a direct relationship exists between the prevalence of dental
caries and the frequency with which fermentable
carbohydrate in a sticky form is consumed. The studies
which provide the evidence for this are of the following
types: (1) Population studies: These have shown that the
prevalence of caries is highest in countries with the highest
and most frequent consumption of refined sugar and flour.
(2) Studies of populations in which national dietary habits
have been drastically changed during world wars I and II.
These have shown that alterations in the prevalence of
caries have accompanied changes in the frequency with
which sugar and sugar products, such as candy, sugar-
containing cookies, and cakes, have been consumed. (3)
Studies of populations in developing countries. These have
shown that the prevalence of dental caries increases when
the people change from their traditional diet to one which
includes refined sugar and flour. Such foods appear to be
universally acceptable not only because of their pleasant
taste but also because of their cheapness and the fact that
they can be stored for comparatively long periods of time.
(4) Controlled longitudinal studies in which groups of people
are kept under observation for a specified period of time.
These have shown that the incidence of caries can be altered
by changing the form in which carbohydrate is eaten (i.e., its
stickiness) and the frequency with which it is taken.
Epidemiologic studies have also shown, however, that
refined sugar is not the sole cause of caries, since in some
isolated communities caries does occur in its absence.
From this it is clear that any study of the diet in relation to
dental caries should not be restricted to an evaluation of its
carbohydrate content. Other important factors include the
selection and preparation of food, the order of eating, and
the frequency of eating. These factors vary widely in
accordance with local custom or habit.
Selection and preparation of food
These factors determine the physical character of the food,
and this affects the vigor and duration of mastication. This in
turn affects the rate of flow of saliva and the rate of
clearance of food debris from the mouth.
Many authors who have conducted surveys in
underdeveloped countries claim that the physical nature of
the food is the most significant factor in the initiation of
dental caries. Klatsky.M (1948)14, for example, claims that
“the refined texture of the food we eat and the sophisticated
methods of its preparation and consumption are the most
important contributing factors in dental degeneration.” He
also claims that soft food which requires little mastication
results in underdeveloped jaws and poorly aligned teeth.
This view, however, is not supported by modern
orthodontists. Neumann and Di Salvo (1954)15 have
suggested that intermittent functional loads on the teeth
resulting from vigorous mastication of tough foods not only
may affect the rate of ionic exchange between the enamel
and its environment but may also induce changes in the
structure of enamel which increase the resistance of teeth to
caries.
Several observers have noticed that some people who
habitually chew sugar cane (but do not eat refined sugar)
have a relatively low caries rate. Further studies are
required, however, to determine whether or not the
incidence of caries can be reduced by altering the physical
character of the food in people who frequently consume
sticky, refined sugar preparations.
In several underdeveloped countries the customary
methods of cooking result in the incorporation of sand and
ashes in the food. This results in extensive abrasion of the
teeth. Occlusal surfaces are worn down below the maximum
circumference of the teeth, and the proximal enamel breaks
away, creating a space into which food becomes impacted.
In this way heavy abrasion tends to decrease occlusal caries
and predispose to proximal caries.
Order of eating
Fibrous or tough food will promote the clearance of food
debris from the mouth, only if it is eaten at the end of a
meal. In some countries this is a routine practice. It is also
widely advocated in most highly developed countries.
Frequency of eating
In many underdeveloped countries and isolated
communities the people have only one or two meals a day.
Between-meal food consumption is neither so frequent nor
as ritualized as in many European countries. In most cases,
the food requires vigorous mastication, and the diet
contains little or no refined carbohydrate.
Under these circumstances the prevalence of caries is
always very low, but no attempt has yet been made to
determine the relative contribution of the frequency of
eating and vigorous mastication to this state of affairs.
Examples of dietary preferences according to some
cultural and religious beliefs
African American

 Diet varies greatly according to region of country and

lifestyle.
 They have high incidence of lactose intolerance; low
consumption of dairy products.
 Most popular meat dishes include pork (variety cuts),
fish, small game, and poultry.
 Frying and boiling are the most common preparation
methods.
 Primary grain product is corn.
 Honey, molasses, and sugar products are preferred as
snacks.
Asian

 High incidence of lactose intolerance; traditional

alternative sources of calcium include tofu, soy milk,
small bones in fish and poultry.
 A variety of protein rich foods are often preserved by
salting and drying.
 Make Pastes of shrimp and legumes.
 Wheat and rice are primary grain products.
 Fresh fruits and vegetables, also pickled, dried or
preserved.

Buddhism

 Vegetarianism with five pungent foods excluded: garlic,

leek, scallion, chives, and onion.

Hinduism

 Mostly vegetarian except in northern India where meat

is consumed (except for beef)

Islam

 No consumption of unclean foods (carrion or dead

animals, swine).
 No consumption of animals slaughtered without
pronouncing the name of Allah or killed in manner that
prohibits the complete draining of blood from their
bodies.
  No consumption of carnivorous animals with fangs,
birds of petty, and land animals without ears (frogs,
snakes).

Latino

 They have high incidence of lactose intolerance; low

consumption of dairy products.
 Vegetable proteins are more common in countries with
large rural and urban poor populations.
 Pork, goat, and poultry are common meats. Much of it is
marinated, chopped or ground, and often mixed with
vegetables and cereals.
 Principle bread is tortilla.
 Foods are often heavily spiced.

Native American

 They have high incidence of lactose intolerance; low

consumption of dairy products.
 Meat is highly valued, mostly grilled, stewed, or
preserved through drying and smoking.
 Primary grain used is corn; wild rice is also popularly
consumed.

Orthodox Judaism

 Prohibits consumption of swine, shellfish, and carrion

eaters.
 Ritual slaughtering of animals.
 Ritual breaking of bread.
 Meat and milk are prepared in separate dishes/utensils
and containers and not cooked, served, or eaten
together.The dentist as a member of the health team
can and in fact, is expected to impart sound nutritional
information to his patients, particularly if it has an oral
relevance. It is essential to have knowledge of the
culture, nutrition and its effect on oral
disease.References