Tip Sheets

A road map for exploring the crossroads of nutrition and oral health

By Melinda Hemmelgarn

An apple a day keeps the doctor away – providing we can eat it.

Oral health predicts whole body health, and is one of the 12 leading indicators for the U.S. Department of Health and Human Services’ Healthy People 2020 initiative. The Academy of Nutrition and Dietetics’ position on oral health and nutrition says: “scientific and epidemiological data demonstrate a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease.”

Former U.S. Surgeon General David Satcher’s landmark 2000 Oral Health In America referenced the associations between periodontal (gum) disease and systemic diseases and conditions including diabetes, heart disease, stroke and preterm births. Research aimed at gaining a fuller understanding of the relationships between oral and systemic diseases and conditions continues.

The World Health Organization emphasizes the role diet and nutrition play in oral health, including its influence on craniofacial development, risk of oral infections, cancer and dental and periodontal disease.

Think About Oral Health Disparities

Oral diseases can be prevented with regular dental care and sound nutrition, yet many Americans lack affordable access to both.  In her essay, Poor Teeth, author Sarah Smarsh says: “The underprivileged are priced out of the dental-treatment system yet perversely held responsible for their dental condition.”

Not only are the poor priced out of preventive dental care and treatment, individuals facing economic hardship often live in communities lacking access to the nourishing foods that support oral health. 

According to the Food Research and Action Center, low-income neighborhoods frequently lack full-service grocery stores and farmers’ markets where residents can buy a variety of high-quality protein, fresh fruits and vegetables, and low-sugar, high-fiber, whole grain breads and cereals – foods identified by the Academy of Nutrition and Dietetics for reducing risk of dental decay.

Alternatively, convenience and “quick-shop” markets typical in both urban and rural low-income neighborhoods are dominated by highly-processed, carbohydrate-rich “cheap” foods and beverages –  those identified by dietitians and dentists as contributing to poor oral health and host of chronic diseases.

For those already suffering with painful or missing teeth, the health-promoting foods on dietitians’ prescription pads and national dietary recommendations become nearly impossible to chew.

Consider the Statistics

According to data gleaned from the National Health and Nutrition Examination Survey, approximately one in four children between the ages of three and nine, living in poverty, had untreated dental decay. Among older adults, ages 65-74, whose income is at or below the federal poverty level, the prevalence of complete tooth loss was 34 percent, compared with 13 percent of those in that age group living above the poverty level.

The National Association of Dental Plans  reports that at the end of 2014, approximately 114 million Americans had no dental coverage, with 67.7 million of them younger than 65 years old.  Those without dental benefits are more likely to have extractions and dentures, and less likely to have restorative care or receive treatment for gum disease. This group also is 67 percent more likely to have heart disease, 50 percent more likely to have osteoporosis, and 29 percent more likely to have diabetes.

Remember Biology

Teeth are naturally covered with a sticky film called plaque. When we eat foods containing simple sugars, sticky foods, and sugary and starchy snacks, the bacteria in plaque metabolize these fermentable carbohydrates and produce acids that attack tooth enamel, which can result in decay and gum disease. The longer the teeth stay in contact with those carbohydrates, through frequent snacking or prolonged sipping of sugary beverages, the greater the likelihood of decay. Nutrient deficiencies, including inadequate intake of protein, vitamins and minerals further compromise the integrity of oral mucosal cells, our immune system and jaw bone density.

Chewing sugarless gum immediately after a meal or snack, drinking water rather than sweetened and acidic beverages, choosing fresh, whole, unprocessed foods that stimulate saliva secretion, and using fluoridated toothpaste can help reduce risk for oral decay and disease. For information, check out these tips from the American Dental Association’s Mouth Healthy campaign.

Special Populations and Conditions

Children: According to the American Academy of Pediatrics, dental caries, or cavities, is the most common chronic disease of childhood. To promote oral health, the AAP recommends that infants be exclusively breastfed for 6 months, then continue to breastfeed while solid foods are introduced.  Putting children to bed with a bottle, and allowing them continual access to sugary beverages in sippy cups increases risk for dental decay.

Elderly:  Medicare does not include dental benefits, yet approximately one third of those 65 and older have untreated dental caries or decay according to the Centers for Disease Control and Prevention. Compounding their risk for decay, older adults tend to take more medications that can lead to xerostomia, or decreased saliva flow.  Due to disabilities or limited income they may not be able to access a nutritious diet that supports oral health. The Nutrition Screening Initiative provides a check list to assess nutritional status, and recognizes tooth or mouth problems as a risk factor in predicting malnourishment.

Eating Disorders: Individuals diagnosed with bulimia are more likely to have tooth erosion and decay due to exposure to acidic contents of vomit. Those with anorexia are more likely to be deficient in nutrients necessary to support oral health.

Additional Areas

Health journalists can raise awareness of risk, lead consumers to care, and promote the critical role of diet and nutrition in protecting oral health.

  • Look at community water fluoridation’s role in reducing dental disease. There may be a controversy coming to a place near you.

  • Institutional diets and dental care: Do the food and beverages served in prisons, nursing homes, daycare, group homes, and schools support oral health?

  • Marketing of foods and beverages to children and teens that promote dental decay.

  • Explore Human Oral Microbiome, and look at how diet impacts the bacteria in the mouth and its contribution to oral health or disease.

  • Nutrition screening tools to assess oral health and malnutrition throughout the lifecycle.

  • Oral health and eating challenges during cancer treatment.

  • Pharmaceutical side effects on oral health.

  • Poverty’s impact on diet and oral health.

Melinda Hemmelgarn (@food_sleuth) is a registered dietitian, “investigative nutritionist,” award-winning writer and radio host with more than 30 years’ experience in clinical, academic and public health nutrition. Prior to her freelance media career, Hemmelgarn developed and directed the Nutrition Communications Center at the University of Missouri. In 2011, her Food Sleuth radio show won first place in the radio interview category from the National Federation of Press Women.