Veganism and oral healthNews
Posted by: The Probe 18th February 2020
In 2016 more than 1% of adults in the UK were vegan (around 540,000 people), while 2-3% were vegetarian. Veganism seems to have grown more popular since then, and one survey estimates that as many as (7%) of the population have adopted veganism or vegetarianism (14%) due to environmental or ethical concerns.[i]
The effects of vegan and vegetarian diets on health, including oral health, are still widely debated. Many people are aware that vegetarian and in particular vegan diets, can result in lower calcium and protein intake than a typical omnivorous diet. However, a Bayesian meta-analysis of studies found that while vegetarians and vegans do generally exhibit lower bone mineral density than omnivores (more so for vegans), the magnitude of the effect is actually more modest than popularly imagined and on average not clinically significant.[ii]
Vegetarian and vegan diets typically see individuals consuming less saturated fat, and more fibre and phytochemicals. There is evidence that suggests such diets have some protective effects against cardiovascular disease (CVD), type 2 diabetes, colorectal and prostate cancer. However, there is also the potential for nutritional deficiency, including for vitamin D which can be a risk factor for various cancers, CVD, diabetes, musculoskeletal and oral health problems.[iii], [iv], [v], [vi] Likewise, vegan diets can make getting sufficient vitamin B12 difficult, a lack of which is associated with worsening periodontal health.[vii], [viii]
Studies have also found vegetarian diets to be associated with dental erosion and caries.[ix] Proposed mechanisms for this include relatively greater consumption of carbohydrates compared to an omnivorous diet, increased acidity and nutritional deficits. When proteins are consumed putrefaction takes place, resulting in the oral pH balance shifting towards alkalinity, rather than tooth damaging acidity which occurs when carbohydrates ferment. Consequently, assuming individuals are consuming around the same number of calories, because omnivores get a significant portion of their energy intake from protein, that should lead to less acidic oral conditions and therefore less tooth decay.[x] It is worth noting that differences between individual diets within these categories (omnivores, vegetarians, vegans), can vary tremendously, which can frustrate drawing generalised conclusions. While the mechanisms are as yet uncertain, multiple studies have found that vegetarians and vegans have an increased risk of demineralisation and dental caries compared to non-vegetarians.x, [xi] That said, green vegetables have anticariogenic properties and consuming sugary foods and carbonated drinks regularly and in substantial quantities has a greater effect on oral health than the presence or absence of meat in the diet.vii
Cow’s milk is non-cariogenic; lactose has the least cariogenic protentional of all di- and monosaccharides. Dairy products with no added sugar, provide significant amounts of calcium phosphate and casein that help prevent demineralisation.[xii], [xiii] Alternatives to animal milk are increasingly available including soy, almond, oat, rice and coconut milk, though these generally contain very little calcium unless specifically fortified. With the exception of soy milk, these alternatives generally offer little protein. Many non-dairy milks are sweetened with non-trivial quantities of added sugar, so patients would be well advised to seek out the non-sweetened versions of these products. People following meatless diets still need to be as careful of their sugar intake as meat eaters. Smoothies and fruit juice in particular can be very high in sugar.
Diet affects the composition of oral and gut bacteria, which may have far-reaching health implications. A vegan diet appears to encourage microbial diversity in the gut, but also Campylobacter rectus, which has been associated with periodontal disease. It should be noted that many people become vegans in their second decade of life or later, by which time much of their microbiota is already well-established. Consequently, microbiome results for people raised vegan/vegetarian may be quite different to those who change diet later.[xiv], ix
Vegans can sometimes find certain foods unsuitable following extractions or during orthodontic treatment. Tiny seeds and other vegetable matter can become lodged, and if not cleared, result in discomfort, irritation and plaque build-up. Soup, mashed vegetables, pasta, rice and cutting portions into small manageable bites are all helpful, while nuts and foods that require a lot of chewing (such as raw carrots) should generally be avoided during treatment or recovery.
Braces can make maintaining oral hygiene difficult. The Waterpik® Water Flosser includes a specialised Orthodontic Tip, that makes it easy for patients to clean stubborn debris that can accumulate around appliances. Its effectiveness is due to comfortable water pressure and pulsation, which cleans difficult to reach interproximal spaces and below the gumline, helping patients maintain optimal oral hygiene while the appliance does its work.
