This article focuses on the dental challenges for those who go through the bariatric surgery process.
What is Bariatric Surgery
Bariatric surgery is a general term for a group of surgical procedures to treat chronic obesity. These surgeries entail some form of restriction to or reduction of the stomach, which ultimately limits how much food can be absorded at a time. At least 7 of 10 recipients show obvious improvement after surgery especially when coupled with proper diet, exercise, and hormonal changes that reduce the urge to splurge on foods.
Life Altering Dietary Habits after Surgery
Some patients can get by eating 3 meals while others may need to eat like a Hobbit having 6 meals a day for the first 6 months. A general recommendation is to eat foods first and drink liquids 30 minutes later to aid in digesting. A meal will have smaller portions than before surgery and can take at least 20 minutes to finish eating. After the first 6 months, meals are less regimented.
Common Oral Sequela
With a change in dietary habits, two undesired frequent consequences affecting your mouth after surgery are regurgitation and nutritional deficiencies.
Regurgitation often occurs when a person eats too quickly or doesn't chew food properly. This causes reflux or vomiting. The acidic oral environment thins the teeth causing erosion, yellower teeth, and a heightened hypersensitivity to hot and cold temperatures in 60-80% of bariatric patients.
Nutritional deficiencies, especially with calcium, occur in nearly all bariatric patients due to diet limitations. This has long-term effects on teeth making them weaker, more brittle, and prone to breaking.
Bariatric Patients and Increased Cavity Risk
1 in 4 bariatric patients have a drastic increase in cavities. Cavities occur predominantly due to eating frequently and having the same oral hygiene habits prior to surgery.
Know that it is not just sugars that cause cavities. Oral pH/acidic levels are crucial in understanding cavity prevention. The mouth at rest is at a neutral 7.0 pH. Cavity formation begins at 5.5pH or less. When reflux or vomiting occurs the mouth's pH drops drastically to 1.2pH (soda is usually 2.5-3.5pH). Our mouth acidic levels also drop below that ca vity-causing threshold whenever we eat most American foods. Bariatric recipients are eating constantly and the mouth is chronically bathed in acids not allowing enough time for the teeth to fortify themselves from cavities. This fortification process starts to occur about two hours after the last bite. This means if one snacks throughout the day between meals, the teeth will get cavities.
Checklist of Ways to Prevent Cavities
3 of 4 bariatric patients do not change their oral hygiene habits after surgery. What worked before to prevent cavities usually will not work afterwards. We suggest doing all the following even if it's mastering 1-2 different recommendations at a time:
Drink water after eating. This will neutralize and wash away foods from your teeth
Stop snacking between meals. Grazing on foods is just as destructive as drinking soda
Eat foods that are more alkaline: and limit breads, coffee, and any flavored beverages
Daily take 1,200-1,500mg calcium vitamins. If using soft chews, drink water afterwards.
Chew Xylitol gum at least 3x/day. Common brands are Ice Cubes or Trident
Brush your teeth with toothpaste 2-3x/day
Use a prescription fluoride toothpaste, Prevident 5,000, for extra resistance to cavities
Schedule dental cleanings every 3-4 months instead of 6 months/year
Request fluoride varnish at each dental cleaning
Use any of the recommended Mouthrinses daily: ACT, Pro Maintenance Rinse (Previously called CTx3), Plax, Therabreath, Biotene
For further questions, please reach out to Dr Nelson or Southern Oregon Bariatric Center. They are a great resource and we encourage all bariatric patients to have constant follow up with your bariatric center.