In anticipation of the first phase of the sugar tax, Professor Andrew Eder looks beyond the more commonly-associated topics of obesity and caries, and considers the effect of sugary drinks in terms of tooth surface loss.
Trends in relation to tooth surface loss, revealed by the most recent Adult Dental Health Survey (2009), suggest that erosion, abrasion and attrition are on the increase. Indeed, comparison between the 1998 and 2009 surveys reveal an increase of 10% in the incidence of tooth wear; when extrapolated, this is very concerning for the future.1
The good news is that some help is around the corner in the form of the so-called ‘sugar tax’, but it has predominantly been promoted as a tool in the fight against obesity and, to a lesser extent, caries. But in truth it also has a role to play in reducing the incidence of tooth wear, as the inherent acids have acidogenic potential, possibly resulting in erosion over time.
So, whilst this outcome is not directly linked to sugar, if the tax could be used as a tool to encourage patients to drink fewer carbonated beverages and high-sugar fruit juices, tooth surface loss beyond that expected as we age may be reduced, or even prevented.
It is anticipated that the tax on sugary beverages will come into being in April 2018,2 in form of a tiered tax on the drinks industry as follows:
• A high tax for drinks with >8 g of sugar per 100ml
• A moderate tax for 5g to 8g of sugar per 100ml
• No tax for <5g of sugar per 100ml.3
As Jeremy Rees, Professor of Restorative Dentistry at Cardiff University, told the British Dental Journal in 2015 regarding what was – at that time – a campaign to tax sugary drinks, ‘I believe that would be a step in the right direction because the average consumption of carbonated drinks in the UK (particularly for young people in their twenties and younger) is half a litre a day per person.’4
Responding to a question about what milestone he would like to see in preventive dentistry, he responded: ‘I think it’s making people more aware of the issues relating to acid erosion.’4
This is the key; educating patients about tooth surface loss. The public has been told repeatedly about the detrimental effect of sugar consumption on their oral health, and many have responded to this call to action by switching to sugar-free carbonated drinks and fruit juices. They genuinely think this is a healthy move, and, of course, in some ways it is.
Undeniably, telling a patient that they are suffering from tooth wear can come as something of a shock, especially for those in their 20s, 30s and 40s who are well educated and try to live a healthy lifestyle.
Whatever their age and status, patients need to be made aware that ill-considered drink choices can cause damage to the enamel and dentine. If you would like support in doing this, The London Tooth Wear Centre® offers an evidence-based and comprehensive approach to managing tooth wear, using the latest clinical techniques and an holistic approach in a professional and friendly environment.
1. Adult Dental Health Survey 2009. Health and Social Care Information Centre 2011
2. https://www.gov.uk/government/news/soft-drinks-industry-levy-12-things-you-should-know. Accessed 1 June 2017
3. Briggs ADM et al. Health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study. The Lancet Public Health 2017; 2(1): e15–e22
4. Rees J. ‘We ned to make people more aware of the issues relating to acid erosion.’ BDJ 2015; 219(4): 157-158