Sooyun Christina Kim, Amreet Minhas, Beatrice Sixt
Project Smile Global
20 October 2024
Fig. 1. Jones, Halloween Treats and Dental Health: Choosing Smarter Treats, 2023
Halloween is a widely observed annual celebration, beloved by children for the trading of candy and other sweet treats. Unfortunately, an increased consumption of sweets can have negative consequences on oral and overall health (Maiti 1). While a single day of consuming candy will not lead to oral health complications, it is essential to cultivate healthy oral hygiene habits from a young age to prevent oral problems in the long run. Excessive sugar intake can lead to dental caries, which is further compounded by other social determinants of health, such as food insecurity.
It is known that excessive sugar intake can lead to oral health issues. More specifically, frequent consumption of processed foods and snacks containing sugar contribute significantly to tooth decay (Hancock et al. 468). This effect is most prominent in children and adolescents (Hancock et al. 469), the age group most likely to go trick-or-treating! When sugar is frequently consumed, it disrupts the activity of bacteria in the mouth (Giacaman 1186). This bacteria forms “biofilm” that surrounds the teeth and ferments carbohydrates from sugary foods, which can lead to the accumulation of acids (Du et al). While this can be managed to a certain extent, the level of acidic content in the mouth can outpace the activity of saliva and other neutralization mechanisms, resulting in a lower overall pH (Du et al). When the pH of the mouth becomes relatively low, acid erosion gradually compromises the integrity of the tooth’s surface due to demineralization (Sato et al). Interestingly, different types of sugars have varying effects on the progression of tooth decay (Du et al). For example, sucrose has been found to cause more severe caries as compared to other sugars such as glucose, though the exact reason why remains unclear (Du et al). Nonetheless, sucrose is a major component of processed snacks, including candy (Groves).
It is no secret that marketing plays a considerable role in children’s eating habits and preferences (Pournaghi Azar et al. 110). A primary source of influence is advertisements, mainly on television, given its prevalence in everyday life (Pournaghi Azar et al. 110). Additionally, the fact that children are usually the target audience for products such as snacks and candies causes them to associate these products with feelings of happiness, comfort, and popularity among peers (Graham et al. 241). Since the happiness of children can hinge on access to sweet snacks, parents may in turn feel pressured to shop for these products, despite the fact that they are unhealthy (Graham et al. 249). If parents were to deprive their children of trick-or-treating, for instance, this could ostracize them from their peers, which is undesirable. Therefore, allowing children to regularly consume processed snacks and treats can contribute to a sense of belonging (Graham et al. 249).
This is also associated with overarching attitudes towards diet and lifestyle based on the country in question (Marino et al). A 2021 review by Marino and colleagues determined that “ultra-processed foods” such as packaged snacks and candy were a considerable component of total energy intake in the United States and, in general, Western countries. Conversely, those in Mediterranean countries, which are known to thrive on balanced diets, demonstrated limited energy intake from ultra-processed foods (Marino et al). Overall, it was found that children consumed the highest amount of ultra-processed foods (Marino et al). This is congruent with findings from Wang and colleagues, in which consumption of ultra-processed foods increased among American children from 1999 to 2018.
Poor diet can also lead to poor oral health, which is exacerbated by food insecurity (Merchant 3). Food insecurity is defined as inadequate access to food, resulting in disrupted eating patterns and hunger (Chi et al. 1599). It also acts as a social determinant of health, as children from low socioeconomic status (SES) backgrounds are more likely to experience food insecurity, leading them to consume more fast foods, which contain high levels of cariogenic (tooth decay-causing) carbohydrates, including sugar (Chi et al. 1599). Furthermore, childhood obesity is associated with low SES, mediated by low-cost foods, particularly those high in fat and sugar, like soda-pops (Marshall et al. 450). While obesity is a complex disease that results from multiple etiological factors such as genetic, demographic, and environmental factors, low socioeconomic status has been found to be the strongest predictor in caries development (Marshall et al. 456).
This is compounded by the fact that those from low socioeconomic backgrounds are less likely to utilize dental care services, resulting in worsened oral health conditions (Listl et al. 62). Parents coming from low SES backgrounds, as measured by limited education, are also more likely to allow their children to consume soft drinks, leading to a higher prevalence of dental caries in low SES youth (Marshall et al. 456). However, food insecurity and consuming food high in sugar alone are not the sole contributors to tooth decay; they can be modified through topical fluorides, preventative care, and consistent oral hygiene practices (Chi et al. 1599).
Fig. 2. Merchant, Context and Interaction of Nutrition, Disease, and Oral Health, 2022
To prevent tooth decay, proper oral health care should be implemented. One of the most important factors in maintaining good oral health is the level of fluoride in the mouth (Anne-Marie Glenny et al.). Fluoride contributes to the normal mineralization of the tooth and forms a thin protective layer known as fluorapatite. This substance primarily acts as protection against tooth deterioration (Mankar, Nikhil, et al.). In addition to maintaining the appropriate levels of fluoride in the mouth, removing plaque is also an important aspect of correcting tooth brushing. Plaque is harmful; it creates the aforementioned biofilm of bacteria on teeth, which produces acids as byproducts that weaken the enamel. Over time, it can even escalate to become harder substances like tartar or dental calculus, which require professional removal (Sharma and Thrushab). As a result, plaque removal is instrumental in having a healthy mouth, working in tandem with optimal fluoride levels.
Adhering to these guidelines is key to correctly brushing your teeth. To ensure adequate dental hygiene, brush your teeth at least twice a day, once in the morning and once in the evening. This helps to remove plaque and maintain optimal levels of fluoride in the mouth, both of which prevent the formation of dental caries. (Anne-Marie Glenny et al.) Brushing your teeth after meals is important, as it counteracts the effects of food particles and sugars left on the teeth. Brushing your teeth on a daily basis also promotes sulcular cleaning, which helps to control periodontal disease (Pindobilowo et al. 1650). It is more important to ensure that each area of the mouth is fully washed and that all surfaces are adequately cleaned than to focus on a specific brushing time (Anne-Marie Glenny et al.). However, it is suggested that each quadrant of the mouth receives around thirty to forty-five seconds, for a total of two to three minutes (Pindobilowo et al. 1650). For children, who are the ones mostly eating Halloween candy, parent or caretaker supervision is highly encouraged, not just to make sure that they are getting everything right, but also to build healthy habits for their future (Anne-Marie Glenny et al.). To improve your oral care even further, you should also floss on a daily basis, especially at night, to help remove often ignored plaque that sits below the gumline (“Importance of Flossing.”). Furthermore, the chances of getting periodontitis are reduced by 17 percent for those who floss more frequently than once a week than for those who floss less frequently (Cepeda et al.). Additionally, using antimicrobial mouthwash is recommended, as it has been proven to reduce plaque and improve gingival health (McGrath et al.).
Oral health is mediated by a variety of factors, including sugar intake, socioeconomic status, and food insecurity. Excessive sugar intake can disrupt bacteria activity in the mouth, encouraging the formation of cavities. Low socioeconomic status can also contribute to poor oral health, as children experiencing food insecurity are more likely to consume low-cost, sugary foods, which can also result in childhood obesity. However, through preventative care and consistent oral hygiene practices, oral health in children can be improved.
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