CE0835: Is a Diet Good for Teeth, Good for Health? – A Review of the Evidence

Philippe Hujoel, DDS, MS, MSD, PhD

Course Description:

Unhealthy eating habits and tobacco smoking have been identified by most international organizations as key behavioral risk factors influencing the onset of both dental and systemic diseases; they are both considered initial causes, and they are both considered to be responsible for a large proportion of the total mortality and morbidity in the world. There is general consensus on tobacco smoking as an initial cause for destructive periodontal disease, oral cancer and other chronic problems such as lung cancer and cardiovascular disease. On the issue of tobacco, the dental and medical professional organizations can work together on primary prevention. In contrast, there is no consensus on defining unhealthy eating habits for dental and general health.

Beliefs on diet have changed fundamentally over the last decades. In the early 20th century, fermentable carbohydrates were considered a common cause for dental and systemic diseases: a diet good for oral health was considered to be synonymous with a diet good for general health. Dental diseases were the canary in the coalmine for systemic diseases. All this changed when a new hypothesis took hold in the medical field; dietary fat as a cause for most human chronic diseases, not fermentable carbohydrates.

Indeed, dietary guidelines from the 1980s on, such as those from the World Health Organization, explicitly promoted fermentable carbohydrates as beneficial for general health, and only harmful for dental health. This hypothesis became dominating in the medical field. As a result, the dental profession could no longer advocate primary prevention of dental diseases and had to gravitate towards secondary and tertiary prevention: toothbrush, dental floss, professional cleanings, fluorides, sealants, and dental fillings became synonymous with maintaining dental health.

Are these beliefs on dental and general health about to change again? Large randomized trials results increasingly suggest that some of the weak scientific evidence on fat, fibers and micronutrients may have been wrong. Low fat diet did not protect against heart disease or cancer in the Women’s Health Initiative study, supplemental fiber intake failed to protect against colon cancer in randomized trials on over 4000 individuals, and supplemental anti-oxidants increased, as opposed to decrease, mortality risk in multiple large randomized studies. The current scientific evidence is most consistent with the hypothesis that fermentable carbohydrates negatively affect both general and dental health. What is good for your teeth may very well be good for general health, and vice-versa. Such evidence, if further confirmed, could lead to profound changes in dental practice.

Course Objectives - As a result of attending this course, the participant should be able to:

• Lose 5 pounds and decrease gingival bleeding ;-)
• Recognize the five main components of diet: micronutrients, fat, protein, water, and carbohydrates.
• Understand why most national and international organizations recognize diet and tobacco smoking as the primary driving force behind the ongoing obesity, cancer, and diabetes epidemic.
• Understand how for most of the 20th century public health policy on diet was based on weak scientific evidence. This contrast with the strong scientific evidence on the harm of tobacco smoking.
• Become familiar with the results of large randomized controlled trials on different diets.
• Recognize the available evidence on fermentable carbohydrates in both dental caries and periodontal diseases.
• Understand why the dental profession was forced into promoting secondary and tertiary prevention of dental diseases and how it led for dental diseases to become defined as local infections.
• Consider the evidence that dental diseases truly are the earliest markers for an unhealthy lifestyle. This hypothesis was ridiculed in the 20th century, but epidemiology and randomized trial evidence is becoming increasingly supportive of both caries and periodontal diseases to be predictive of diabetes, certain cancer, and cardiovascular diseases.
• Understand how a primary prevention of dental diseases may improve your patients’ dental health, and their general health.

Instructor:

PHILIPPE HUJOEL is a Professor with appointments in the School of Dentistry and School of Public Health at the University of Washington. He spends one day per week in a private periodontal practice. He received a dental degree at the Free University of Brussels in Belgium, a MSD in Periodontics and PhD in Epidemiology at the University of Washington, and a MS in Biostatistics at the University of Michigan. He has over 100 peer-reviewed publications and several book chapters. He has completed several research projects on the associations between dental and general health, some of which have been published in leading dental and medical journals such as JADA, JAMA, and the Journal of Dental Research. He maintains an active research interest in the area of dental-systemic disease connections.

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