Sugar and Truth Decay |
Why not just concentrate efforts on trying to make sure everyone eats less sugar and uses fluoride toothpaste?
BFS suggested answer
Although dental health has improved for many, but as a result inequalities in dental health have widened (sic). Changing people’s behaviour is difficult and takes time. Meanwhile young children in our poorest communities continue to suffer high levels of avoidable disease.
Water fluoridation is the only measure we know of which will reduce tooth decay for everyone irrespective of behaviour.
BFS suggested answer refuted
Why is it that so many of the profession [dentists] who are preventively orientated are so frequently seen eating the biscuits richly embellished with jam, chocolate and sugar that are provided at virtually all meetings organized by dental societies, hospitals and members of the dental trade?
Elizabeth Elliott, executive manager, British Dental Health Foundation
It is generally accepted within medical circles that prevention is better than cure. Certainly we all seem to say that, even if we are not inclined to do much about it ourselves. Over the past couple of decades, our knowledge of how different foods affect our bodies has increased dramatically: we all know that if we didn’t smoke, took more exercise, watched our diet, and so on, we would be healthier. Having said that, however, there are still many diseases that changing to a ‘healthier’ regime will not prevent.
Tooth decay is not one of them.
There is no need whatsoever for anyone to have decayed teeth. We know exactly what causes dental caries, and we know exactly how to prevent it: we’ve known it for decades. The problem is that dentists don’t seem to want to tell us very forcefully. True, there is advice dished out in dentists’ waiting rooms and by health authorities, generally built around three main pillars: brush your teeth regularly (with a fluoridated toothpaste, naturally); visit your dentist regularly; and don’t eat sweets between meals. But it isn’t very successful: people are still queueing up to get their teeth filled, capped, bridged or removed.
Half a century ago, toothpaste ingredients were all the rage: ingredients that purported to kill bacteria, or neutralise the acids made by the bacteria, or make your breath smell sweeter, but they never quite worked. Then came the magic ingredient: fluoride. All the chlorophyll, GL99, and abrasives, which had been the mainstay of toothpastes’ supposed effectiveness, disappeared in favour of this new ingredient which promised ‘fewer fillings’. Despite this dramatic change of emphasis, little else changed. The claims for this new wonder ingredient, just like those that went before, were still aimed at ‘cure’ rather than ‘prevention’. And the basis of all the advice given has little real basis in fact.
Extravagant claims are made for fluoride, but dental advice is still based around the same three pillars – and it seems there is little evidence that these pillars have sound foundations. Before we look at these in detail, it would be as well to understand the process of decay.
Tooth decay
The smell of a baby’s breath while it is breast feeding and before its teeth start to erupt is sweet and curiously attractive. But get to the teething stage, and all that begins to change. The reason for this change is in the design of our mouths. Warm and moist, they are the ideal breeding ground for bacteria and minute yeasts. Nature has determined that under normal circumstances, if we eat a natural diet, the dominant bacteria are benign and, by crowding out more dangerous bacteria, protect our mouths. But when we eat foods that we are not designed to eat, we create a situation in which a class of bacteria that ‘glue’ themselves to our teeth and gums can thrive. It is these bacteria – principally Streptococcus mutans – that cause tooth decay. The ‘glue’, made from sugars and starches (carbohydrates) that we eat, is also their food supply. The combination of bacteria and glue is called ‘plaque’.
In the middle ages and before, tooth decay was rare.1 Nobody brushed their teeth in those days, levels of plaque were high, yet rates of decay were small. It was only among the rich that decay occurred earlier in life, as they could afford to buy prohibitively costly sugar.2
We have known since the Middle Ages that sugar is the cause of blackened, rotting teeth. Paul Hentzner, describing Elizabeth I, says she had ‘a hooked nose, narrow lips and black teeth, a defect the English seem prone to from their too great use of sugar’. And Shakespeare in Romeo and Juliet writes: ‘Because their breaths with sweetmeats tainted are’.
The three pillars of dental wisdom
The three pillars of dental advice should be looked at in more detail and revised:
•Brush your teeth after meals. We know that when teeth are exposed to a sugar solution, the acidity at the tooth rises to a dangerous level within one minute and stays at that strength for another twenty minutes.3 So brushing teeth immediately after a meal seems like good advice. But how many people get up from the table immediately and brush their teeth – I mean immediately: within seconds? Professor G.N. Jenkins, in his standard work, The Physiology of the Mouth, published in 1956, says that it makes much more sense to brush teeth before eating a meal. Plaque bacteria feed on and ferment dietary sugars and starches. These bacteria start the process of acid formation immediately you start eating these foodstuffs. It is better to remove the bacteria before eating. That way there aren’t any bacteria on the teeth to start the dental decay process during a meal.
•Visit your dentist every six months. According to dentists Richard and Elizabeth Cook, nobody knows how this one began. Certainly a study published in 1977 could find no scientific basis for the recommendation.4 An American dentist, Jack Anderson,5 managed to trace it back to the Amos and Andy Show, which was sponsored by the Ipana Toothpaste Company in the 1930s. Ipana’s slogan was ‘Brush with Ipana twice a day and visit your dentist twice a year.’ But children who visit their dentists twice a year have no better teeth than people who go at greater intervals.6 A Swedish study showed that people who visited their dentists more often merely ended up with more fillings.7
•Don’t eat sweets between meals. This is very good advice with plenty of evidence to support it. If teeth are continually bathed in a solution of sugar, then the bacteria in plaque will produce acid continually. So don’t eat sweets between meals. Don’t drink pop and colas either. Or fruit juices, or bags of crisps, or biscuits, or bread. But how often and how loudly do we hear it? You will see adverts on TV for fluoridated toothpaste, but how many have you seen warning of the dangers of eating between meals? The truth is that dentists are trained to repair teeth. They are not trained to prevent cavities. So they promote fluoride instead. This, we are assured, will prevent dental decay. Use fluoride toothpastes and drink fluoridated water, and we can eat all the sweets we like with impunity.
Dentists make more money in fluoridated areas
Dentists make much more money in fluoridated areas. Fluorosis causes disfigurement: cosmetic dentistry is far more lucrative than cavity repair. Fluoride also causes a delay in the normal shedding of the baby teeth and their replacement by permanent teeth. This delay increases the number of children with malpositioned teeth, so today more braces are fitted. Braces are also far more lucrative than fillings.
Conclusion
As fluoridation is the easy option and dentists make more money in fluoridated areas, there is little incentive for dentists to instil healthier eating practices in their patients.
1.Moore WJ, Corbett ME. The distribution of dental caries in ancient British populations. Caries Res 1971; 5: 151–68; Caries Res 1973; 7: 139–53; Caries Res 1975; 9: 163–75.
2.Rushton MA. The teeth of Anne Mowbray. Br Dent J 1965; 119: 355–9.
3.Stephan RM. J Am Dent Assoc 1944; 27: 718.
4.Sheiham A. Lancet 1977; ii (27 Aug): 442.
5.Quoted in Cook R, Cook E. Sugar off! A practical guide to sugar-free living. London: Pan Books, 1983.
6.Children’s dental health in England and Wales. London: HMSO, 1975.
7.Axelsson P, Lindhe J. J Clin Perio. 1978; 5:133–51.