Nutrition and its relationship to health is very complex. Patients shouldn’t feel attacked for their dietary choices, but should be advised to make sure they are getting essential nutrients and avoiding excessive amounts of sugar. By understanding where certain diets can typically be suboptimal or pose certain challenges, advice to patients can be more tailored to their specific needs, rather than generalised warnings. Individuals following a vegan diet can enjoy excellent oral health, but they must be wary of the potential for specific vitamin deficiencies, and compensate for them.
For more information on Waterpik® products please visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Asda, Costco UK, Boots and Superdrug online and in stores across the UK and Ireland.
[ii] Ho-Pham L., Nguyen N., Nguyen T. Effect of vegetarian diets on bone mineral density: a Bayesian meta-analysis. The American Journal of Clinical Nutrition. 2009; 90(4): 943-950. https://academic.oup.com/ajcn/article/90/4/943/4597049 October 18, 2019.
[iii] Craig W. Health effects of vegan diets. The American Journal of Clinical Nutrition. 2009; 89(5): S1627-1633. https://academic.oup.com/ajcn/article/89/5/1627S/4596952 October 18, 2019.
[iv] Parva N., Tadepalli S., Singh P., Qian A., Joshi R., Kandala H., Nookala V., Cheriyath P. Prevalence of vitamin D deficiency and associated risk factors in the US population (2011-2012). Cureus. 2018; 10(6): e2741. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/ October 18, 2019.
[v] Gani L., How C. Vitamin d deficiency. Singapore medical journal. 2015; 56(8): 433-437. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545131/ October 18, 2019.
[vi] Uwitonze A., Murererehe J., Ineza M., Harelimana E., Nsabimana U., Uwambaye P., Gatarayiha A., Haq A., Razzaque M. Effects of vitamin D status on oral health. The Journal of Steroid Biochemistry and Molecular Biology. 2018; 175: 190-194. https://doi.org/10.1016/j.jsbmb.2017.01.020 October 18, 2019.
[vii] Hujoel P., Lingström P. Nutrition, dental caries and periodontal disease: a narrative review. Journal of Clinical Periodontology. 2017; 44(18): S79-84. https://onlinelibrary.wiley.com/doi/pdf/10.1111/jcpe.12672 October 18, 2019.
[viii] Hugar S., Dhariwal N., Majeed A., Badakar C., Gokhale N., Mistry L. Assessment of vitamin B12 and its correlation with dental caries and gingival diseases in 10- to 14-year-old children: a cross-sectional study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571382/ October 18, 2019.
[ix] Smits K., Listl S., Jevdjevic M. Vegetarian diet and its possible influence on dental health: a systematic literature review. Community Dentistry and Oral Epidemiology. 2019; 00: 1-7. https://doi.org/10.1111/cdoe.12498 October 18, 2019.
[x] Prasada L., Raghunath R. Assessment of the influence of vegetarian and nonvegetarian diet on the occurrence of dental caries in Sullia, India. International Journal of Oral Care and Research. 2016; 4(4): 247-250. https://www.researchgate.net/publication/312285747_Assessment_of_the_Influence_of_Vegetarian_and_Nonvegetarian_Diet_on_the_Occurrence_of_Dental_Caries_in_Sullia_India October 18, 2019.
[xi] Laffranchi L., Zotti F., Bonetti S., Dalessandri D., Fontana P. Oral implications of the vegan diet: observational study. Minerva Stomatologica. 2010; 59(11-12): 583-591. https://www.ncbi.nlm.nih.gov/pubmed/21217622 October 18, 2019.
[xiii] Touger-Decker R., van Loveran C. Sugars and dental caries. The American Journal of Clinical Nutrition. 2003; 78(4): S881-892. https://academic.oup.com/ajcn/article/78/4/881S/4690063 October 18, 2019.
[xiv] Hansen TH., Kern T., Bak E., Kashani A., Allin K., Nielsen T., Hansen T., Pedersen O. Impact of a vegan diet on the human salivary microbiota. Scientific Reports. 2018; 8: 5847. https://www.nature.com/articles/s41598-018-24207-3 October 18, 2019.
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