Keep Your Smile Bright

Many people experience an improvement or resolution of many chronic health conditions as a result of weight loss surgery. It’s important, however, that this newfound health isn’t taken for granted. For optimal results, the tool of weight loss surgery requires healthy food choices, participation in regular exercise, appropriate vitamin and mineral supplements, follow-up visits, and regular monitoring of lab tests. Even with all of the improvements to health, weight loss surgery can increase the susceptibility to dental problems if recommendations are not followed.

Dental problems can be costly, painful and unattractive. Learn what can lead to dental problems after weight loss surgery and what you can do to protect your pearly whites.

Download On Track with Barix: Keep your Smile Bright

CAVITIES AND EROSION

First let’s take a look at how cavities and erosion occur in the first place. Your teeth are covered by a hard mineral substance called enamel that helps to protect them. The enamel can break down when it comes in contact with the acids in your mouth.

Cavities. When you eat, certain strains of bacteria in your mouth multiply. These bacteria especially thrive on starches and sugars. If sugars and starches aren’t cleaned off of teeth, the bacteria feed on them and produce acid. The acids, bacteria, food particles, and saliva together form a sticky substance on your teeth called plaque.

Once plaque forms on the teeth, acids wear away the enamel, eventually forming a cavity. If allowed to continue, the acids from the bacteria and plaque will make a destructive path to the inner tooth material where the bone may be affected. Once the decay reaches this point, you may experience sensitivity and pain.

Erosion. While cavities are more prevalent in hard to clean areas of the mouth where plaque is likely to form, erosion of the enamel occurs across the entire tooth surface when it is exposed to acid. Acid from the stomach or from acidic foods and drinks damages the enamel on contact. Over time, this damage causes the enamel to soften and thin, turning the tooth dull and yellow. Erosion also makes teeth more susceptible to sensitivity and decay, and can even change the shape or texture of teeth. Acid wear may lead to serious dental problems. It is important to notice the signs of tooth erosion in its early stages before more severe damage occurs. Signs of erosion:

• Sensitivity. As your teeth’s protective enamel wears away, you may feel pain when consuming hot, cold or sweet foods and drinks. Teeth become increasingly sensitive as more enamel wears away.
• Discoloration. Teeth become yellow as the thinning enamel layer exposes the underlying dentin.
• Rounded teeth. Teeth may have a rounded or “sand-blasted” appearance.
• Transparency. Front teeth, especially, may appear slightly translucent near the edges.
• Cracks. Small cracks may appear at the edges of teeth.
• Cupping. Small dents may develop on the chewing surface of the teeth, and fillings may appear to be rising up out of the tooth.

BARIATRIC SURGERY AND TOOTH DECAY

Some of the physiological changes that occur with bariatric surgery may increase your risk of erosion and decay. Even some of the behaviors that help you protect the integrity of your bariatric surgery and successfully reach and maintain a healthy weight, can work against your oral health.

An Acidic Environment 

An acidic mouth is the perfect environment for both the erosion of enamel and for cavity-causing bacteria to multiply. When high-acid foods and beverages are consumed, it takes longer for the pH of the mouth to neutralize—giving the acid and bacteria extra time to wreak havoc on the teeth and gums. Another source of acid may come from the stomach due to GERD (gastroesophageal reflux disease) or vomiting.

Dry Mouth

Some people experience dry mouth after surgery. Saliva has an important role in oral health. It washes away food particles, keeps oral tissues moist and fights cavity-causing bacteria with antibodies that help stop decay before it starts. When your mouth is dry, it’s easy for harmful bacteria to proliferate.

The 5/30 Rule

The 5/30 rule (not drinking 5 minutes before until 30 minutes after eating) prevents the mouth from being rinsed after eating. This can result in a longer time for saliva to return to a neutral pH (more erosion), a dryer mouth, and the perfect environment for harmful bacteria to proliferate.

Six Small Meals 

Eating six small meals helps you to meet your nutritional goals, keep portions small and reduces the likelihood of reflux. However, every time we eat, we feed the cavity-causing bacteria which can lead to an increase in plaque accumulation.

Nutritional Deficiencies 

You may think of calcium and vitamin D deficiencies in relation to dental health, but in fact, many different nutrients impact the health of teeth and gums. As you review the list below, you can see how important your overall nutritional status really is.

• Protein–Tooth structure, mucosal/connective tissue development, and immune function.
• Calcium–Tooth structure; may enhance enamel remineralization.
• Phosphorus–Tooth structure.
• Zinc, Folate, Antioxidants, Iron, and Vitamin A–Mucosal/connective tissues and immune function.
• Vitamin C–Collagen maturation and to maintain the integrity of the periodontal ligament; mucosal/connective tissues and immune function.
• Omega-3 fats–Mucosal/connective tissues and immune function; modulates the inflammatory response.
• Vitamin D–Mucosal/connective tissues, immune function; may enhance enamel remineralization.
• B vitamins–Epithelial cell turnover.    

What to Do?

Knowledge is power. Equip yourself with the knowledge to understand the risks of dental decay and learn what you can do to keep your teeth functional and beautiful.

After Eating

You’ve got to eat and eating small frequent meals makes the most sense after weight loss surgery. To limit the damage to your teeth, rinse your mouth after eating by swishing and spitting water. Avoid brushing right after eating when pH levels may be lower and enamel is softest.

Do brush more often. Twice a day may not be enough to remove food, bacteria and plaque. Use a soft toothbrush and be gentle.

During the Day

Chew sugar-free gum sweetened with xylitol. Xylitol inhibits the growth of the bacteria that cause cavities. With continues use, xylitol sweetened gum can change the type of bacteria in the mouth, leaving fewer and fewer decay-causing bacteria to live on tooth surfaces.

