Dental Tribune UK & Ireland

Sugar, sugar … honey, money

By Aws Alani
April 08, 2016

The sugar tax is finally upon us, but are corner shops or supermarkets for that matter likely to worry about this potentially threatening change to their flagship product line? The tax targets all drinks and equates to a tax of 24p per litre on those with the most sugar content. This could potentially equate to an increase in the price to the consumer, but bearing in mind that soft drinks are more accessible and cost less in the UK than water in many Third World countries, it is doubtful that things will change markedly.

There is the argument that taxing tobacco has had an effect on the uptake of smoking and the consequent addiction, but the evidence for this is relatively sparse and weak. Although a worthy initiative, taxing drinks may result in a greater squeeze on those who can afford it the least and I doubt whether little Jimmy will stop his tearful tantrums for penny sweets as a result of a celebrity chef’s campaign as our sugar saviour. As a child of the eighties, these celebrity-led campaigns remind me of rock bands who decided that African poverty should be on the agenda, but this does not seem to be as important to them now. It would appear that it is easier to tax sugar than to provide funding for dentistry; unfortunately, there is unlikely to be a symbiotic decrease in caries as a result.

One could argue that sugar pollutes much in the same way that inefficient power stations do. The societal repercussions need to be managed by all, with no or little comeback for the fizz producers. As carbonated drinks are so popular, these juggernaut companies are powerful and, as a result, denting their progress with a tax is unlikely to truly positively affect the general health of the population. In 2014, the UK soft drinks industry was worth £15.7 billion, with over 14.8 billion litres in overall consumption, which represents a steady and exponential growth that is likely to continue. One interesting observation is the slow demise of the 330 ml can—it being replaced by the 500 ml plastic bottle. The larger bottle may represent better value for money, but is less likely to represent better health value, especially since a resealable bottle is more likely to be sipped over hours than a can once opened.

Overconsumption of sugar causes an inordinate amount of health problems. Indeed, Type II diabetes and obesity are leading causes of death and disability in the US, the birthplace of the canned, likely red, refreshment. These life-threatening conditions are in addition to our experiences of sugar-laden drink devastation. In contrast, but just as worrying, the emerging evidence shows that low-/no-calorie drinks (49 per cent of drink consumption in 2014) actually fuel hunger and trick one’s stomach into thinking that calories are on the way, only to be disappointed, resulting in further food-seeking behaviour. The ordering of diet beverages in all-you-can-eat restaurants may not be as ironic as I first thought!

Erosive tooth wear seems to have been forgotten amongst overweight toddlers needing ear-to-ear clearances. From bulimics who like to taste but do not like their waist to the energy drink crew who prefer machismo gothic graphic designs, the younger generation is likely to experience more dissolution of tooth tissue. At the other end of the spectrum, obese patients are more likely to develop diabetes, which in turn makes them more susceptible to periodontal disease.

Society’s gluttonous overconsumption is manufacturing pathology unheard of 50 years ago. Lest we forget the ageing population among the tabloid’s sugar mania of the young—polypharmacy is likely to increase caries owing to a variety of co-morbidities, such as a dry mouth or heavily sugar-supplemented medication. I have seen restorations seemingly intact for generations in hospital notes only to sprout caries at the cavity margin within months of a new medicine being prescribed. Is there a pill for every ill or do pills allow ills to be masked by other ills while slowly swelling corporate turnovers?

Society is forever changing and food is now at the centre of how we relate and connect with each other. From Instagram posts of freshly cooked home meals to wedding cake bliss after inordinate tastings, it seems to be important to everyone. As a result, food is an emotive issue that affects oral and general health in ways that may not be readily apparent to our patients. I have an old friend in Florida, who I visited last year. He is a specialist in periodontology and runs a successful, swish, modern referral practice. As a matter of routine, he tells patients they need to stop carbohydrate intake post-surgery. Once patients understand that this improves outcomes owing to decreased plaque build-up on the wound edges, they are receptive to this brief change in their diet. He also advocates periodontal medicine while identifying stress as a risk factor for periodontitis.

Research by Prof. Iain Chapple in Birmingham investigating the effect of diet on periodontal disease confirms that one is what one eats and the gingivae follow suit. Purely taxing sugar may not impact on its consumption. Patients need to be motivated to take ownership of their health and relate this with foresight to repercussions in the future. It is this lack of responsibility and potential blame shifting by patients that not only results in poorer health, but also makes providing National Health Service care for all increasingly impossible if prevention is the best cure. This commonly occurs when patients claim to be unaware of the oral health effects of smoking and the related exacerbation of periodontal disease, only for it to become important when teeth are all but held in by the last tenuous Sharpey fibre. Owing to their own lack of awareness or lack of engagement with a toothbrush, they can request some sort of compensation or pursue a litigious course likely to involve an expensive implant-based restoration. What may escape the lawyers and the patient is that previous periodontal disease is a significant risk factor for implant failure, and so the cycle is likely to continue. Patients are responsible for their own health and the lack of recognition of this cannot be the fault of the clinician.

Successful dental care requires collective effort between the patient and the dentist. Health care is a partnership in which both sides have different responsibilities and active roles, but if the clinician provides a service for ailments that the patient could have prevented, the question of self-governance arises. Patients have a right to health care, but they also have responsibilities derived from the principle of autonomy. The patient’s physical and mental integrity should always be upheld and respected. In contrast, autonomy identifies the human capacity to self-govern and choose the most appropriate pathway to protect that integrity.

As such, capable patients exert some control over lifestyle choices that influence their well-being. Unfortunately, regardless of the imminent extra tax on the already dirt-cheap confectionery, the innate responsibility held by the patient to self-govern will always trump our advice, treatment, knowledge or collective experience.

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