With new dietary fads hitting the headlines on a monthly basis, Maria Paparvergos looks into the impact these may have on patient’s oral health.

Bombarded with buzzwords from ‘plant-based diet’ and ‘veganism’ to ‘gluten free’ and ‘healthy eating’, it’s no wonder we are a little overwhelmed and confused about making the right dietary choices for our health and well-being.

With the New Year launching Veganuary and ‘gluten free’ decorating many a menu and recipe, we are all led to believe this is the healthy way forward, but is it really understood how these choices can impact our health and our less well vocalised dental health?

Social media can be a wonderful tool for inspiration and positive thinking, but also a minefield of mixed messages and a secluded snapshot of lifestyle choices. Finding the full picture and achieving the right balance can be like searching for your sourdough starter in a supermarket. The answers might be out there, but after sifting through aisles of distraction and temptation, even if we find our desired product or fad, are we sure how to steer it towards healthier habits?

Sugar

First, we need to look at the holistic picture when it comes to diet, meeting our body’s nutritional needs. By cutting out meat and dairy, this does not automatically assume we are healthier. There are certainly plant-based alternatives that can provide nutritional sustenance, but there must be an education around these choices, so not to starve our bodies of certain essential nutrients or overindulge in others. Let’s start with our biggest dental enemy…sugar!

It is important to bust some myths around sugar…sugar is sugar, whether you dress it up as ‘natural sugar’, ‘unrefined sugar’ or ‘organic sugar’. Be it honey, maple syrup, molasses or agave syrup…our bodies and our teeth see it as the same molecule.

As you bite into a slice of gluten free, vegan carrot cake, don’t kid yourself that you are making a healthy choice. Sugar, or more specifically, extrinsic sugars, as all these types of sugar are, attack our teeth.

We all remember the trusty ‘Stephan Curve’ from our dental school days…but herein lie some basic principles that fashionable fads and flowery, fluffy terms can lead us to forget. Sugar drops the plaque pH in our mouths below its ‘critical level’ due to the acidogenic bacteria present, metabolising these simple molecules at a rapid rate. This drop in pH permits demineralisation of hydroxyapatite in dental enamel. The elevated frequency of these cariogenic challenges will lead to dental caries – tooth decay.

Our patients need to know this. With every drizzle of maple syrup that goes into our salad dressing and with every teaspoon of balsamic syrup that is dolloped into our tomato sauce, we are creating a cariogenic challenge. Yet the misconception is this is ‘healthy eating’. We have a unique role and insight to help educate our health-conscious patients and lead them towards truly healthy dietary and dental choices.

Furthermore, regular spikes in sugar intake will have holistic implications on our health over time. This negative effect on our blood sugar can result in erosion of the ability of the cells in our pancreas to make insulin, damaging the pancreas and ultimately leading to type II diabetes.

High blood sugar can also cause hardening of the blood vessel walls; atherosclerosis, which can lead to a plethora of debilitating conditions, not to mention the fluctuating effect on mood and energy levels. This doesn’t mean that your next gluten-free flapjack is going to give you diabetes…the key is moderation and education about moderation.

Juice diets

Another misnomer in healthy eating is fruit juices and smoothies. Instagram is inundated with pictures of scintillating smoothies in a haze of healthy eating messages, offering juicing diets and ways to get your ‘five a day’ without any mention that smoothies = sugar.

There is virtually no education about the difference between extrinsic and intrinsic sugars in the public domain. As soon as fabulous, vitamin-rich fruits hit the blender, their cleverly created intrinsic sugars become nasty, attacking extrinsic sugars, as we banish the fibrous matrix of cell walls that nature has intricately designed to benefit our gut health, whilst protecting our dental health.

Regular intake of fruit juices and smoothies is torture for our teeth, as is fruit that has been treated or processed in a way to break those invaluable cell walls. Dried fruit is so commonly distributed and disguised into ‘healthy diets’, yet these sticky natured additions with their high extrinsic sugar content do little to separate them from a scattering of toffees in our muesli.

Vegan diets

Sometimes we are trying to banish the baddies, but actually the replacements are increasingly blighted. Veganism eliminates milk and dairy products from the diet, but often milk alternatives and plant-based milks can have added sugar or ‘free sugar’, increasing their cariogenic potential.

Dairy milk contains lactose, which being bound into the cellular structure, does not have the same damaging potential to our teeth. It is important to educate vegan patients and also parents that they may unwittingly be delivering a high sugar, dentally damaging diet to themselves and their children alike, whilst attempting to make a healthy choice. Furthermore, animal milk is naturally rich in fat-soluble vitamins and iodine – all essential for holistic health. Plant-based milks will often be fortified, but it is important to educate the consumer to check the label for what each milk has been fortified with.

Acid

Onto our next dental demon…acid! So many so-called healthy practices are laced with acidic intake, from ayurvedic eating to juicing diets. To start the day with a slice of lemon in hot water is akin to swirling battery acid around your mouth first thing. The pH of lemon juice is around two, slightly above battery acid at pH one. The erosive effect on our dentition is alarming. The ayurvedic diet preaches warm lemon water being great for digestion and assimilation, yet if this is daily practice, dental erosion may well manifest.

As dental professionals, it is our duty to educate and let people make informed decisions about their dietary choices and how they may impact both their dental and nutritional health. It is important to bust some myths, exert moderation and above all, be able to empower our patients with the tools to navigate their way through this maze of dietary fads and mixed media messages.