Those eating more sour fruit may risk greater erosion of their tooth enamel (especially if teeth are brushed in a softened state), but there’s a simple solution.
Plant-Based Diets: Dental Health,
The foods found most protective include raw and green/leafy vegetables, tomatoes, citrus, and carrots. Citrus fruits are acidic, though. Fine, less oral cancer, but what the health of the teeth themselves? Might eating lots of sour fruit eat away at our enamel. Well early case reports that raised red flags involved things sucking on lemon wedges—not a good thing for your teeth. Or, rampant cavities as a result of the bizarre habit of sucking bananas. Turns out you should not give your preschool child a banana to suck on day and night as a pacifier. Juicing 18 oranges a day for a decade or two can also take quite a toll. The conventional wisdom that fruit juice may be bad for your teeth, but not whole fruit, was challenged recently. The ability fruits and their juices to erode enamel appear to be comparable, whether you're eating grape or grape juice, carrots or carrot juice, oranges, apples, tomatoes or raisins. Now fruits and fruit juices weren't as bad as soda—diet coke takes the title for softening teeth the quickest, but it was a surprise that fruits and their juices had comparable effects, a result no doubt celebrated by the study's funders, the sugar bureaus as well as the Biscuit, Cake, Chocolate and Confectionery Association. It's interesting the spin the Dental Association put on it, if " eating fruits and vegetables as “whole” foodstuffs may cause similar demineralization in enamel to when they are consumed as a juice," then hey, saying hey maybe fruit juice is not so bad at all. Of course the glass half empty interpretation is that wait a second, fruit is as bad as juice? Maybe fruit is worse than we thought. And indeed, the latest research to study whether the consumption of fruit is cavity causing found that the frequency of fruit consumption was associated with higher odds of cavities, though they acknowledge that the role of fruit sugars in initiating dental cavities in humans has long been a subject of debate. But is this going to be a problem for those eating like this, as opposed to this. Among vegetarians, significantly more frequent consumption of sour products (predominantly raw vegetables and fruit and tomatoes) was observed. Though the ''level of oral hygiene was similar in both groups, those eating vegetarian did have more erosive lesions, but did not find enough to be statistically significant, unlike the other study. No differences in plaque, gingivitis, cavities or tooth loss, but they did find a greater incidence of demineralization and white spots, in the vegan subjects compared to the omnivorous ones, markers of greater acid erosion. So what should people do? There are a number of foods and drinks that have the potential to cause dental erosion, both unhealthy foods like soda and sour candy, as well as healthy foods, such as fresh fruit and some herbal teas. In the biggest study to date, consuming citrus fruits more than twice a day was associated with 37 times greater odds of dental erosion compared to those who consumed citrus fruits less often. It also appears risky to consume apple cider vinegar or sport drinks once a week or more often, or soft drinks daily. These habits resulted in the odds of erosion being ten, four, and four times greater, respectively, than when the habit did not exist. So should we avoid healthy these foods? No. Even the study that found more cavities in kids eating more fruit concluded that even though the consumption of fruit might not be considered completely safe to eat in relation to cavities, we are not in a position to suggest that fruit consumption should be curtailed as a cavity-preventive measure. At this stage, of greater importance is the preventive advice that children should brush their teeth twice daily using fluoride toothpaste. In fact that study that looked at the erosive potential of fruit was done on folks not using fluoride toothpaste . Just don't brush right after you eat the fruit. You have to wait at least 30 minutes. Acid softens your enamel such that if you brush right away you can actually brush away your enamel. They did this study where they had some folks swish some acidic solution —in this case diet Sprite, and then brush immediately after, 10 minutes after, 20, 30 or q full hour. As you can see if you drink soda without brushing at all you may lose some of your teeth, but you can double or triple that damage if you then start brushing your teeth when they're in the acidified softened state. They say we should wait at least 30 minutes and probably a whole hour to be safe. Instead, after eating anything sour, we should rinse out mouth with water to help neutralize the acids. IS there evidence to support this? No, unfortunately Due to the limited number of clinical studies performed to investigate the association between diet and dental erosion, prevention and treatment (from a dietary perspective) are based on common sense rather than an evidence-based approach. In fact there's not a single study concerned with dentist advice for dietary change aimed at preventing tooth erosion." But rinsing with water after eating or drinking anything acidic is the best advice we have so far.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by Jonathan Hodgson.
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That was a long one! Normally I'd split it up across a few videos into a series but I didn't want to leave people hanging. And I figure they're easier to share with friends and family if it's all packaged into one video. Well almost all--for other aspects of oral health check out the previous video Plant-Based Diets: Oral Health.
What's so great about citrus? I've got a bunch of interesting videos coming down the pike, but there are a few on the site already that hint at the benefits:
Anything else people eating healthy diets should be aware of? The most important consideration is vitamin B12. See my blog posts Vitamin B12: how much, how often? and Vegan B12 deficiency: putting it into perspective.
I imagine there are those not happy with my mention of the F word, but I am not convinced by the concerns that have been raised about fluoride (see my Ask the Doctor entry The dangers of fluoride (tap water fluoridation)?), though it may be possible to get too much in tea, especially for children. See my video Overdosing on Tea.
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