Treat, Without Worrying About Teeth?

Have you noticed, little ones these days get invited to birthday parties almost every month? One of the many perks of being a parent, I usually go with Katelyn. While she enjoys the games and all, I get to catch up with the adults and enjoy the plethora of treats on offer. Interestingly, there is always somebody who finds my love for chocolates, cakes and coffees amusing. Often, I’d hear, “You don’t eat chocolates or cakes, do you?” My response would express curiosity, “Why?” and the corresponding reply would be rather matter of fact, “You are a dentist, aren’t you?” I’d laugh and reply honestly, “Actually, I have a sweet tooth, probably several. Desserts are right up my alley.” From there, a conversation about dental cavities, fillings, dental experiences and dental expenses would surge. I’d get ask at least once, “Katelyn doesn’t have any cavities in her teeth, does she? Is this because, you don’t let her eat any treats? Share your dentist secrets!!”

TREAT AND KEEP

Sorry to disappoint….actually…there are no secret short-cuts to keeping cavities away. The basics of regular toothbrushing, flossing and eating healthy are still the gold standards for good oral health. Treat and keep - treat your kids but "brush and floss the teeth you want to keep".  

Even healthy foods, like fresh fruits, grains and breads, can result in dental cavities, if residuals of these are left in the mouth for long enough.(1) Although research suggests that when compared to added sugars or free sugars, natural sugars in fresh fruits, breads and grains do not contribute significantly to the development of dental decay.(2-4) However, natural sugars are still sugars. It is also worth considering that carbohydrates including starch breaks down to glucose - a basic sugar, that not only fuel our bodies and minds, but also fuel the cavity-causing germs in our mouth to produce acids that destroy our teeth.(1,4) We even have enzymes in our saliva (they are called “amylases”) to kickstart the carbohydrate breakdown process.

It's true, Katelyn doesn’t have dental cavities to date. It is not because we are ultra-disciplined with treats though. It usually causes a jaw or two to drop when I say, somewhat embarrassed, “We eat treats…regularly…more than we’d like to admit.” However we have a strict philosophy about daily toothbrushing with fluoride toothpaste and flossing. Katelyn does not go to sleep without a throughout cleaning of her teeth. Toothbrushing morning and night and regular flossing happen regardless of moods, tantrums and tiredness. Even when she falls asleep, the toothbrush still goes in and toothbrushing is still done. Even during the “terrible two” stage, there was no negotiation. When she was little, hubby and I did her toothbrushing and flossing for her. Now that she’s older, we help her only at night. The aim is for good oral hygiene practices to become second nature. Early establishment of desirable oral hygiene habits have been shown to provide long term protective effects against oral problems such as tooth decay.(5)

As for treats? Most children enjoy treats! I enjoy treats! I’ve not seen consistent success in preventing cavities by forbidding treats. It takes way too much discipline to totally eradicate treats from our pantries, probably more so than regular toothbrushing and flossing, for most people. And what about the added sugars hidden in our healthy foods? Or acids in food and drinks that can damage teeth just as decay can? So when it comes to food and drinks, a balanced diet for overall health and well-being, remains key.

DON'T FORGET, IT'S NOT JUST SUGARS THAT ARE BAD FOR TEETH

Acid-loving-acid-producing germs causes dental decay, which when allowed to progress over time, becomes a dental cavity as teeth structures are destroyed. Putting sugars aside, acids alone, without cavity-causing germs, can be destructive to teeth structures too and results in dental erosion.(6-8) When both dental erosion and dental decay occur in the same mouth, destruction of teeth structures may occur more quickly, resulting in bigger, deeper cavities and toothaches. The problems become exponentially worse when residual foods, sugars and/or acids are allowed to stay on the surfaces of teeth for extended periods of time. Sticky foods and drinks are especially difficult to clear completely from the mouth!

SWEET + SOUR + STICKY = SICK SAD TEETH

Treat temptations are hardly going to disappear any time soon but certain types of treats are worth avoiding if possible. When it comes to choosing treats, my family avoids treats that are of the “3 S” category i.e. treats that are SWEET and SOUR and STICKY, because “sweet + sour + sticky = sick sad teeth”.  For example, we try to stay away from  juices, dried fruits, toffees, candies and carbonated drinks.

