Dental Health Week 2020: Be Sugar Savvy

Posted on 29th July 2020

How much sugar is hiding in your patients’ trolleys? You can’t go food shopping with your patients, but you can start the discussion during Dental Health Week, from August 3 to 9

Chairside discussion

Dr Fleur Creeper, committee member of the Oral Health Committee and spokesperson for ADAWA, says although it can be hard to find the time during busy chairside sessions to talk about sugar, it’s important to start the conversation.

“Explaining to patients why they have a cavity and how tooth decay happens, rather than just fixing the problem, is a great start,” she says. “Incorporate questions into your medical/dental history and discussions about diet.”

Fleur suggests utilising your team members and making sure everyone is on the same page with knowledge, resources, and prevention strategies.

ADA Inc have produced some great resources – including the short, sharp oral health videos with pro tips, including ‘How Tooth Decay Forms’ and ‘Tooth Friendly Diet’, which are great for your website and social media,” she adds.

The Dental Health Week website is a great starting page for both professionals – to familiarise yourself with the key messages and all the resources available – but also your patients and the general public as a whole.”

Aside from chairside discussion, there are other effective ways to show your patients the damage that sugar can have on their teeth.

“Obviously, pictures, photos or intra-oral videos are worth a thousand words,” Fleur says. “Seeing the damage is going to reinforce the message and help understand what is happening inside their own mouth. Radiographs can also show the damage but remember patients may not see these as clearly as we do, so a clear ‘walk through’ of the image is required.

“Utilise technology like the internet or YouTube – it is not just for funny cat videos! There are lots of resources out there for use in the surgery but also for the practice waiting room, websites, email and follow-up home viewing for your patients.”

Fleur also suggests familiarising yourself with campaigns from other organisations – and directing your patients towards them.

“The fact that a number of different organisations are sending the same message adds significant weight to the impact,” she explains. “Recently, ADAWA partnered with Cancer Council and LiveLighter on a sugary drinks campaign, focusing on the dental impacts. Discussing these campaigns with your patients and may help to create a great talking point and highlights the importance of the messages.

“It is vitally important to keep having this conversation, as only 53% of adults in Australia brush twice a day and many don’t understand the link between what they eat and drink (especially between meals) and their oral health,” Fleur adds.

“The latest data indicates that nearly 48% of adults and 70% of children are consuming too much sugar. Tooth decay is the most common chronic disease in childhood and childhood oral health is the greatest predictor of dental disease into adulthood.

“Sugar is everywhere today; a lot of us consume too much and too frequently and it is having an enormous detrimental impact on our oral and general health and this needs to change. The first step is to have the conversation.”

Dietitian advice

Are your patients unsure how to identify the sources of sugar in their diet?

Charlene Grosse, spokesperson for Dietitians Australia and an advanced accredited practising dietitian, says the evidence for reducing sugar intake worldwide is strong. “Not only does it affect our health and risk of diseases, it also affects our risk of dental decay,” she says.

“It is important that health care professionals work to provide a consistent message on the importance of reducing empty sugars, where it is likely to affect someone’s health.”

She says packaging and food labelling can be confusing, but there are some key things to look for. She provides the following advice:

  • Ingredients are listed in descending order of their quantity, so the highest ingredients feature in the greatest amount.  Look out for sugar that is listed early in the ingredients
  • Be aware that sugar may be listed under numerous names– including rice malt syrup, honey, dextrose, sucrose, malt, maple syrup, corn syrup solids, table sugar and many others.
  • The Australian Dietary Guidelines recommend checking the ‘per 100g’ column of anutrition information panel, as this makes comparing product within the same food group more reliable – serving sizes often differ between products. Look for products with 15g or less sugar per 100g – and check that sugar is not listed high on the ingredient list.
  • Be wary of claims  such as “natural” or “with added …”. These can be misleading, and don’t necessarily paint the full picture.  There are no clear guidelines for these sorts of claims, so being  label-savvy means you can make an informed decision.
  • While itis true some packaged foods can be low in nutrition, many are convenient, and if you are aware of what to look for, can be part of a healthy diet.

Keep in mind that there are some deceptively high-sugar foods, including sauces and dressings (such as tomato sauce and mayonnaise), non-dairy milks, “healthy” cereals and breads.

