Hardly a week goes by that we do not see a teenager or
twenty-something with extensive decay between the teeth. This happens even
though the patient has had topical fluoride every six months for their entire
life. The most recent case was a seventeen-year-old with beginning decay
between many of his back teeth. The cavities were not visible to the naked eye
but were very obvious on x-rays. This young man’s physician told him that he might benefit from
the electrolytes in sports drinks, so he was drinking two or three large ones
every day. I don’t know whether the electrolytes were doing him any good, but I
do know that the acid and sugar in the drinks were rotting his teeth away. It’s
more than a little depressing to me that a physician would recommend these drinks
as a health benefit without considering the potentially huge negative
consequences.
This is an enormous problem – and not just because of the
teeth. In the last twenty years there has been a 1000% increase in type 2
diabetes in children. (This is also known as adult onset diabetes.) Forty
percent of children are now overweight. Of those, almost 2 million are morbidly
obese, meaning that they exceed the 99th percentile for weight. The
average American drinks 54 gallons of soda every year. The average child in
America consumes 34 teaspoons of sugar EVERY DAY. We consume 600 more calories
per day from sugar than we did thirty years ago. The cavity problem is only the
tip of the iceberg. To be blunt about it, the American diet is killing our
kids.
When it comes to cavities, sometimes we can motivate a
patient to change the specific dietary habit (often soda) that is causing the
problem. Unfortunately, one-on-one counseling is not going to have much effect
when tens of millions of children are overweight. This is a social problem and
it demands a social cure. If it’s going to get fixed, it needs to start in our
homes, schools, and communities and must encompass changes in government
policies and industry practices. Does it make sense to have the government subsidize
production of high fructose corn syrup? Is it wise to allow food stamps to be
used to buy soda when they cannot be used to buy alcohol and tobacco? Tobacco
and alcohol are regulated because we recognize the social costs attached to
their use. Why not sugar? One of our great social problems is figuring out how
to pay the cost of medical care, yet we actually subsidize one of the causes of
a very significant chronic disease.
So I cheer when Mayor Bloomberg of New York City proposes a
sixteen ounce limit on soda sales. I’m in favor of proposals to tax sugar and
sweet drinks. What I hope for is a national awakening much like what happened
beginning in the sixties regarding smoking. I know that it will not happen
overnight but I see signs that things are beginning to move in the right
direction. In the meantime, we will continue to put fluoride on kids (and
sometime adults) teeth. We will increase our vigilance for the telltale signs
of decay. And we will continue to nag you about diet, knowing that tooth decay
can be an indicator of an even more serious metabolic problem.
