Having one’s teeth cleaned is not as bad as undergoing a root canal procedure, but certainly not as pleasant as getting a manicure. However, it does give one time to think of the implications of not doing so frequently, and the importance of carrying out the in-between cleaning tasks such as brushing, flossing and not eating caramel apples. Many of us may be not as compulsive about doing so as our dentist would like, but if we are also obese there is a greater cost to the health of our teeth and gums if the basic requirements of good dental hygiene are ignored.
No one disputes the adverse effects of consuming simple sugar on tooth decay. Ideally, if we indulge in eating or drinking sugar (as in soda or juice), we should race to the sink and brush our teeth immediately. Dentists see the unfortunate consequences of not doing so, especially among those whose weight was gained by frequent consumption of sugar-rich snacks and drinks. Very few people will stop in the middle of a chocolate chip cookie or ice cream binge to floss and brush their teeth.
Obesity puts teeth and gums at risk for other reasons as well. Gastroesophageal reflux (aka acid reflux or heartburn) tends to be common, and causes teeth to be in contact with acid from the stomach, thereby contributing to the breakdown of teeth enamel. If the obesity is associated with depression or other mood disorders, the medications used to treat these disorders often leave the mouth extremely dry. The absence of saliva is also associated with dental decay. (“Obesity Complicates Dental Health – Be Proactive!” Obesity Action Coalition, Stillwell, D.)
Patients who choose bariatric surgery to reduce the size of their stomach may be even more vulnerable to dental problems. Often vomiting occurs after this stomach surgery if too much food is put in the now tiny digestive organ. As with acid reflux, the teeth are coated with stomach acid, and enamel demineralization may result. Moreover, according to Stillwell, an increased craving for sweets has been seen after surgery along with a significant tooth sensitivity that may make exposure to water or pressure uncomfortable. Patients who were not diligent about caring for their teeth before surgery are not likely to improve their dental hygiene afterwards, unless the importance of doing so is stressed.
Complicating care of the teeth and gums for someone struggling with obesity is this unpleasantness of attempting to fit an oversized body into a dental chair sized for smaller bodies. For someone with morbid obesity who finds walking difficult, getting to a dentist’s office is often physically painful. Added to this is the psychological pain of attempting to squeeze onto the reclining chair underneath the hanging trays and instruments. Stillwell suggests in his article that obese patients seek out dental offices equipped to handle their needs, but admits that there are very dental few practices that even consider this a problem.
Ironically, dentists were involved in developing and inserting devices in the mouth that would markedly reduce food intake to produce significant weight loss. Wiring of the teeth to prevent chewing was popular several years ago, but interest in using this approach declined rapidly in proportion to the rapid regain of weight when the jaws were freed. A modified version using a retainer-like device custom made to fit the roof of the patient’s mouth has been used with some success. The mouth can open only partially, so the patient has to take very small bites and consequently must eat very slowly. Since it takes about 15-20 minutes for the brain to realize that food has been consumed, the idea behind the retainer is that forced slow eating will produce fullness or satiety before excessive amounts of food can be consumed. Of course, it is also possible that the eater loses patience or becomes bored with the length of time it takes to complete a meal and goes on to do something else. (“Are dentists involved in the treatment of obesity?” Karma, M.,Aw, G., and Tarakji, B., J Int Soc Prev Community Dent 2016 183-188) Once the retainer is removed, weight can be regained, unless the patient is willing to continue to eat very slowly. .
Although dental devices to reduce food intake may not be the most effective way of producing weight loss, the dentist may be an effective “first responder” in offering help and advice to obese patients. Most of us are unaware of the health of our mouths since it is almost impossible to see the state of our teeth and gums except for what stares back at us in the mirror. The possibility of losing our teeth and/or going through the pain and expense of periodontal surgery for gum disease is enough to motivate or frighten us into practicing what the dentist preaches. Unlike a physician who makes the obese patient confront his or her weight, a dentist does not deal with the size of the patient’s body. The advice and suggestions about modifying food choices to decrease sugar intake and pointing out the association of gastric reflux with enamel erosion focuses on what is above the neck. It is hard to ignore advice which, if not followed, may cause loss of one of our basic functions— chewing—as well as negatively affecting our appearance. The simple suggestion about brushing in association with snacking might be enough to decrease between-meal food intake. The feel of a clean mouth and teeth is sometimes enough to prevent eating from immediately starting again.
And the dentist has an immense advantage over everyone else trying to help an individual improve food intake and lose weight: the patient can’t talk back.