“It’s been so hot this summer, we drink agua frescas throughout the entire day to help cool off.” My seven-year-old patient, Camille, had a mouth full of dental caries. Camille’s mom was explaining why she had been drinking so many sugar-sweetened beverages. “My favorite is the Jamaica!” exclaimed Camille. As a dentist, I see many patients who suffer from increased dental disease and pain due to their dietary habits. Something as simple as one’s choice of beverage can deteriorate oral health outcomes over time.

So, what exactly counts as a sugar sweetened beverage, or SSB for short? SSBs are drinks that contain added sugars, including sodas, fruit drinks, sports drinks, and coffee and tea beverages with added sugars.¹ Overconsumption of SSBs can lead to chronic health conditions, such as obesity, diabetes, and cardiovascular disease. But the risks tied to overconsuming sugary beverages don’t end there. Increased sugar consumption also contributes to poor oral health, including conditions such as dental caries and erosion of teeth.² How can we as health professionals educate and empower our communities about the dangers of excessive sugar consumption?

As a Champion Provider Fellow, I collaborated with the Los Angeles County Department of Public Health to implement an SSB Screening and Education Program at my community health center, Wilmington Community Clinic. All patients aged 6-9 years old receive this intervention during their biannual exam. The patient’s parents or other caregivers answer two questions: “On a usual day in the last month, how often did the patient drink 100% juice?” and “On a usual day in the last month, how often did the patient drink sodas, fruit flavored drinks (e.g. Kool-Aid or lemonade) and sports drinks?” These questions help guide us to provide education around SSBs as needed. Patients who, for instance, are reported to drink SSBs three or more times a day may need more in-depth discussion and information.

We inform the parents that the American Heart Association (AHA) recommends consuming no more than 8 ounces (two-thirds of a can) of SSBs per week, including fruit juice and soda.³ This fact is surprising to most parents, who state that they were unaware of these recommendations. We then show the patient and parent a short video about SSBs, conduct motivational interviewing, and distribute an infographic along with CalFresh Healthy Living materials. One of these materials is the children’s book Potter the Otter: A Tale About Water, which highlights the importance of drinking water. The book is an instant hit with families due to its entertaining drawings and characters. We give oral hygiene instructions and toothbrush kits to encourage regular brushing and flossing. Patients who screen positive for high SSB consumption, dental caries, and overweight/obesity are referred to our in-house nutritionist who provides further education on dietary recommendations and strategies to improve oral and overall health.

Before starting this intervention, I distributed a pre-assessment to my staff to gauge current understanding and perceptions around SSB recommendations. A theme among the staff responses was an uncertainty about dental providers’ roles in educating patients about SSBs. A comment from one of our dentists was “diet and nutrition are very personal to a parent, especially for a child with caries. We do not want to make the parents feel that we are blaming them for their child’s poor oral health.” After training and implementation of the intervention, staff felt better equipped with the educational tools and skills to provide SSB education to our patient population. One dental assistant commented “the parents appreciate the information and are receiving it positively.”

A bit of knowledge can go a long way. As a dentist, I aim to empower my patients with the knowledge and motivation to improve their own well-being. Improving health and dietary habits can be difficult, but incremental adjustments can lead to a lifetime of well-being. My favorite motto is “everything in moderation.” Camille and her mom learned that water and milk are the best drinks for the teeth and body; but that it is perfectly acceptable to enjoy an agua fresca when it gets hot every now and then!

References

1. US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020.
2. Valenzuela, MJ, Waterhouse, B, Aggarwal, VR orcid.org/0000-0003-0838-9682 et al. (2 more authors) (2020) Effect of Sugar-Sweetened Beverages on Oral Health: A Systematic Review and Meta-Analysis. European Journal of Public Health. ckaa147. ISSN 1101-1262 https://doi.org/10.1093/eurpub/ckaa147
3. American Heart Association. (2022) Decreasing Sugary Drink Consumption [Fact Sheet]. American Heart Association, Advocacy Department. https://www.heart.org/-/media/Files/About-Us/Policy-Research/Fact-Sheets/Access-to-Healthy-Food/Decreasing-Sugary-Drink-Consumption-Fact-Sheet.pdf

Dr. Mindy Truong serves as Dental Director at Wilmington Community Clinic. She aims to increase access to quality oral health services and education in underserved communities. Dr. Truong is a firm believer in interdisciplinary healthcare and is particularly interested in the role of nutrition in oral and overall health.