Sir, – I refer to the welcome discussion by Ann Marie Hourihane on diet and oral health in her column (Opinion, March 12th).
Our sympathy, as dentists, is with those readers who are anxious to heed the best available advice but find themselves confused by seemingly contradictory guidance. On closer reading, however, there is no real contradiction and certainly there is compelling evidence that a diet rich in fruit and vegetables lowers the risk of cardio-vascular disease.
Dietary guidelines for good oral health do not generally conflict with those for good general health. Fruit and fruit juices can provide beneficial nutrients in the diet. However, excessive frequent consumption of fruit juice can result in dental erosion and dental caries.
When consuming drinks patients, and parents of young patients, often seem to regard fruit juice as a “safe” alternative to soft drinks. It is important to understand that while fruit juices can provide beneficial nutrients the sugar content and acidity of juices can be damaging to their dentition if consumed too frequently. For most children the best advice is to drink milk or water when thirsty and avoid sugary drinks whether they are “fruit based” , “soft drinks” or “sports drinks”. Excessive consumption of acidic fruit can also contribute to dental erosion.
Dental erosion appears to be increasing and, aside from the type of food and drinks we consume, there are many factors that can contribute to this. A high frequency intake of fruit juices, and/or acidic fruit can cause significant erosion and also contribute to dental caries. To minimise the potential negative effects of “acidic” food and drink it is advisable not to brush teeth immediately after eating. Brushing twice a day for most people is sufficient and over vigorous brushing can contribute to tooth wear and erosion. It is generally best to restrict consumption of fruit juice to mealtimes and drink rather than “sip” acidic drinks.
A high intake of fruit and vegetables and reduced intake of energy dense foods is recommended by most international health groups including the World Health Organisation. Avoiding “sugary drinks” is also advised.
Often when advising patients of the potential negative problems associated with certain foods we neglect to advise them of safer and more nutritious alternatives. As with most dietary advice consumption of fruit should be seen in the context of an overall balanced diet and not as a “good or “bad” food.
It is important to distinguish dentists’ concerns about the impact of fruit juices and the still widely supported policy of consuming at least five portions of fruit and vegetables each day.
Finally, the decade-long absence of a chief dental officer undoubtedly contributes to great confusion in advising both the public and the politicians on important choices faced in terms of diet and oral health.
In many cases the State’s decision to effectively abandon support for patients’ dental care will only become more obvious when lasting and often irreversible damage is done. If nothing else, this latest debate might force the Government to honour its commitment to appoint a chief dental officer and take the lead in informing the public on good dietary advice. – Yours, etc,