January is a popular month to go vegan or just eat less meat. However, do we take the potential impact of this on oral health into consideration? Dr Maria Papavergos explores this choice from an oral and overall health perspective.
Often Veganuary, or becoming vegan, is often a choice towards leading a healthier lifestyle.
The principle of eating a plant-based diet is brimming with positives for oral health, providing an informed and educated approach is adopted.
Nutrition is a key component of oral health. Its influence extends to our inflammatory and immune status, directly affecting the periodontal condition.
We know oral health has established links to overall health. Periodontal disease correlates with increased risks of cardiovascular disease, diabetes and Alzheimer’s. As well as emerging evidence in the role of the oral microbiome in gut health and pregnancy outcomes.
Then there is what the dental profession knows best – the effects on our teeth and gums.
When it comes to oral hygiene, evidence suggests vegans are doing it better.
With an interest in leading a healthy lifestyle, comes an attention to oral health practices. So whilst brushing and flossing are likely to feature meticulously, the question we need to ask is: ‘Does the patient use a fluoride toothpaste?’.
In the author’s experience, vegans are more likely to opt for natural toothpastes, which are often fluoride free. Since fluoride is still the gold standard for caries prevention, this is worth highlighting as a potential downfall in achieving a disease-free mouth.
When it comes to lifestyle, again vegans score quite highly.
Vegans are less likely to to smoke, drink alcohol or consume highly-sugared beverages. This bodes well for their oral health.
However, it is the ‘so-called’ healthy choices that can trip up the well-meaning vegan.
An increased consumption of masked sugars in a ‘healthy’ elixir may be seen, such as fruit juices and smoothies, without awareness of the attacking potential of these ‘free’ extrinsic sugars or the erosive potential of these acidic drinks.
Lemon in hot water, claimed as a ‘detox’, can appeal to vegans or those keen to adopt healthy choices. This is often consumed without consideration to the harsh erosive effects.
This potential increase in risk of caries and tooth surface loss falls on the responsibility of our profession to educate and inform patients, from both a mindful and mitigating perspective.
We can encourage practices like rinsing with a fluoride mouth rinse or chewing with xylitol chewing gym after mealtimes.
Nutritional pros and cons
Now, back to nutrition. A nurtured oral microbiome relies on good macro and micro-nutrition.
A diet high in plant diversity will be rich in antioxidants and phytochemicals that support oral and periodontal health.
Similarly, foods rich in refined carbohydrates are a major cause of chronic inflammation, having a direct negative impact on periodontal health.
This ties in well for those choosing a vegan diet. Provided the key messages of plant variety and choosing whole grain carbohydrates are well anchored.
There are, however, certain nutrients that vegans will easily miss out on, for both oral and overall health, unless guided.
Animal milk is naturally full of calcium, fat-soluble vitamins and iodine. Plant-based milks will often be fortified, but also often have sugar added.
It is important to educate the consumer to check the label and be wary of options other than the ‘unsweetened’ varieties.
Other plant-based sources of calcium include green, leafy vegetables and pulses. Sources of iodine (essential for thyroid hormone synthesis) include whole grains and green beans. A vegan diet often overlooks Omega-3 fatty acids too. These nutrients, abundant in oily fish (think SMASH – sardines, mackerel, anchovies, salmon, herring) help support our cardiovascular health, immune health and positively impact our inflammatory status, and so our periodontal health.
Evidence suggests that plant sources (walnuts, chia seeds) may not have the same benefits. So supplementation is often appropriate.
Iron-deficiency anaemia may also present in vegans. Especially those trying Veganuary, who may usually eat red meat; a major source of iron.
Oral manifestations could include burning mouth, glossitis, increased prevalence of candidal infections or angular cheilitis.
Vegan sources of iron include pulses, nuts and dark green, leafy vegetables. Although plant-based iron (non-haem) has reduced bioavailability. But we can enhance it through concurrent vitamin C consumption. For example, drizzle vegetables with a squeeze of lemon or follow with an orange.
It is important for dental professionals to be vigilant to these signs as well as offering relevant dietary advice.
So Veganuary is a great opportunity to experiment with more plant-based recipes and up our imaginations with vegetables, and all their mouth-loving, gut-loving properties.
Nonetheless, an educated approach is key to truly achieving a healthy mouth and body. We, as dental professionals, must remain mindful of the potential downfalls.
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