AVOID FREQUENT TREATS - EAT TREATS ALL IN ONE GO MINIMIZES ATTACKS ON TEETH

Dental cavities are also more likely to form when our teeth are “attacked” frequently by frequent eating and drinking.(9) Every time we eat and drink, the oral environment becomes acidic (oral pH decreases) which put our tooth structures at risk of destruction. The saliva in our mouth helps to balance the oral pH back to “happy neutral mode”. If the oral pH does not get to recover in time for the next “attack”, irreversible destruction of the tooth structures becomes more likely. For this reason, in my family, we try to have treats all at the one time rather than having treats throughout the day. Avoiding treats just before bed might also be helpful since when we sleep, there is less saliva to protect our teeth.

DRINK WATER

We also make sure we drink plenty of water after food, regardless of it being treats or healthy foods, with the aim of clearing some of the residuals away from our teeth and mouth. If drinks other than water are consumed, a drinking straw is used if at all possible and swishing avoided, to reduce contact with teeth surfaces. (I even drink my latte through a straw…hilarious as that may seem, this helps to reduce my coffee from contacting my teeth, helping with oral clearance and also decreasing coffee stains….sorry, getting side-tracked into the topic of extrinsic stains here.)

START PREVENTION EARLY

Come to think of it, Katelyn didn’t get 3 “S” treats regularly in the first 3 years of her life and we didn’t regularly share utensils, foods or drinks either. The scientific rationales for these practices are related to the understanding that taste preferences are developing in the early years of life, so in order to limit the “sweet tooth” from overtaking the tastebuds during “taste training”, foods were kept natural as much as possible.(10) In addition to taste development, the bacteria in our mouths (oral flora) are also establishing themselves in the first three years of life. Limiting sugars and acids, can help to reduce the number of decay-causing and acid-producing bacteria establishing themselves as permanent residents and prevent them from dominating.(11) As for not sharing utensils, foods or drinks with Katelyn when she was young, this contributes to making sure that our acid-loving-acid-producing decay causing bacteria didn’t get establish themselves early in Katelyn’s mouth.(12,13) These microscopic nasties are transferred by saliva. The earlier the decay causing bacteria establish themselves as permanent residents in a mouth, the higher the risks of dental decay for life.(14)

EDUCATE AND MOTIVATE,  HELP CHILDREN MAKE GOOD LIFESTYLE CHOICES

As a mummy, I’ve also come to realize, that educating children to make the right choices is much more beneficial than setting rules (particularly, the “don’ts”) that they must follow. This applies to many aspects of growing up and learning including, treats and oral hygiene practices.  Once children get older, it is more difficult to watch over their every move. Have you had the experience of well-meaning relatives and friends insisting on giving treats to your child even when you tell them “no, thank you”? Or other children kindly offering to share their treats with your child?  Or teachers and doctors rewarding your child with treats you’d rather not accept?

When Katelyn came home with her first jelly beans (as a reward from her teacher for being good in class), the thoughts of “why can’t these be stickers?” and “if this kid gets a tooth decay from regular jelly beans rewarded in class, who is going to pay the dental fees?” crossed my mind. I was happy that, Katelyn chose not to eat the jelly beans and brought them home just to “show and tell”. I was thankful that something from our many chats about nasty germs, 3 “S” foods and drinks, hurty teeth, actually stuck with her and made enough impact for her not to succumb to the exciting new world of jelly beans. Helping our children make good lifestyle choices from an early age, have lifelong benefits.

Candy rewards continued at school and most of the time, they came home, untouched. Katelyn will tell you, her idea of a delicious treat is a bowl of chocolate ice-cream, not jelly beans. Sweet treat it is – every kid deserves to be treated sometimes, even a dentist’s child! But, ice-cream is not sour or overly sticky, so passes the “3 S” test. Moreover, there’s potential benefits with certain types of dairy and cacao products (15-17)…research is still limited, but something perhaps to explore together next time we chat?

THREE KEY POINTS:

• "Treat and Keep" = "treat your teeth, but afterwards, brush & floss the teeth you want to keep". Otherwise, tooth cavities will eventually become a reality.
• Educating our children is fundamental to them making wise choices in life. That includes treat choices. Next time we go shopping with our children, play the “i spy” game with them and see how many 3 “S” (sweet AND sour AND sticky) products they can detect?
• There are treats and there are “smart treats”. Also, let's consider not just the what, but also the when and how of having treats. Small adjustments can lead to big benefits over time, do you agree?

