Feature

Enough of the sweet talking

Vested interests are working against the interests of better dental health, warns Stephen Hancocks

Ask a friend what causes lung cancer and they will answer ‘smoking’. Ask them how to avoid it and they will answer: ‘Don’t smoke’. Now ask them what causes tooth decay: ‘Sugar’. And how to avoid it? ‘Brush your teeth’.

The idea of prevention after the event is so deeply ingrained when it comes to sugar that persuading people to reduce sugar consumption in order to prevent tooth decay is an uphill task. After all, they’ll say, sugar is nice and sweets are nice, so if we can have our cake and eat it, why shouldn’t we? Metaphorically and actually.

One of the difficulties in the sugar versus dental health debate is that the cause of dental decay is complex. The basic sequence of events can be represented as:

Sugar + Plaque (bacteria) = Acid.

Acid + Tooth = Decay.

Bacteria in the mouth, in the form of plaque, the white furry substance that continually grows on our teeth, convert the sugar we eat into acid. Held close to the tooth surface by plaque, the acid begins to soften the tooth enamel by dissolving away its mineral content, mainly calcium. After each intake of sugar, this demineralisation process lasts about 30 minutes, the time it takes for our saliva to neutralise the acid. Until the next intake of sugar the calcium and other minerals in saliva can begin to remineralise the attacked tooth surfaces.

It is when this process gets out of balance that decay can progress. Frequent consumption of sugar maintains acid production and allows no time for remineralisation to get under way. The result is that the more frequently we consume sugar the more chance we have of tooth decay.

Even this simplifies things a little, since different kinds of sugar have different capacities to cause decay. Refined sugars such as sucrose and glucose are the worst offenders. The physical state of the food or drink containing the sugar is also significant - hard sweets and sticky toffees being obvious villains.

In addition the shape, position and composition of each tooth exerts an effect. The patterns of naturally occurring grooves on the biting surfaces of back teeth are particularly vulnerable in younger children, and even thorough cleaning with a toothbrush will not remove the acid from the depths of the fissures where the decay most easily begins.

Because of the complicated and varied natural history of the disease it is easy for misunderstandings to flourish, so that the task of educating health professionals and the public is far from straightforward. The situation also provides the maximum opportunity for creating confusion and disinformation by those whose livelihood depends on the continued and increasing sale of sugar.

The Sugar Bureau is the trade association for the sugar refining industry in the UK, comprising mainly Tate and Lyle and British Sugar. It exists to promote the interests of the industry, through encouraging increased sugar consumption.

Advertising is the most obvious way of increasing sales. Recent campaigns on television and in the press have reputedly cost in excess of £10m, and strive to create a connection in the consumer’s mind between refined sugar and nature, or ‘natural’ foods.

The industry also promotes directly to health professionals. Free newsletters to dieticians and dentists claim to present a balanced view of sugar as a nutrient, arguing that refined sugar in its many guises should form a part of a balanced diet. Needless to say, little attention is paid to the fact that sugar alone provides no nutritional content and is essentially ‘empty’ calories, as well as causing dental decay.

Recently schools have also been the targets of this promotional activity. The Sugar Bureau has produced an ‘information pack’ designed to be used in Key Stages one and two of the National Curriculum. The pack was sent, free and unsolicited, to 24,000 primary school teachers throughout the country. Not surprisingly, there was considerable emphasis on sugar use. One classroom exercise involved making sweets with a 95% sugar content. Clearly, the aim was to encourage children - and even parents - to see such activities as acceptable because they are ‘taught at school’.

Action and Information on Sugars is a voluntary network of health professionals, established to counter disinformation about sugar and provide independent, clear information, advice and specialist contacts about sugar, without any vested interest. The network is multidisciplinary, and includes academics, dental public health specialists, dieticians, researchers and health promotion officers. It accepts no funding from the food industry, relying instead on membership fees and publication sales to raise money. One such publication is Exposing the Sweet Talk, a critique of the Sugar Bureau’s ‘information pack’, which has been sent to all district dental officers and to health education advisers in each local education authority.

The answer to tooth decay is a simple one: less sugar and less often. But as long as those with an interest in increasing sugar consumption continue their promotional activities, there will remain a need to provide clear and accurate information to public and professionals alike.

For further information on Action and Information on Sugars, write to: AIS, PO Box 190, Walton-on-Thames, Surrey KT12 2YN.