Dental disease may be a wake-up call that your diet is harming your body. "The five-alarm fire bell of a tooth ache is difficult to ignore," says Dr. Philippe P. Hujoel, professor of dental public health sciences at the University of Washington (UW) School of Dentistry in Seattle. Beyond the immediate distress, dental pain may portend future medical problems. It may be a warning that the high-glycemic diet that led to dental problems in the short term may, in the long term, lead to potentially serious chronic diseases.
Hujoel reviewed the relationships between diet, dental disease, and chronic systemic illness in a report published July 1 in the Journal of Dental Research. He weighed two contradictory viewpoints on the role of dietary carbohydrates in health and disease. The debate surrounds fermentable carbohydrates: foods that turn into simple sugars in the mouth. Fermentable carbohydrates are not just sweets like cookies, doughnuts, cake and candy. They also include bananas and several tropical fruits, sticky fruits like raisins and other dried fruits, and starchy foods like potatoes, refined wheat flour, yams, rice, pasta, pretzels, bread, and corn.
One viewpoint is that certain fermentable carbohydrates are beneficial to general health and that the harmful dental consequences of such a diet should be managed by the tools found in the oral hygiene section of drugstores. A contrasting viewpoint suggests that fermentable carbohydrates are bad for both dental and general health, and that both dental and general health need to be maintained by restricting fermentable carbohydrates.
The differing perspectives on the perceived role of dietary carbohydrates have resulted in opposing approaches to dental disease prevention, Hujoel notes, and have prompted debates in interpreting the link between dental diseases and such systemic diseases as obesity, diabetes, and some forms of cancer.
Over the past twenty years or so, Hujoel says, people have been advised to make fermentable dietary carbohydrates the foundation of their diet. Fats were considered the evil food. A high-carbohydrate diet was assumed to prevent a number of systemic chronic diseases. Unfortunately, such a diet - allegedly good for systemic health - was bad for dental health. As a result, cavities or gingival bleeding from fermentable carbohydrates could be avoided only - and not always successfully, as Hujoel points out -- by conscientious brushing, fluorides, and other types of dental preventive measures. When these measures are not successful, people end up with cavities and gum disease.
Hujoel observed that the dental harms of fermentable carbohydrates have been recognized by what looks like every major health organization. Even those fermentable carbohydrates assumed to be good for systemic health break down into simple sugars in the mouth and promote tooth decay. All fermentable carbohydrates have the potential to induce dental decay, Hujoel notes.
But what if fermentable carbohydrates are also bad for systemic health? Hujoel asks. What if dietary guidelines would start incorporating the slew of clinical trial results suggesting that a diet low in fermentable carbohydrates improves cardiovascular markers of disease and decreases body fat? Such a change in perspective on fermentable carbohydrates, and by extension, on people's diets, could have a significant impact on the dental profession, as a diet higher in fat and protein does not cause dental diseases, he notes. Dentists would no longer be pressed to recommend to patients diets that are bad for teeth or remain mum when it comes to dietary advice. Dentists often have been reluctant, Hujoel says, to challenge the prevailing thinking on nutrition. Advising patients to reduce the amount or frequency of fermentable carbohydrate consumption is difficult when official guidelines suggested the opposite.
The close correlation between the biological mechanisms that cause dental decay and the factors responsible for high average levels of glucose in the blood is intriguing. Hujoel explains that eating sugar or fermentable carbohydrates drops the acidity levels of dental plaque and is considered an initiating cause of dental decay.