The S Word – Sugar and How it Affects Your Teeth

Sugar is the nutritional equivalent of a friend who seemingly has all the answers but doesn’t really have your best interests at heart. From weight gain to the risk of diabetes, heart disease to tooth decay, sugar has a lot to answer for. But how exactly does it affect our teeth, is there such a thing as ‘good’ sugar, and what can we do to minimise our intake and the risks of tooth decay from consuming it?

What effects does sugar have on teeth?

Although it’s the hardest substance in the human body, tooth enamel -the thin outer shell of the tooth- can be damaged by dental caries and decay. It’s designed to protect the tooth from harm when eating, mainly because our teeth grind against each other when biting and chewing. Enamel can, however, be dissolved by a bacterial process. Bacterium in the mouth reacts with sugary foods, producing an enamel-dissolving acid. Within five minutes of consuming sugar an acidic environment is created that can take 45 minutes to an hour to recover.

Once bacteria have been around for a while, they start to dissolve the enamel, creating a cavity in the tooth’s outer layer. If left unchecked they will eat through the enamel to the softer dentine underneath. You’ll need a filling to repair this damage and to stop decay spreading to the nerve.

A tooth with an infected nerve leads to toothache and/or abscess formation and needs to be treated either with a root filling, or, in some cases, extraction: if a tooth is badly decayed it can’t be saved.

Is sugar bad for your gums?

Excessive sugar consumption can also cause gum disease which can lead to the loss of teeth. It’s been shown to contribute to inflammation in the body and can be particularly aggressive in patients with diabetes.  Poor gum health can affect your general health including your heart so it’s important to minimise the risk and take good care of your gums.

What are the main sources of sugar and are there ‘good’ sugars?

Sugar is known by many names and comes in many forms;

• Glucose
• Dextrose
• Fructose
• Sucrose
• Isoglucose
• Levulose
• Maltose
• Invert sugar
• Syrup
• Treacle
• Molasses
• Corn sugar
• Unrefined sugar
• High-fructose corn syrup
• Honey
• Maple syrup
• Agave syrup
• Coconut sugar
• Palm sugar
• Jaggery:

These are all types or forms of sugar and this is not an exhaustive list! Some have lower inflammatory properties, and some contain more nutrients than others. On a dietary level it is ‘better’ to consume the more natural and unrefined versions of sugar, but they all have a similar impact on teeth.

How much sugar is too much and why do we overindulge?

Two hundred years ago it took the average American a year to eat just two thirds of the sugar they now eat in a week. The UK government recommends no more than 30g for adults, or 10% of a person’s daily calorie intake.

As a rule of thumb, the less added sugar we eat, the better for our health and our teeth. One thing is certain: in many countries, the UK included, average daily sugar intake is higher than the guidelines.

We need to be mindful of what we are eating and drinking, and when and how we do it. To minimise the effects of sugar on our teeth we should consume sugary foods and drinks as part of a meal.

This way the other foods we are eating at the same time act as a buffer. Sugary snacks should be eaten quickly, and sugary drinks consumed with a straw.

How does sugar affect your hormones?

While not physically addictive, sugar can cause chemical and behavioural addiction. Eating it releases dopamine which is strongly linked with mood and sensations of pleasure.

Tolerance builds up over time, so you need increasing amounts to get the same effect. In times of stress cortisol is released which leads to sugar cravings: consuming sugar increases serotonin levels, which counteracts the cortisol.

In a similar way, low levels of serotonin, typically associated with depression and anxiety, produce sugar cravings because sugar increases serotonin levels.

The daily recommendations refer to ‘free’ or ‘added’ sugars which are added to, or included in, foods and drinks (often unexpectedly). Whole fruits and vegetables, fruit and milk are not included in the amounts recommended for dietary purposes but the sugars in them can still have an impact on teeth.

What are the mains sources of free sugars?

Free sugars are found in many foods and drinks: some more obvious than others.

• Table sugars and syrups, confectionery and preserves

People often add sugar in one form or another to hot drinks, cereal, desserts, and so on. As sugar is a preservative it is found in substantial quantities in jams, chutneys, and sauces.

• Soft drinks and fruit juices

Sugar is added to soft and fruit-based drinks for sweetness and enhanced ‘mouthfeel’. A 500ml bottle of cola contains 47g, or 13.5 cubes, of sugar!

Although natural fruit juice should have no added sugar, free sugars are released when you juice fruit or make a smoothie. So, to reduce your free sugar intake it’s much better to eat an orange than to drink a glass of orange juice.

• Biscuits, baked goods, and snacks

Sweet snacks are often particularly high in sugar (and fat). Humans have evolved to gorge on these sorts of foods as calorie dense food needed to be consumed when it was available.

This is one of the reasons we can find, sugary, fatty foods so hard to resist and so ‘moreish’.

• Alcoholic drinks

Alcohol, particularly liqueurs and alcopops can be a significant source of sugar. While spirits tend to be lower in sugar, many mixers contain large amounts.

• Dairy products

Dairy products such as yogurts and ice cream are sweetened with sugars.

• Savoury foods

A lot of people are surprised to learn that many savoury processed foods contain sugar. Ready meals, flavoured crisps, nuts and crackers, bread, ketchup, stir-fry sauces, soups, and so on, can all have large amounts of added sugar.

How do you reduce sugar consumption?

Being aware of where sugar is lurking in our food and drink makes it easier to reduce. Don’t forget that the ‘healthier’ or naturally derived forms still count.

Try to choose reduced- or lower-sugar options. Limit fruit juice consumption to one glass a day. Drink water instead of sugary drinks.

If you must have soft drinks choose the diet version. If you use mixers in alcoholic drinks, again, choose the diet or low-calorie option.

Swap cakes, biscuits, chocolates, sweets and dried fruit snacks for fresh fruit, nuts, rice cakes, oatcakes, crudités, and savoury dips with no added sugar. Avoid adding sugar to tea or coffee, porridge, cereal or pancakes.

Reduce the amount of sugar in baking where possible or use recipes that have already had the sugar reduced. The more you make from scratch instead of relying on processed, takeaway, or prepared food, the more control you have over the sugar in your diet.

Check the sugar content on labels so you are making informed choices.

How do you prevent tooth decay?

There are things that we can do to reduce and delay the risk of tooth decay and gum disease. And prevention is definitely better than the cure!

By eating a healthy diet low in free sugars, eating sugary food at the right times, following good oral hygiene practices, and seeing your dentist and hygienist regularly you can reduce your risk of dental decay or caries.

Good hygiene practices at home include using an electric toothbrush for two minutes twice a day with a fluoride toothpaste. And don’t forget to floss and/or use interdental brushes to reach the bits the toothbrush can’t.

See your dentist at least annually and your hygienist as recommended (usually every 3-6 months depending on how good you are with your home care and if you suffer from gum problems).

Regular visits are essential to check your teeth and review your oral health as decay can be detected at an early stage.

Using dental x-rays your dentist and hygienist can create a protocol to try to stop the progression and the need for further treatment. Removing plaque deposits that have formed on your teeth can help to slow the process and the need for intervention. Good oral hygiene is key for good dental and gum health and the longevity of your teeth.

Caring for your teeth and gums is a team effort – but worth it to avoid treating a disease that without sugar and plaque is 100% preventable

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