Does Sugar cause Dental Caries? Yes, it’s the primary cause behind the rotting tooth and also the best-kept secret.
Sugar crash after a chocolate heavy day is one favorite habit I gave up. Almost.
I had a severe sweet tooth. I saved up money to buy chocolates when I was a little girl. Dairy milk was a favorite, but now I love silk, the Lindt Swiss chocolates, and Bournville too. Do you get the drift?
I also used to have chocolate grilled sandwiches for breakfast when I was pregnant to ensure calorie count. Life was blissful . At least so I thought. There was only one minor toothache, in this rosy picture.
The problem was two folds:
I started having a toothache
I had severe GERD.
Even with cutting down on fried and spicy food, the GERD didn’t go away, The dental Xray, revealed no caries tooth, but an unerupted molar. That one I had extracted uneventfully, but the teeth sensitivity continued.
My dentist is an excellent doctor and gave me tips about brushing after breakfast to ensure more extended fresh mouth. That helped a lot. I skipped morning milk tea and tried ginger Green, and still, the sensitivity continued
My serum calcium and vitamin D were perfect. But the sensitivity continued.
What was wrong?
It worried me. I knew the answer at the back of my head and just didn’t acknowledge it. My hubby was becoming concerned.
Then a year back after a severe episode of tooth sensitivity, while in the cold mountains of Ladakh, my hubby put his foot down. He told me to keep a record of the food I ate on the days I had tooth sensitivity.
I still wanted to ignore the nagging voice in my head.
I decided to talk to a few other Dental surgeons and did my own research.
The culprit was sugar!
WHO advisory mentions‘free sugars’ to be limited in your diet. The daily average of a maximum of 10% of total calories (‘strong recommendation’) for adults and lower for children. This helps to minimize the risk of dental caries throughout the life course.[1]
Coincidentally I found an article in the Newspaper, about the World Dental association talking about how no one discusses this simple step of lowering sugar, for better dental hygiene. They were very vocal about how cosmetic dentistry is the rage, but Dentists were keeping quiet about preventive Dental care.
Why does no one give advice about saying no to excess sugar? Maybe because you and me we all know that sugar is bad, just didn’t want to acknowledge it. Sugar addiction helps big processed food corporations mint money. They would be the last people to tell you that.
The right amount of calcium, magnesium, phosphorus, and VitaminD, fluoride are all critical. But low dietary simple sugar is non-negotiable.
The worse culprits are processed sugary snacks like packaged cakes, cookies, pies, frozen desserts, ice creams, ice lollies, definitely candies, sweets, and most chocolates.
Calories in Sugar
That’s about 40 -55 grams of sugar per day. That’s 1o teaspoons of sugar. Remember one teaspoon holds about 4/5 grams of sugar. One tablespoon is equal to 3 teaspoons. One gram sugar is around 4 Calories.
The American Heart Association recommends about 100 calories from free sugar. That comes to even lower than the WHO recommendation to about 6 teaspoons per day.
I have perfectly normal blood sugar, but eating sweet stuff made my tooth sensitive and gave me a sour taste in the mouth!
I combatted this by eating something savory at the end of meals and not sweet. Interestingly I face no problems with fresh fruits. The nature of the carb is obviously important.
I avoid sugar in my morning tea. The morning coffee does have sugar, but very little and I brush afterward that helps. When I do have a piece of chocolate, it’s not more than one piece a day. I just nibble the chocolate and take a long time eating it. It’s a little sad but I like being healthy and toothache free better!
But what are these free sugars in your diet?
List of Simple sugars in your food labels will have sugar dressed up as raw, brown, processed, molasses, syrups, etc.
Monosaccharides:glucose,fructose,galactose
Disaccharides are two monosaccharides holding hands in chemical composition.
Maltose:glucose +glucose
Lactose: Glucose +galactose
Sucrose: Glucose+Fructose
Table sugar, granulated sugar, or regular sugar has sucrose. Inside your body, these disaccharides easily break down into monosaccharides.
They are added to your food at multiple steps and build up.
What about the sugar content in Jaggery?
Jaggery is a natural sweetener having several benefits nutritionally.But it has a whole lot of simple free sugars too! It has 65-85% sucrose and 10-15 % glucose and/or galactose. For people with dental caries or diabetes, you cannot go overboard with jaggery or any other natural sweeteners.
Who adds the sugar in your food?
