IF YOU need a filling at the dentist how many times have you heard the message ‘you must stop eating sweets and sugar’? Really, in this day and age with

Dr Mark Boulcott: Explaining dental disease to a patient.

sugar being added or included in almost all foods as not only a sweetener but as a preservative, texture modifier, fermentation substrate, flavouring and colouring agent, bulking agent and emulsifier, is it even possible to comply with this message and not starve?

It is no surprise, therefore that the statistics of decayed teeth in Pembrokeshire as regularly reviewed by the Hywel Dda Health Board Oral Health Profile (last published in 2013) shows an appalling incidence of dental decay in 5 year olds – and yet dental decay is a totally preventable disease!

So what in reality can you and your children eat and be reassured that your teeth will remain decay free? The answer is that there are really no safe foods. The food industry confuses us with statement like ‘no added sugar’, ‘contains natural sugars’ or ‘reduced sugar’. Sucrose, Glucose, Maltose, Fructose (as labeled on many foodstuffs) are all naturally occurring sugars and all, when eaten, cause acid to form in the mouth: The cause of dental decay with the acid ‘dissolving’ teeth. What is less obvious is the amount of sugar contained within the product.

In essence, sugar is sugar: They all cause dental decay no matter how much or how little you eat. One teaspoon of sugar (sucrose) in your Tea is just as bad for your teeth as five sugars. The only difference is that you may get fat, more prone to diabetes and other health complications with a higher sugar intake but much lower amounts of sugar ingestion will still cause teeth damage. So we have to assume all foods we eat contain sugar (fermentable carbohydrate) of some type.

This dissolving of the teeth, called dental decay or dental caries, puts you and your child at the risk of dental pain, infection and the need for treatments possibly including tooth removal.

Thinking that, in the case of young children, it does not matter (after all, ‘baby teeth’ will be replaced) is wrong. The decay of deciduous teeth may still lead to your child having pain and infection but worse, teeth removal possibly needing General Anaesthesia. This is a procedure not without risk and not easy to access in Pembrokeshire with the nearest GA treatment centre being in Swansea with waiting times often inappropriate for acute pain. There is also the fact that early loss of first teeth is much more likely to lead to crowded or crooked permanent teeth: a fact that may require later orthodontics (treating with braces).

The dentists at Herbrandston, one of Pembrokeshire’s most proactive dental practices in regard to prevention of dental disease, give a different message. Dr Mark Boulcott, the principal dental surgeon states: “I never tell parents to stop giving sweets. That message is unrealistic and unhelpful. The modern diet is full of sugary drinks, sugary confectionary and sugar containing meals. Instead I am far more interested in the frequency of sugar ingestion: how often patients eat sugar, not how much sugar.”

“It has been known for decades that sugar causes bacteria in the mouth to form acid which in turn damages teeth. Of course, no sugar equals no tooth decay, but what most patients (and indeed many dentists) fail to understand is that the amount of sugar required to cause bacteria to produce acid is minimal. The more sugar you eat does not mean more acid in your mouth – but even the slightest sugar intake causes tooth damage.”

Dr Boulcott points to evidence from as far back as the 1940s, when Dr Robert Stephan postulated the coincidence of reducing pH (acidity) and tooth decay: “It is evident even before the advent of the NHS that dental decay was not caused by having too much sugar, but by having too great a frequency of intake. Sugar causes damage by allowing mouth bacteria to produce acid but the amount of sugar eaten is irrelevant. Any damage caused by the acid (at a microscopic level) should be repaired provided the saliva is allowed and able to work properly, converting acid back to neutral products and acting to ‘repair’ damaged teeth. If sugar is regularly ingested and more acid is produced before this ‘repair’ process is completed then dental decay will result. The upshot of this is that if a child ate a chocolate bar for breakfast, lunch and dinner, it is in fact unlikely that they will get significant dental decay. If they eat the same amount of chocolate between meals, then they are much more likely: Twice the cycle of damage and far less time for repair. It should be understood that a sugar diet is inevitable,” states Dr Boulcott.

“What people must understand is that keeping food intake to mealtimes only is the best way to keep your teeth safe. This one fact is more important than tooth brushing or Fluoride. So, yes, Children (and adults) can eat sweets but keep these short acting (chocolate rather than a chewy sweet) and confine these to mealtimes – avoid eating between meals.”

Sadly some 60 years on and this simple message is still failing to get through. Dentistry and preventive messages still seem to mean little to a large percentage of the population with people in Wales being less likely to have been seen a dentist in the past two years than people in England. (52.2% of adults in Wales and 56% in England; and 64.7% of children in Wales compared to 69.1% in England). Many people argue that the reducing amount of NHS dentistry is to blame but in reality many patients (over half the population of Wales) seek dentists only in event of an emergency; citing anxiety rather than money (or NHS access) as being the major obstacle to visiting.

At Herbrandston, the dentists are trying to change this attitude by breaking down the barriers of fear and anxiety offering often unique ways of dealing with even the most difficult of dental phobias. This not only includes a gentle caring atmosphere of quiet professionalism mixed with genuine friendliness but also techniques such as dental sedation, hypnosis, introductory sessions without treatment and even animal therapy using pigs and ferrets to desensitize. They are working hard to emphasise the preventative message rather than the cycle of repair after repair. A very busy practice despite being in a rather isolated part of Pembrokeshire, Herbrandston will be expanding to open a state of the art new practice in Narberth in March.