ANY parents feel confused about how to give their children the recommended 'five a day' of fruits and vegetables. Food labelling and clever marketing can make fruit juices, flavoured waters and smoothies seem like healthy options however, there are risks for dental health of which parents should be aware.
On one side, fruit and vegetables are an important source of vitamins, minerals, fibre and other essential nutrients. Some children are prescribed prune juice as a remedy for constipation. Cranberry juice is sometimes recommended to help prevent urinary tract infections. Many popular sports drinks contain fruit flavouring. On the other hand fruit flavoured beverages are responsible for many of the dental problems experienced by Irish children and teenagers.
The discussion is not black and white. It is not as simple as saying that all fruit juices, smoothies and flavoured waters are bad for teeth. The health benefits of consuming many of these beverages cannot be overlooked. The problems associated with fruit beverages have a lot more to do with how they are consumed. When consumed moderately these products are not harmful. However, when they come into contact with teeth too frequently or for long periods of time they may cause damage.
Beverages containing fruit can damage teeth in two ways. Fruits are full of natural sugars; they can also be quite acidic. The most common problem is tooth decay. Development of tooth decay needs bacteria, a tooth, time and sugars. Bacteria in the mouth feed on the natural sugars in fruit beverages. When these drinks are consumed in moderation the saliva in the mouth can provide adequate protection. When teeth are exposed to the sugars too frequently decay develops.
The acid in fruit causes teeth to become soft. This is known as dental erosion: The outer structure of the tooth - the enamel - is weakened and wears away when exposed to acids. This damage cannot be reversed. In the same way as with decay, saliva normally helps defend teeth from this damage. However, if the exposure time to acid is very long or very frequent, the challenge for saliva becomes too great and the result is permanent loss of tooth structure. This can lead to sensitivity, poor aesthetics and if severe, death of the nerve of the tooth.
We know that damage caused by acid is on the increase across Europe and the United States. The extent of the problem is often overshadowed by the amount of decay in Irish children's teeth which sometimes masks the effects of acid damage.
Sometimes drinks can be labelled 'no added sugar' and this causes a lot of confusion because parents then think the drink must be safe for teeth. The fact is that while the label is not saying anything untrue, the natural sugars in the beverage are still potentially damaging to the teeth.
Parents may notice brown spots or decay when brushing a child's teeth but by this time the decay can be quite advanced and require extensive treatment to put right. X-rays are an important way of finding decay in children's teeth even before it can be seen on a visual check.
Damage from acid can be more difficult to spot. The teeth might become sensitive at first or the front teeth might start to look short or ragged. The problem is usually quite advanced when this happens. The key message is make sure your child has a dentist and regular checkups. When problems are identified early the solution is usually a lot simpler.
Interestingly, despite claims made in the media that healthy eating guidelines are misleading, the guidelines are very clear. The new Food Safety Guidelines published in 2011 state unequivocally that one serving of juice can only count towards one of the 'five a day'. The guideline encourages children to eat a diet rich in different colours of fruit and vegetables and don't forget that pulses such as beans and lentils are also included in the five a day.
The good news is that juices and smoothies can be consumed safely. The recommendation is to keep the daily intake to one serving. This should be consumed at meal times and not over long periods of time. It is best not to brush for an hour after drinking acidic juices because the teeth are still soft and it is a good idea to rinse the mouth with water or milk after having juice. Two servings of fruit as part of between-meal snacks are very unlikely to cause damage to teeth once the teeth are brushed twice daily with a fluoride toothpaste. Juices should never be held in the mouth, swished or sipped over time as this prolongs the exposure time to the teeth.