Approximately 27 per cent of UK adults are believed to have active tooth decay.[i] Even more worrying is the prevalence of dental caries among children.

In England alone, 23.4 per cent of five-year-olds are estimated to have “visually obvious” dental decay[ii] – though this figure jumps substantially to 92.5 per cent in specific regions. Indeed, oral health inequalities remain rife across the UK, making patient education and improved access to dental care a priority for dental teams everywhere.

There are many potential causes of dental caries and the consequences of continued attack on the enamel can be severe for patients if left untreated. Among the most common modifiable risk factors is diet, so helping patients to protect their teeth with improved food and drink consumption is a key focus for the dental team. Acidic attack and enamel erosion is worsened by consuming high levels of carbohydrate and sugar, which alters the pH of the mouth, facilitating demineralisation and resulting in caries. According to the World Health Organization, dietary intake of more than 15-20kg per year of free sugars increases caries risk.[iii]

The sweet escape
Sugar has long been targeted for its detrimental effect on the health of individuals, increasing the risk of various health concerns from obesity and diabetes to tooth decay.[iv] There is an extensive body of research evidencing the potential impact of excessive sugar consumption. It demonstrates that frequent exposure to sugar-containing food and drink has a greater influence over caries development than just a large sugar amount.[v] Given that 33 per cent of the UK population admitted to more unhealthy snacking since the pandemic began,[vi] this is more relevant now than ever before.

Interestingly, there is debate among nutritionists and other healthcare professionals about what might constitute a ‘healthy’ snack. The benefits of fruits and vegetables when juiced or dried versus whole, for example, is widely debated. In recent years, warnings have been issued regarding the potential for juiced and dried fruits to contain a higher concentration of sugar than their solid counterparts and therefore pose a greater risk to dental health. Whilst more evidence is needed, some research has already suggested the risks to be lower than some may have thought. For instance, one study found there is no difference in the demineralisation impact of juiced and solid fruits and vegetables.[vii] A systematic review into the effect of fruit juice on dental caries and tooth erosion also published inconclusive results, with potential discrepancies between children and adults studied.[viii]

Of course, there are many foods that we can all agree are highly damaging to the teeth and can lead to disproportionate demineralisation, such as fizzy and sports drinks, crisps and alcohol. Dental professionals are charged with educating patients on the dangers of excessive sugar consumption, as well as offering easy ways to change eating behaviours and focus on healthier alternatives.

Prevention and treatment
Fluoride – both topical application and in water – has been found to reduce caries risk significantly around the world.[ix] So too can adjustment of eating patterns to help minimise frequency and/or duration of exposure to acid-producing sugar and other carbohydrates. For example, reduction of snacks between meals can help to limit both total amount and frequency of sugar consumption and drinking water after eating can help to rinse the mouth of food debris.

As is true of most dental diseases and health concerns, maintaining good standards of oral hygiene is vital for all patients to avoid developing caries. Twice daily brushing should be an absolute basic standard, with effective interdental cleaning a welcome supplement to oral health routines.

Utilisation of specially designed products can also help to remineralise enamel either in-practice or at home between appointments. Recommendation of an appropriate fluoride toothpaste is vital. Use of sugar-free chewing gum between meals can also be beneficial as it promotes saliva production to minimise the risk of demineralisation.

Curasept Biosmalto from J&S Davis offers the flexibility of both in-practice and at-home application, offering an innovative formula that contains substituted hydroxyapatite. This enables the product to deliver rapid remineralisation benefits and protect the teeth from further damage through acid erosion, acid attacks, mechanical abrasion and sensitivity.

Stronger teeth for a healthier future
Though sugar is not the only culprit of demineralisation and dental caries, it is a major contributor. The government has already recognised the role sugar plays in the health of the nation and is encouraging everyone to think differently with nationwide campaigns promoting healthy diet choices in addition to the ‘sugar tax’. This, combined with the continued efforts of the dental team, is designed to further educate and support the general population to strive for a healthier mouth and body. Not only does this afford greater quality of life for individuals, but may also help to reduce the burden on national health services at time when they are particularly stretched.

For more information call 01438 747 344, email jsdsales@js-davis.co.uk or visit www.js-davis.co.uk

[i] Statistica. Share of adults with active tooth decay in England in 2018, by region. https://www.statista.com/statistics/1131977/active-tooth-decay-in-england-by-region/ [Accessed January 2022]

[ii] Public Health England. Public Health Profiles. Percentage of 5 year olds with experience of visually obvious dental decay. 2018/19. https://fingertips.phe.org.uk/search/dental#page/3/gid/1/pat/6/par/E12000001/ati/102/are/E06000047/iid/93563/age/34/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/ovw-do-0_car-do-0_car-ao-1 [January 2022]

[iii] Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental diseases. World Health Organization. Public Health Nutrition. 2004. 7(1A);201-226. DOI: 10.1079/PHN2003589

[iv] NHS. Live Well. Sugar: the facts. https://www.nhs.uk/live-well/eat-well/how-does-sugar-in-our-diet-affect-our-health/ [Accessed January 2022]

[v] Scientific Advisory Committee on Nutrition. Draft Carbohydrates and Health report. Scientific consultation: 26 June to 1 September 2014. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/339771/Draft_SACN_Carbohydrates_and_Health_report_consultation.pdf [Accessed January 2022]

[vi] Food Standards Agency. Food in a pandemic. From Renew Normal: The people’s commission on life after Covid-19. March 2021. https://www.food.gov.uk/sites/default/files/media/document/fsa-food-in-a-pandemic-march-2021.pdf [January 2022]

[vii] Issa AI, Toumba KJ, Preston AJ, Duggal MS. Comparison of the effects of whole and juiced fruits and vegetables on enamel demineralisation in situ. Caries Res. 2011;45(5):448-52. doi: 10.1159/000330597. Epub 2011 Aug 26. PMID: 21876354.

[viii] Liska D, Kelley M, Mah E. 100% Fruit Juice and Dental Health: A Systematic Review of the Literature. Front Public Health. 2019;7:190. Published 2019 Jul 12. doi:10.3389/fpubh.2019.00190

[ix] Riva Touger-Decker, Cor van Loveren, Sugars and dental caries, The American Journal of Clinical Nutrition, Volume 78, Issue 4, October 2003, Pages 881S–892S, https://doi.org/10.1093/ajcn/78.4.881S

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