Charlene’s top tips to reduce sugar:

  • Be wary of the sugar in your drinks. As always – it is best to make water your drink of choice. However, for other beverages, there are some simple swaps you can make to reduce your sugar intake. Some examples include reducing the added sugar/syrups to coffee/tea; if you choose to drink alcohol, opt for lower-sugar options (eg choosing soda water and fresh lime, rather than soft drink as a mixer); and opting for whole fruit where possible (and if you like fruit juice, make it an occasional choice, rather than as the ‘go-to’ option).
  • Choose whole foods first.  Where possible, aim to choose foods that are unprocessed or minimally processed, as this will reduce the likelihood of sugars being added.
  • Cook at home. Cooking at home puts you more in control of what goes into your meals – and this can help reduce the amount of added sugars in your diet. It can also help boost other healthy habits (like increasing your fruit and vegetable intake) and can save you money in the long run too.

Making a difference

Cancer Council WA spokesperson for the LiveLighter® campaign, Kelly Kennington (Obesity Prevention Manager), says over the last eight years, LiveLighter has run several waves of two different TV-led advertising campaigns targeting sugary drinks (‘Sugary Drinks’ and ’13 Cancers’) as well as two outdoor-orientated campaigns (‘Don’t Be Sucked In’ and ‘Sugary Drinks Are A Rotten Choice’).

“These campaigns have increased Western Australians’ understanding of the health effects of soft drinks and have motivated people to avoid or cut down on sugary drinks,” Kelly says. “Campaign evaluation has shown that weekly sugary drink consumption among WA adults has decreased by almost 20% (from 60.3% in June 2012 to 41.3% in June 2019) while intentions to drink less sugary drinks has increased significantly over this time period.

“The most recent evaluated wave of the campaign (‘13 Cancers’ in October 2019) showed that the proportion of people who think about the health risks of drinking sugary drinks and who were concerned about their sugary drink consumption was significantly higher than at the last ‘Sugary Drinks’ campaign wave in June 2018. Pleasingly, this effect was stronger in the target audience (people who drink sugary drinks regularly).

“We have also seen a significant reduction in sugary drink consumption in secondary school students in WA, despite them not being the target audience for LiveLighter,” Kelly adds. “Between 2012 and 2018, the proportion of secondary school students drinking four or more cups of sugary drinks per week reduced from 27% to 10%. The decline follows a national trend, but the reduction in WA has been significantly steeper. This might be a reflection of the LiveLighter messages and their broad impact in the community.”

Why it is so important

Dr James Muecke AM, ophthalmologist, chair of Sight for All and Australian of the Year 2020, says sugar has been neuro-scientifically proven to be as addictive as nicotine. “I suspect that much of the world has a physical dependency on sugar and that many have an even deeper psychological addiction,” he says.

“Our addiction is fed by the ready accessibility of sugary products in our lives, the astronomical amount of sugar that’s added to our food and drinks, and the lure of advertisements and predatory marketing tactics that flood our environment.

According to James, the most concerning health issues of excessive sugar in our diet are:

  • Dental caries– sugar is the leading cause of tooth decay. One-third of 5-6-year-olds have decay in their baby teeth and 40% of 10-12 year-olds have decay in their adult teeth.
  • Obesity– one-quarter of children and adolescents, nearly half of 18-24 year olds, and two-thirds of adults are overweight or obese.
  • Type 2 diabetes– type 2 diabetes is a blinding, maiming and deadly disease impacting at least 1.7 million Aussies, nearly 10% of our population. In some areas of the country, such as Greater Western Sydney, half of all adults have type 2 diabetes or pre-diabetes.

James says health practitioners need to have evidence-based, open and frank discussions with their patients regarding the multitude of health dangers of sugar – its role in tooth decay and obesity and the life-changing and life-threatening complications of type 2 diabetes, all preventable dietary diseases. However, he says they first need to be aware of the latest evidence, including:

  • That excessive sugar consumption has been linked to tooth decay.
  • That excessive sugar consumption has been linked to type 2 diabetes, independent of obesity.

“I also believe that they need to be aware that type 2 diabetes can be reversed in many people, and that it doesn’t have to be a life sentence,” James adds. “This needs to be communicated clearly to patients, perhaps reinforced with powerful examples of adverse outcomes in those who have not heeded medical or dietary advice.”

This article first appeared in the August edition of the Western Articulator magazine.