10 February 2000 --
Picture the scene: it's a Saturday night, the kids are in front of the TV with their favourite combination of candy bars, drinks and snack foods. Meanwhile their parents, worrying about the dental havoc the foods might cause, issue dire warnings of fillings, tooth extraction and decay.
Their worries, although well meaning, are largely misplaced. Today's research shows that dental problems arise not so much from what you eat as from how you clean up your teeth afterwards.
An international survey recently showed that children in Singapore have better teeth than their contemporaries in most other countries.
Dr Myra Elliot, an oral surgeon at the Mount Elizabeth Medical Centre in Singapore says this demonstrates that the improvement in the children's dental health is not diet-based.
"The Singaporean diet has not changed much in the last ten years," said Dr Elliot. "However, the number of dental problems has declined due to fluoridation of drinking water, better dental care and fluoridated toothpaste."
A shift in preventative care
For many years, the primary focus of oral health care was diet-based. Children were warned to avoid certain types of food in order to prevent the onset of tooth cavities (dental caries).
Today, however, the focus of prevention has shifted. Dentists are now more concerned with other factors: the presence of fluoride in the water and in toothpaste, the use of sealant on the teeth, the frequency of eating and good oral hygiene.
In Asia, there is a clear correlation between the availability of good dental care and the incidence of dental caries. Children in Japan, Hong Kong and Singapore have among the lowest rates of dental decay in the world. In developing countries, where dental services are less established, untreated dental caries are a more serious problem. In the Philippines, for example, where the majority of people do not have regular dental care and the water supply is not fluoridated, 98 percent of the population have dental caries and 50 percent suffer gum disease.
Plaque and acid build-up
Nevertheless, eating patterns and food choices are important factors in tooth decay.
Everything we eat or drink passes through the mouth. For teeth, the problems start when carbohydrates (such as breads, rice, fruits and sweets) come into contact with bacteria in the mouth. The bacteria ferment the carbohydrates producing acids, which can damage the tooth enamel.
The bacteria and food remnants also cause plaque, a filmy deposit on the tooth's surface. The plaque helps the acids cling to the teeth allowing them to work away at the hard enamel shell. After many such attacks, the tooth enamel may break down, forming a cavity. Factors involved in plaque build-up or acid production include:
- Frequency of eating. Each time carbohydrate-containing foods are consumed, acids are released to work on teeth for about 20 to 40 minutes. The greater the frequency of eating, the more opportunity for acid production.
- Food characteristics. Some foods tend to cling or stick to the teeth, and there are some surprising culprits. Cooked starches such as chips and crackers rank higher on the list of foods that stick to the teeth than sugary foods such as candy bars and toffee.
- Length of time food stays in the mouth. The amount of time a particular food spends in the mouth is also important. Foods that are slow to dissolve, such as biscuits and muesli bars, are in longer contact with the teeth providing more time for the acids that damage enamel to do their work.
It's not just sugars that cause dental decay. Starches (such as bread, rice and crackers) as well as sugars (from fruit to milk to honey and refined sugar) can all produce the acids that damage teeth.
Fluoride: the filling fighter
Worldwide, the most important factor in reducing caries during the last two decades has been the widespread introduction of fluoride into water supplies as well as the fluoridation of toothpaste.
Fluoride makes tooth enamel stronger and more resistant to decay and prevents the growth of harmful bacteria.
In Asia, fluoridation has been introduced in Hong Kong, Singapore and parts of Malaysia. In these areas, children have only around half the number of dental caries as compared to children in other nearby countries. In Hong Kong, there was a 70 percent fall in tooth decay rate among children after fluoridation was introduced in 1961. Among adults the rate fell by 40 percent. Likewise in the United States, widespread use of fluoride is credited with a dramatic decline in dental caries during the last 20 years, according to a survey by the National Institute of Dental Research (NIDR).
Dr Rene Sison, Dean of the College of Dentistry at Manila's Centro Escolar University, says water fluoridation is an effective way of bringing improved dental health to a majority of the population in Asia. He suggests putting fluoride in bottled water in countries where the main water system is unreliable. "Fluoridation should bring about a dramatic decrease in the incidence of dental caries," he says.
The role of regular dental care
Above all, regular dental care is crucial in the fight against dental decay. Ideally this should start from as early as six months of age and continue throughout life. For babies and small children, preventing the decay of primary teeth, including "baby bottle tooth decay", is critical. This condition can occur when an infant is allowed to nurse continuously from a bottle of milk, formula or fruit juice during naps or at night.
Dr Sison says it's important to establish good eating habits and good oral hygiene at the pre-school age. He points out that the condition of a child's first teeth, or milk teeth, control the outcome of the child's permanent teeth and should not be neglected.
"If the milk teeth are badly cared for and lost too early, the next batch could come out crooked. Brushing in these early years will also strengthen the gums," he says. "It's like building a house. A good house needs a strong foundation and the same goes for teeth."
Modern technology also means that today a trip to the dentist need not be the frightening experience it once was. Children's teeth can be covered with a plastic protective film called a sealant which helps prevent dental caries by covering up fissures in the teeth. This is a painless procedure performed without the use of drills or other frightening implements.
Good teeth mean good health
For adults, a regular dental check provides important information on your dental health and indeed on your general health. The dentist will check for gum disease and other aspects of oral health. He can check that dentures or bridges fit correctly treat mouth sores; and in rarer cases spot the first signs of pre-cancerous or cancerous lesions. Check-ups are also important because some diseases or medical conditions have signs that appear in the mouth. Diabetes, nutrient and vitamin deficiencies and hormonal irregularities may be detected by an oral examination.
Oral health education for all
Prevention of tooth decay can be tackled from a number of angles. Good oral hygiene, sensible eating practices, regular dental care and water fluoridation all form important parts of the picture.
Raising awareness about the importance of dental care is also crucial. This can be done through community programmes, school projects and by information provided by the local dentist.
"Education about dental hygiene is the key," says Dr Sison. "With good information made available to the public at large we can work together to significantly reduce the incidence of tooth decay in our society."
Top teeth tips
Begin dental care early as soon as the first baby teeth erupt. Clean teeth with a fluoride toothpaste twice daily and especially before bed. Dont eat too frequently. Six to seven eating occasions per day is OK. Give your teeth a "rest" between meals and snacks. Visit the dentist regularly at least once a year.