Touger-Decker and van Loveren, 2003; WHO, 2003; Zero, 2004). Dietary habits of children remain a major component of the caries process (Dye et al., 2004). Furthermore, given the American propensity for frequent snacking, it is likely that many starch-containing processed foods also contribute to caries formation (Zero, 2004).

Other important factors in caries development are food form (e.g., liquid, solid, sticky), duration of exposure, nutrient composition, sequence of eating, potential to stimulate saliva, and presence of buffers (e.g., cheese, gum containing xylitol) (Moynihan and Petersen, 2004; Touger-Decker and Mobley, 2003). Risk factors related to food consumption include nocturnal meal consumption and frequent sugar consumption (Bankel et al., 2006), and the form of sugar-containing food (Marshall et al., 2007). Intake frequency of sugars is considered the most important dietary factor in caries development (Lingstrom et al., 2003; Moynihan and Petersen, 2004). Tooth erosion refers to the gradual loss of the outside, hard surface of the tooth due to chemical, not bacterial, processes (Touger-Decker and Mobley, 2003). Tooth erosion involving frequent intake of acidic foods and beverages weakens tooth integrity and further increases caries risk (Touger-Decker and Mobley, 2003). Tooth erosion is increasing in industrialized countries and is thought to be related to increased consumption of acidic beverages (e.g., soft drinks, sports drinks, and fruit juices) (Moynihan and Petersen, 2004). Because of the synergistic relationship between nutrition and oral health, and because nutrition is a critical component of oral health, the dietary habits of children and adolescents are needed to improve oral health.

Disordered Eating Behavior

Relative to many other public health problems, full-syndrome eating disorders are fairly rare among children and adolescents; however, they are a serious cause of morbidity and mortality in this group. More than 10 percent of individuals with anorexia nervosa admitted to university hospitals eventually die from the disorder (APA, 2000). Anorexia nervosa (characterized by self-starvation, weight loss, intense fear of weight gain, and body image distortion) (APA, 2000) affects less than 1 percent of adolescent females (Emans, 2000). Bulimia nervosa affects 1 to 5 percent of adolescent girls (Emans, 2000) and is characterized by binge eating and purging (APA, 2000). The onset of eating disorders often occurs during adolescence or early adulthood (Emans, 2000). About 5 to 10 percent of all adolescents with an eating disorder are male (APA, 2000).

Eating disorders are viewed as multifactor disorders with environmental and social factors, psychological predisposition, and biological and genetic predisposition. “Dieting” is a common entry point in both anorexia nervosa and bulimia nervosa, with the greatest risk being the group of se-



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