REFERENCES

1. Bradshaw DJ, Lynch RJ. Diet and the microbial aetiology of dental caries: new paradigms. Int Dent J 2013 Dec; 63 Suppl 2: 64-72. DOI: 10.111/idj.12082.
2. Sheiham A, James WP. Diet and dental caries: The pivotal role of free sugars reemphasized. J Dent Res 2015; 94(10): 1341-1347. DOI: 10.1177/002203451559377.
3. Moynihan P. Sugars and dental caries: evidence for setting a recommended threshold for intake. Adv Nurt 2016; 7(1): 149-156. DOI: 10.3945/an.114.009365.
4. Lingsrom P, van Houte J, Kashket S. Food starches and dental caries. Crit Rev Oral Biol Med 2000;11 (3): 366-380.
5. Wigen TI, Wang NJ. Does early establishment of favourable oral health behaviour influence caries experience at age 5 years? Acta Odontol Scand 2015; 73(3): 182-187. DOI: 10.3109/00016357.2014.976264.
6. Nadimi H, Wesamaa H, Janket SJ, Bollu P, Meurman JH. Are sugar-free confections really beneficial for dental health? Br Dent J 2011; 211(7): F15. DOI: 10.1038/sj.bdj.2011/823.
7. Kanzow P, Wegehaupt FJ, Attin T, Wiegand A. Etiology and pathogenesis of dental erosion. Quintessence Int 2016; 47(4): 275-278. DOI: 10.3290/j.qi_a35625.
8. Shen P, Walker GD, Yuan Y, Reynolds C, Stacey MA, Reynolds EC. Food acid content and erosive potential of sugar-free confections. Aust Dent J 2017; Jan 20. DOI: 10.1111/adj.12498. [epub ahead of print].
9. Chankanka O, Levy SM, Marshall TA, Cavanaugh JE, Warren JJ, Broffitt B Kolker JL. The associations between dietary intakes from 36 to 60 months of age and primary dentition non-cavitated caries and cavitated caries. J Public Health Dent 2015; 75(4): 265-273. DOI: 10.1111/j.1752-7325.2012.00376.x.
10. Mennella JA, Bobowski NK. The sweetness and bitterness of childhood: insights from basic research on taste preferences. Physiol Behav 2015; 152(Pt B): 502-507. DOI: 10.1016/physbeh.2015.05.015.
11. Berkowitz RJ. Mutans streptococci: acquisition and transmission. Pediatr Dent 2006; 28(2): 192-198.
12. Da Silva Bastos Vde A, Freitas-Fernandes LB, Fidalgo TK, Martins C, Mattos CT, de Souza IP, Maia LC. Mother-to-child transmission of Streptococcus mutans: a systematic review and meta-analysis. J Dent 2015; 43(2): 181-191.
13. Douglass JM, Li Y, Tinanoff N. Association of mutans streptococci between caregivers and their children. Pediatr Dent 2008; 30(5): 375-387.
14. Wan AK, Seow WK, Purdie DM, Bird PS, Walsh LJ, Tudehope DI. Oral colonization of Streptococcus mutans in six-month-old predentate infants. J Dent Res 2001; 80(12): 2060-2065.
15. Osawa K, Miyazaki K, Shimura S, Okuda J, Matsumoto M, Ooshima T. Identification of cariostatic substances in the cacao bean husk: their antiglucosyltransferase and antibacterial activities. J Dent Res 2001; 80(11): 2000-2004.
16. Verakakj E, Duggal MS. A comparison of different kinds of European chocolates on human plaque pH. Eur J Paediatr Dent 2003; 4(4): 203-210.
17. Caglar E, Kuscu OO, Selvi Kuvvetli S, Kavaloglu Cildir S, Sandalli N, Twetman S. Short-term effect of ice-cream containing Bifidobacterium lactis Bb-12 on the number of salivary mutans streptococci and lactobacilli. Acta Odontol Scand 2008; 66(3): 154-158. DOI: 10.1080/00016350802089467.