Tooth Decay And Sugar
Dental problems are widespread among people who eat sugar and the more that is eaten, the worse the problem. Refined sugars such as sucrose and high-fructose corn syrup are staples in the urban diet so it is not surprising that untreated tooth decay affects 36% of the world’s population.1
The problem arises because sugar feeds bacteria in the mouth that form biofilms around teeth, the sticky coating we notice when we don’t brush them often enough. Biofilms consist of polysaccharides, protein, fats and DNA, a three dimensional matrix that supports a colony of micro-organisms, nourishing them and protecting them so that they can proliferate and spread. Bacteria and fungi generate acid byproducts underneath these films which demineralise the enamel while plaque and tartar develops on the surface of the teeth and promotes gum disease (gingivitis).
Several factors influence tooth decay, for instance lactose (milk sugar) is less problematic than sucrose in promoting the main bacteria responsible which are Streptococcus mutans and Streptococcus sobrinus. The frequency of consumption and adhesiveness of the food also affect the time that the enamel is exposed. Furthermore, many foods contain hidden sugars thereby creating inadvertent exposure, while soft drinks are often consumed throughout the day helping to maintain the biofilms.2
For example, soft drink contains up to ten teaspoons of sugar, while a glass of fruit juice may also contain 5-10 teaspoons. A serve of breakfast cereal, pasta, pizza, curry or soup can also contain several teaspoons of hidden sugar. Wine, soft drinks, sport drinks and even carbonated water present the added problem of their acidity, which bathes the teeth in a corrosive solution. Just imagine, if you sip these acids leisurely for hours throughout the day then the enamel gradually softens on the teeth and can simply be brushed away.
A diet high in sugars (carbohydrates) alters the pH balance of the biofilm, favouring micro-organisms that prefer acidity. The mineral balance of the body is also upset because excess sugar and acid consumption affects calcium, phosphorus and magnesium balance, something the dentist Melvyn Page discovered in the 1960s by using simple blood tests. He recommended the complete avoidance of processed sugar, and promoted instead the consumption of old-fashioned wholefoods which unfortunately led to his harassment by the Food And Drug Administration.3
In fact, it has been known since the 1970s that sucrose increases calcium and magnesium excretion,4 and now fructose adds to the picture by increasing calcium, oxalate and uric acid excretion. This means that those people consuming foods high in sucrose and high-fructose corn syrup are prone to developing kidney stones.5 It also correlates with another very painful condition, gall stones.6
This alteration in mineral metabolism can be observed in tests of bone mineral density where obesity is found to correlate with a lower density, as well as a dietary pattern high in processed foods (fats and sugars). This occurs because fat cells secrete inflammatory mediators which disturb mineral metabolism. These mediators, called cytokines (IL-6, TNF-α), upset the balance between bone-building cells (osteoblasts) and the cells involved in bone-dismantling (osteoclasts).
It is worth pointing out that bones are an active mineral store, and a certain measure of building and dismantling is normal, depending on the level of activity of the person and the quality of their diet. This dynamic process is skewed during transient states of nutrient deficiency, the periodic consumption of an inflammatory diet, as well as during sedentary phases; however, demineralisation becomes pathological when these states form a consistent lifestyle.
Type 2 diabetics also demonstrate altered bone metabolism with a tendency to lower mineral density and altered microstructure, leaving them prone to developing micro-fractures. The excess sugar and fat of the modern urban diet creates several problems: bone cells are dysregulated as we have seen, fat accumulates in bone marrow, proteins are glycated, and collagen is crosslinked in an abnormal fashion.7
The caffeine in soft or sport’s drinks, when consumed in excess, also affects the bone structure by inhibiting osteoblasts, a problem that can affect the teeth as well as the jaw in gum disease.8 The potential for trouble is obvious when a drink such as coffee that has been sweetened with sugar is sipped all day at work, accompanied biscuits—the bone of the jaws is weakened within while the teeth are eroded without.
The problem of excess soft drink consumption is more obvious in early childhood and tooth decay is recognised as a major public health problem in both underdeveloped and developed countries. This problem can also relate to bottle-feeding where the infant is left at night with an infant formula sweetened with lactose or other sugars. Nevertheless, reducing a child’s consumption of sugar overall to below 40–55 g per day has been found to help significantly in preventing tooth decay.9
Fluoride toothpaste should also be avoided. In a study of the population of Pelotas Brazil, where the water is fluoridated as it is in Australia, it was found that tooth decay ‘increased even amongst low sugar consumers using multiple sources of fluoride.’1 Many countries have in fact removed fluoride from town water because its efficacy in the prevention of tooth decay is still unproven, while the harmful nature of fluoride to general health is well-established: it is associated with a low intelligence quotient (IQ), hypothyroidism in children, as well as other metabolic derangements.10
Finally, the quality of saliva is a significant factor in tooth decay because it normally protects the teeth by cleaning them, neutralising acidity and by its antimicrobial activity. Saliva is in fact adversely affected by mood, nutritional status, hydration, disease and medical drugs; however, brushing the teeth regularly, especially after a meal, is important in order to cut the biofilms and remove plaque.
This article is an excerpt from the eBook Sweet Tooth, Rotten Health, which reviews the evidence-base concerning sugar’s role in the development of common metabolic diseases.
References
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3. Page M. Your Body Is Your Best Doctor. UK: Keats; 1972.
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6. Chen L-Y, Qiao Q-H, Zhang S-C, Chen Y-H, Chao G-Q, Fang L-Z. Metabolic syndrome and gallstone disease. World J Gastroenterol 2012;18:4215–20.
7. Tian L, Yu X. Fat, Sugar, and Bone Health: A Complex Relationship. Nutrients 2017;9.
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