SAN FRANCISCO - If you want healthy teeth, it may be better to opt for dark chocolate instead of crackers, according to a presentation by Roger Lucas, DDS, at the California Dental Association's CDA Presents 2018 meeting on September 6.
Roger Lucas, DDS.Dr. Lucas, a pediatric dentist and author of the book More Chocolate, No Cavities: How Diet Can Keep Your Kid Cavity-Free, broke down the biochemistry of caries prevention, including why sugar concentration makes dark chocolate better for your teeth than crackers.
"This is a mind-blowing concept once you grasp it, at least it was for me," Dr. Lucas told DrBicuspid.com. "The short answer is concentration. The concentration of sugar matters in cavity formation more than the amount."
It's all about concentration
Excess sugar can contribute to a number of oral and systemic diseases, and some researchers argue that free sugars are the main cause of caries. However, the sugar concentration within foods and drinks matters more than the total amount of sugar, according to Dr. Lucas.
For example, a cup of whole milk and skim milk both have 12 grams of sugar. However, a 2014 in vitro study found that whole milk is not acidic enough to demineralize enamel, but skim milk can demineralize enamel, he noted.
"When you take away fat, you are indirectly increasing the concentration of sugar, even though [the milk] remains at 12 grams of sugar," Dr. Lucas said. "So concentration, hands down, matters far more than the total amount of sugar."
The same principle applies to chocolate and crackers. Dark chocolate has about the same concentration of sugar as whole milk, while milk chocolate and crackers both have a much higher concentration of sugar, which makes them more likely to contribute to caries.
"Dentist go crazy about 20% to 40% protection from the acid attack from fluoride," he said. "You can get 20% to 40% less acid attack in the first place by eating foods with higher fat content, such as dark chocolate and whole milk. Do both at the same time? Now you are really preventing cavities."
In fact, the No. 1 thing that every parent can do to optimize their children's diet for oral health is to switch out crackers for fresh bread, such as toast or bagels, according to Dr. Lucas.
"If you aren't telling patients you recommend switching from crackers to bread, you will have a lot of frustrated families who get cavities all of the time and have no idea why," he said.
Other tips for caries prevention
Eating foods with lower sugar concentrations isn't the only way to prevent cavities. Dr. Lucas also recommended picking foods that are high in fiber, protein, and fat.
"Bacteria can't make lactic acid with these macronutrients," he said. "Every time you eat fiber, protein, or fat, you are preventing cavities. That is why peanut butter, even though incredibly sticky, is good for teeth, because of the fat and protein content."
Another component is how long it takes to eat the snack. The longer it takes to eat and process food, the more likely it is to contribute to caries.
"That is why I put ice cream on the neutral list," Dr. Lucas said. "It's a much better treat for teeth than regular candy, even if it isn't healthy."
Finally, he advised asking parents and patients if they want tips to help prevent cavities for their children. The vast majority of parents will say yes, and it opens an opportunity for education.
"If you jump in without permission, it sounds like a lecture," Dr. Lucas said. "If you ask permission, they appreciate your advice more. You also weed out that one jaded person every year who actually says no."