The manufacturer ( processed food and packaged food), cook (in a restaurant, by you (consumer at home).These are also sugar present in honey, corn syrup, maple syrup, fruit concentrates, fruit juice, health drinks, energy drinks, candies, sweets, chocolates, packaged snacks, etc.
High dietary sugar has a significant role to play in the early onset of obesity, diabetes, cardiovascular disease, dementia, and tooth decay.
When fruit juices with pulp are packaged, most of the fruit sugars are already broken down. Until you do a chemical analysis, there is no way of knowing the nature of the calorie you consume.
The rule of thumb. The more processed it is, the simpler is the sugar form. Sugar intake has a strong correlation with a noncommunicable disease like caries with a worldwide load.
What is the Primary Cause of Dental Caries
The primary cause of Dental caries is Dietary free sugar, as proclaimed by the World Dental federation[1], who took out a policy statement to fight misinformation regarding Dental preventive healthcare.
What happens when you eat a free sugar or a simple sugar and don’t brush your teeth immediately after
Sugar anywhere in the oral cavity acts as a bacterial medium, helping in bacterial growth.
The proliferation of Dental caries causing harmful bacteria is caused by that sugar in the chocolate.
The sugar is converted into acids that erode the dental enamel and cause cavity!
Oral hygiene, levels of care, other deficiencies, and educational profiles all have a role to play but are not aetiological factors [2].
How to Prevent Dental Caries?
Remember, this is the most extensive worldwide study, which found that higher prevalence and severity of dental caries intimately related to free dietary sugar intake. If sugar is more than 10% of total daily calories,higher it is the risk of caries. The risk is lifelong, and so are the benefits.[1,4]
Tooth brushing helps prevent the severity and prevalence of Dental caries.[5]I prefer Sensodyne for my family, and low free sugar is my new mantra.
Dental Caries in India [3]
In India, the prevalence of dental caries range from 33.7% to 90% in childhood and is alarming due to rampant advertisement and ingestion of sugary food.[4]
Decayed missing and filled teeth are more in teenagers than younger children. Boys more than girls have more sugary drinks and often report more oral health issues [6,7].
Conclusion
Oral health has a deep relationship with overall health. Sugar is also addictive. Unfortunately, a lack of transparency in dental health awareness has led to a massive childhood dental caries incidence with lifetime disease burden.
Low free sugar means small dental caries. The recommended minimum is 40-55 grams of free sugar [6,7].
Food manufacturers should lower sugar quotient in packaged food and clearly declare the relation of HFSS. Affordable toothpaste with good fluoride content and national health authorities creating awareness and food safety guidelines will go a long way in preventing this problem.
This post is a part of Blog Anniversary celebrations of Thoughts by Geethica Turns 3 co-hosted by Zainab and Ashvini.
References:
1 )Dietary Free Sugars and Dental Caries
2)The effects of sugars intake and frequency of ingestion on dental caries increment in a three-year longitudinal study.
Burt BA1, Eklund SA, Morgan KJ, Larkin FE, Guire KE, Brown LO, Weintraub JA.
https://www.ncbi.nlm.nih.gov/pubmed/3053822
3) Salivary levels of Streptococcusmutans and Lactobacilli in 13-15 years
old children of Belgaum city, Karnataka. J Indian Soc Pedod Prev Dent.
2005;23(1):23-26. Hegde PP, Ashok Kumar BR, Ankola VA.
4)Effect on caries of restricting sugars intake: a systematic review to inform WHO guidelines.
Moynihan PJ1, Kelly SA. J Dent Res. 2014 Jan;93(1):8-18. doi: 10.1177/0022034513508954. Epub 2013 Dec 9.
https://www.ncbi.nlm.nih.gov/pubmed/24323509
5) Prevalence of dental caries, the effect of sugar intake and tooth brushing practices in children aged 5-11 years in Bangalore North
Deepak Viswanath, Nimmy Sabu
http://www.srmjrds.in/article.asp?issn=0976-433X;year=2014;volume=5;issue=3;spage=155;epage=162;aulast=Viswanath
6)Chi, D.L., Hopkins, S., O’Brien, D. et al. Association between added sugar intake and dental caries in Yup’ik children using a novel hair biomarker. BMC Oral Health 15, 121 (2015) doi:10.1186/s12903-015-0101-z
7) Association of sugary foods and drinks consumption with behavioral risk and oral health status of 12- and 15-year-old Indian school children
Kailash Asawa, Nandini Sen, Nagesh Bhat, Mridula Tak,1 Pratibha Sultane, and Vishal Patil2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852983/