Dietary Advice and counselling from your dentist

From time to time, your dentist will provide dietary counselling to prevent you suffering from frequent bouts of decay. He/she will also help you understand the importance of a good diet to maintain your gum health. When you receive porcelain restorations or a brace, it is important to realise that some food items can damage this and result in failed treatment or compromised treatment.

A good diet is just as important for good dental health as it is general health. Our advice is based around the Eatwell guide.

There are several key dietary messages that we will give you.

Key Dietary Messages

Public Health England has provided official advice on healthy eating :

  1. Eat atleast 5 portions of a variety  of fruit and vegetables every day. These are a source of vitamins, minerals and fibre.
  2. Starchy foods should make up approximately 1/3rd of our diet. We should try and chose starchy foods which are high in fibre. This provides us with energy and provides a range of nutrients
  3. Proteins. Apart from usual sources of meat, eat some pulses, such as beans, peas and lentils. These are a good alternative source of protein.
  4. Have some dairy products, or dairy alternatives, such as soya drinks and yoghurts. Where possible, chose lower fat dairy products. We derive some proteins, vitamins and a source of calcium from dairy. This is important for strong bones.
  5. Chose unsaturated oils and spreads, and eat in small amounts.
  6. Eat food that is high in fat such as crisps, sauces, chocolates, cakes and biscuits LESS OFTEN as these are not needed in our diets at all.

Dentists issue advice that has been provided by Public Health England. The micronutrients within the food items listed above are very important for healthy gums, the supporting structures of your teeth. It is also very important to moderate alcohol intake, and limit this to 14 units per week or less. Excessive alcohol intake can inhibit the absorption and utilisation of essential micronutrients. There is emerging evidence that this may negatively affect gum health. Additionally, you must be mindful to limit the frequency of acidic beverages, whether these are alcoholic or not as acidic beverages attack enamel, the crystalline ‘wrapper’ around the teeth and cause excessive tooth-wear and breakdown.

When you see your dentist next, he/she will review your dietary history including alcohol intake, and type of beverage intake and undertake a risk assessment for decay, tooth-wear and gum disease. The extent of these dental problems are modifiable by dietary changes.

Many people misunderstand the causes of decay. There is a misconception that decay is genetic and if your parents had extensive decay in their teeth, you will too. The only reason that decay may run within some families is because of poor dietary practice within the family, and erroneous concepts of dental health being passed down from parents to children.

To experience decay in the mouth requires 4 factors at play:

  1. Presence of fermentable carbohydrate
  2. Decay causing bacteria (called ‘streptococcus mutans’, and ‘lactobacilli’)
  3. Frequency of intake
  4. Time

Fermentable carbohydrate comes into our diet in the form of refined sugar  (‘glucose’ or ‘sucrose’) such as that contained within sweets, chocolates and biscuits and deserts. This should not be confused with milk sugars (‘maltose’) or fruit sugars (‘fructose’) which is not as decay forming.

Many savoury food items such as beans, and tinned tomatoe based foods, chinese and indian foods contain refined sugar (‘glucose’ or ‘sucrose’). It is actually fine to indulge in such food items, however it is the daily frequency, typically every 1-2 hourly  that causes damage, such as when snacking on sugar containing food items.

Some sedentary professional workers report excellent diets and healthy lifestyles, however indulge in a sugared tea or coffee every 1-2 hours at their desks.  Such individuals express complete surprise when they return for multiple fillings at the dental office. It is actually the frequency of a small amount of sugar that causes tremendous damage. Bacteria require very small amounts of sugar to remain  very active in the mouth to metabolise sugar and release their metabolic acids that result in tooth breakdown and decay.

People also misunderstand the sugars that exist in fruits. This fruit sugar, or ‘fructose’, is not the same as ‘glucose’ and ‘sucrose’ and is not as decay forming as ‘sucrose’ based sugars. It is therefore safe to snack on fruits. It is under very extreme circumstances that fructose sugared foods will become decay forming

In summary, our advice is:

  • Substitute an artificial sweetener to replace sugar in your tea or coffee
  • Have a frequent glass of water throughout the day. This will reduce hunger pangs and reduce the need for snacking
  • Have a meaningful breakfast, lunch and dinner (but eat small quantities)  to avoid the need to snack
  • When you need to have a snack, chose savoury items that do not contain sugar, such as cheese sticks, or eat one of your portions of fruit and veg
  • Limit sugary items to meal times to avoid frequency of intake
  • Chew sugared free gum, as chewing stimulates saliva, and this neutralises plaque acids generated by plaque bacteria

Dietary modifications  when you have a fixed brace

Fixed Braces are precision devices that only work well when they remain clean and firmly fixed to teeth.

Chewy, sticky foods, such as in some chocolate bars, and chewy sweets and crusty breads can break orthodontic brackets. Tearing firm textured foods or sticky foods with the front teeth will break orthodontic brackets.

Ideally, you must avoid eating chewy, sticky foods. Sticky chocolates, such  as toffees or caramels can only be sucked and not chewed when a brace is present. Firm foods such as apples and crusty bread roles, needs to be cut up into smaller pieces in a plate and chewed on the flats of the posterior teeth.

If you are lucky enough to receive NHS orthodontic care then you must co-operate with your orthodontist in modifying your eating habits.

Continual breakages and repairs of brackets affects the delivery and quality of orthodontic care, and significantly affects duration of time in orthodontics. It is also very time consuming and expensive to continually repair orthodontic brackets which is not remunerated in the NHS.

If you continue to break multiple brackets, then your orthodontist may refuse to continue providing NHS orthodontic care, and you may  only be offered care under private care arrangements and be asked to pay for the additional time that your treatment is taking due to your own poor compliance. Your orthodontist will act reasonably, and understands that some broken brackets are inevitable in orthodontic treatment. It is very evident however when there is a wanton disregard to listen to orthodontic advice and a continual and repeated lack of co-operation with dietary habits when a brace is in place.

For private patients who continue to break brackets because of dietary factors, small additional charges will apply for additional visits that are required to repair your brace.

Please feel free to obtain a visit with our hygienist or orthodontic therapist to obtain further advice on nutritional advice around brace care.

Enjoying alcohol with friends and colleagues is a common british pass-time. Having a solitary glass of wine after a stressful day at work is also cathartic. It is entirely true that there is emerging evidence that a moderate intake of a glass of red wine may introduce antioxidants in the body which is useful to prevent cancer. There is also emerging evidence that red-win may be heart-healthy and can play a part in reducing coronary artery disease.

It is easy for a moderate healthy habit to become unhealthy. Excessive alcohol intake is associated with:

  • an increase in oral cancer
  • gastro-oasophageal reflux disease (GORD). Acid from the stomach is released because of loss of sphincteric control and hydrochloric acid can be sprayed into the mouth from gastric reflux
  • increased tooth wear because of the gastric reflux, which causes dissolution of the enamel tooth shell AND tooth surface loss because of the acid nature of some alcoholic beverages
  • excessive alcohol ingestion may cause malabsorption of fat, thiamine, vitamin B12, folic acid, and other micronutrients which are essential for healthy gums. Reduction in absorption of Vitamin B12 and Folic acid may result in mouth ulcers
  • increased susceptibility to gum disease (emerging evidence due to malabsorption of micronutrients)

Our advice is to drink in moderation, and stay within the Department of Health recommendations of not drinking more than 14 units of alcohol per week or approximately 2 units of alcohol per day.

Refer to the following diagram to help understand the number of units in common alcoholic beverages:

Poor Oral Health can affect General Health

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