Effects Of Sugar Consumption On Tooth Decay

Introduction

Tooth decay is a common oral condition involving loss of minerals (calcium and phosphate) and subsequent breakdown of the tooth structure by acids produced by certain bacteria like Streptococcus in the presence of high levels of sugar from our diet.¹

What causes teeth to decay?

Tooth decay is primarily caused by the interaction of bacteria, high sugar food content and saliva crumbling the tooth structure. 

Below are the main factors contributing to tooth decay.

• Oral bacteria particularly Streptococcus and Lactobacillus species
• Consumption of sugary and starchy foods such as Carbohydrates 
• Poor oral hygiene
• Consumption of acidic food and drinks
• Dry mouth (lack of saliva)
• Genetics 

Out of all these factors free sugar as per WHO findings is one of the major reasons behind tooth decay.

Also, Studies carried out on children indicated that those who consumed free sugar-rich food like 100% fruit juice or sugary candies regularly such as once a week or for example at bedtime caused higher incidence.² 

Now let’s first understand what free sugar is.

What is free sugar?

The type of sugar that adults and children consume daily is mostly free sugar. Ideally, the health authority guidelines advise that adults and children above the age of 10 should not consume more than 30g (about 7 sugar cubes) of free sugar per day. 

• Sugar added to food and drinks is called free sugar
• Cakes, bread, biscuits, candies, and sweets all contain added free sugars³
• Sugar which is not present/found inside the food cells is classified as free sugar. For example when you make a pressed orange juice the sugar inside the cells comes out of it and becomes free sugar whereas the sugar from an orange is not sugar free. Therefore, fruit juices, honey, and syrup are all free sugars
• Sugar found in milk, whole fruits and vegetables, nuts and seeds is not considered as free sugar

How to know if your teeth are decaying?

If you are experiencing any of the following symptoms, you are likely to have tooth decay, which needs to be consulted by a dentist for appropriate diagnosis and treatment.

• Persistent or intermittent tooth pain when chewing is a sign
• Sensitivity to hot/cold or sweet food
• Yellow discoloration of teeth
• White, brown, or black spots or visible holes in teeth indicate cavity formation
• Bad breath due to foul-smelling gas produced by the bacteria in the mouth
• Swelling and severe pain indicating abscess formation at the root of teeth in the advanced stage

How free sugar consumption causes tooth decay?

As soon as free sugar in any form is consumed, the below interaction between the bacteria present in the oral cavity, sugar and tooth structure begins as explained, leading to tooth decay.

1. Fermentation of sugar 

Bacteria like Streptococcus and Lactobacillus are present on the surface of teeth and gum in a sticky colourless film called dental plaque. When sugars like sucrose, glucose and fructose are consumed, they start using these sugars as a source of energy through a process called fermentation.⁴

2. Excess acid production

During fermentation, acids are released as metabolic byproducts. This leads to a highly acidic environment in the oral cavity.

3. Demineralization of tooth enamel

Due to the increased acidity, minerals such as calcium and phosphate from the tooth enamel start dissolving causing demineralisation.⁵ Loss of these minerals cause weakening and eventually lead to breakdown and formation of holes in the surface of the tooth called cavities.

4. Dental plaque build-up

With repeated sugar consumption, there is the growth of larger bacterial colonies in the dental plaque. If brushing and flossing the teeth, they are not properly done, then this plaque starts growing in areas of the mouth that are hard to reach and becomes an ideal site for tooth decay to begin.⁶

5. Problems in remineralisation

 Remineralisation is a natural repair mechanism of tooth enamel in which the minerals are deposited back by the saliva. The acidic environment formed due to sugar consumption arrests/hinders this protective mechanism.⁷

6. Decay of tooth

This weakened enamel to become irregular and microscopic pores start forming on the enamel’s surface. This leads to tooth decay.

What if tooth decay is left untreated?

Cavity formation

If not treated, the enamel eventually breaks down due to advanced loss of minerals and a hole called a dental cavity is formed in the tooth. Over time the cavity becomes larger and the decay reaches the inner softer layer of the teeth leading to increased sensitivity to hot, cold and sweet foods.

Pulp involvement 

When decay reaches the innermost part of the tooth, it causes an infection of the pulp called pulpitis. This causes severe tooth pain, swelling and sensitivity.

Abscess formation and tooth loss 

If still untreated this leads to the formation of an abscess and subsequently loss of tooth and other complications.

Treatment for tooth decay

Fluoride treatment

In the initial stage fluoride varnishes, gels and mouthwashes add the lost minerals to the teeth enamel and strengthen them so that further decay is prevented.⁸

Dental fillings

If cavities are formed already then the decayed portion of the tooth is removed and the cavity is filled with an artificial dental filling material. 

Dental crowns

A dental crown is a custom-made cap covering the entire visible portion of the tooth. A dental crown is placed in an advanced stage of tooth decay to give protection and support to disintegrating tooth structure.

Root canal therapy

If the infection reaches the inner pulp of the tooth then the infected portion is removed, and the root canals are cleaned and sealed to prevent further spread of infection. 

Tooth extraction

In severe decay, an infected tooth is removed to prevent further spread of infection. The lost tooth can be replaced with a dental implant or a denture.

What Measures can be taken to prevent tooth decay?

To avoid tooth decay as a result of free sugar consumption, you need to follow below preventive measures.

Limit sugary foods and beverages

Avoid or reduce intake of food containing free sugars like fruit juices, candies, cookies, cakes, breads, and soda.

Rinse mouth with water

After consuming sugary food or drinks, rinse your mouth with plenty of water. This washes off the sticky sugar residue on teeth and protects teeth from tooth decay. Washing does dilute the acid. 

Maintain good oral hygiene 

Brushing teeth at least twice a day and flossing removes food particles and plaque from teeth and prevents the build-up of bacteria that feed on sugar.

Fluoride toothpaste

It strengthens the teeth enamel by replacing the lost minerals from the enamel.

Sugar-free gum

This stimulates saliva production which washes away food particles and neutralises acids. Gum sweetened with xylitol may help against bacteria causing tooth decay.⁹ 

Drink water instead of sugary beverages

Try to drink water instead of sugary beverages with meals as water hydrates the body and also helps to rinse away food particles and sugar from the teeth.

Regular dental check-ups

This can also detect and address any oral health problems quickly and on time.

By incorporating these strategies into your daily routine, you can effectively minimise the impact of sugar on your teeth and reduce the risk of tooth decay.

Summary

Tooth decay is a common oral condition and occurs due to the lack and loss of minerals and breaking down the health structure of a tooth allowing acids produced by bacteria in the oral cavity. 

Sugar free is the risk factor present in sugar, cakes, bread, candies and biscuits. So it is best to prevent and consume a little.^1,3 

The bacterial activity causes the loss of minerals from the tooth enamel forming pores in the surface of the tooth. You may start experiencing tooth pain when chewing, sensitivity to hot/ cold or sweet food and other sign and symptoms list in this article giving out bad breath due to foul-smelling gas produced by bacteria, swelling and severe discomfort. 

If not treated in time it can result in an abscess formation and even lead to loss of teeth.