Select a Healthy Diet

A healthy and balanced diet will improve your overall nutritional status and oral health. In addition, selecting a low-acid (or alkaline) diet can help reduce the risk for tooth decay and gum disease.  It can also improve bone density, helping with the underlying foundation of our teeth.

Here’s how it works; when we eat and drink, the pH level in the mouth can quickly change from a neutral pH of 7.0 to an acidic pH of 5.5, where cavity-causing bacteria grow. Some fortunate people naturally have a more neutral pH level in their mouth and rarely get cavities. Others are able to influence their mouth’s pH by the foods and beverages they choose. To help neutralize the pH level in your mouth:

Eat more vegetables. Vegetable provide vitamins and minerals boosting overall health and our immune system. Many vegetables are alkaline so they will help to neutralize the pH in the body and in the mouth. Dark green leafy vegetables are especially good choices.

Eat more lower-acid whole fresh fruits such as cantaloupe, mango, melons, and apples.

Limit breads. Grains are more acidic. In addition, the bacteria in the mouth begin the breakdown of starches, feeding cavity-causing bacteria.

Eat more beans and seeds, especially soy, navy, and Lima beans; caraway, cumin, fennel, and sesame seeds.

Eat yogurt or other fermented dairy to stimulate “good” oral bacteria.

Green tea contains polyphenols that decreases the number of bacteria in the mouth and the toxic substances they emit. Green tea is also filled with fluoride which strengthens enamel.

Limit alcohol, diet soda, and coffee. Alcohol consumption leads to increased plaque due to high acidity and dry mouth. Unlike sugar-sweetened sodas, which promote the growth of bacteria that lead to tooth decay, diet sodas contain ingredients that strips away tooth enamel, causing dental erosion. Coffee increases the acid level of the mouth and can lead to enamel erosion. Its dark color can stain teeth.

Avoid added sugars. You’ve already got this one, but here’s another reason to ditch the sweets. As the bacteria in your mouth starts consuming the sweet, acid is produced, dissolving the enamel of the tooth and leading to dental decay.

Take Supplements as Recommended

Vitamin and mineral supplements are for life. Just because you feel great, don’t get lax on either your supplements or annual lab tests (more frequent the first year following surgery). From antioxidants to zinc, your dental health is dependent on your overall health and nutritional status. You only have one set of adult teeth—protect them.

Manage GERD, Reflux and Vomiting

Some experience fewer GERD episodes after surgery, others more. Work with your bariatric surgeon and family doctor to come up with a plan that works for you. Don’t accept a “new normal” of constant reflux.

Reflux and vomiting of food and or liquids due to eating or drinking too fast can be part of learning a new eating style. For most, it occurs shortly after surgery during the healing and reintroduction of food stage and then resolves. To limit reflux, measure food, eat slowly, chew well and stop when you are comfortable rather than full. After the healing stage, regular reflux and vomiting is not expected—contact your surgeon if it is happening regularly.

Talk To Your Dentist

Alert your dentist to your surgery. He will help you be on the lookout for potential problems and may want you to:

• Use customized trays to wear at night with high-fluoride toothpaste.
• Schedule dental cleanings more frequently (every 3-4 months instead of 2 times a year).
• Fill a prescription for high-fluoride toothpaste.
• Use special gum and/or rinses to reduce dry mouth.

Maintaining good oral health not only impacts your mouth, but can reduce your risk of heart disease, infections and chronic inflammation. Functional teeth allow you to properly chew foods to get the nutrients your body needs. And without a doubt, a bright smile gives you confidence. Bariatric surgery makes it more important than ever to take care of those pearly whites.

Recipes

Strawberry Cheesecake Ice Cream 1 cup Fairlife milk, fat-free

2 scoops Matrix (or other brand) vanilla protein powder

1 cup strawberries 4 tablespoons light cream cheese, softened 1 tablespoon erythritol or other sweetener

1 teaspoon vanilla extract

Mix all ingredients in blender. Pour into ice cream maker. Follow instructions for freezing. Makes 3 servings.

Nutrition information per serving: 156 calories, 21 grams protein, 4 grams fat, 8 grams carbohydrate, 187 mg sodium.

Peanut Butter Ice Cream

1 cup Fairlife milk, fat-free

2 scoops of Matrix (or other brand) vanilla protein powder

3 tablespoons PB2 (or other brand) powdered peanut butter

1 tablespoon erythritol or other sweetener

1 teaspoon vanilla extract

2 tablespoons peanuts, chopped

2 tablespoons sugar-free fudge topping, heated

Mix milk, protein powder, powdered peanut butter, erythritol, and vanilla extract in blender. Pour into ice cream maker. Follow instructions for freezing. Top with chopped peanuts and sugar-free fudge topping and serve. Makes 3 servings.

Nutrition information per serving:184 calories, 24 grams protein, 4 grams fat, 15 grams carbohydrate, 176 mg sodium.

Peppermint Ice Cream 1 cup Fairlife milk, fat-free

2 scoops of Matrix (or other brand) vanilla protein powder

1 tablespoon erythritol or other sweetener

1/8 teaspoon peppermint extract 3 peppermint patties, sugar-free, chopped Mix milk, protein powder, erythritol, and peppermint extract in blender. Pour into ice cream maker. Follow instructions for freezing. Top with chopped peppermint patties and serve. Makes 3 servings.

Nutrition information per serving:  140 calories, 20 grams protein, 4 grams fat, 11 grams carbohydrate, 95 mg sodium.