The UK is having another important conversation about obesity, ultra-processed food and how much responsibility should sit with individuals versus the food environment around us. It is a complicated conversation, and there are rarely simple answers. Individual choices undoubtedly matter; what we eat, how often we eat, how active we are and the lifestyle decisions we make all have an impact on our health.
But as a dentist, I find this debate particularly interesting because dentistry provides a very good example of what happens when healthcare focuses heavily on treating the consequences of a problem rather than addressing the factors that contribute to it in the first place. And perhaps there are lessons here that extend far beyond dentistry.
We are very good at treating the consequences
Modern dentistry is remarkably good at repairing damage. We can restore teeth with sophisticated materials, replace missing teeth with implants, treat gum disease, perform root canal treatments and manage increasingly complex oral conditions.
These are incredibly valuable treatments, and I am certainly not suggesting that they aren’t necessary. But there is an important question we should also be asking: Why are so many people developing these problems in the first place?
Tooth decay and gum disease are not simply unavoidable consequences of getting older. They are influenced by a complex combination of factors including oral hygiene, diet, eating frequency, saliva, the oral microbiome, smoking, stress, socioeconomic circumstances and access to healthcare. And many of these factors are influenced by our wider environment.
We can become very focused on fixing the cavity once it exists, rather than asking what could have been done years earlier to reduce the likelihood of that cavity developing. In other words, dentistry has historically been much better at repairing teeth than preventing the conditions that damage them – and the parallels with obesity are interesting.
This is why the current conversation around obesity and ultra-processed food interests me. There is an understandable tendency to frame health as a matter of individual responsibility. And, of course, personal responsibility matters. But it is difficult to separate individual behaviour from the environment in which those decisions are being made. If highly processed, energy-dense foods are inexpensive, convenient, aggressively marketed and readily available, while healthier options can require more time, planning and money, then simply telling people to “make better choices” doesn’t tell the whole story.
The same principle applies to oral health. We tell patients to brush twice a day, limit sugar and look after their teeth – those messages are important. But what happens when someone is constantly surrounded by snacks, sweetened drinks and highly processed foods? What happens when eating becomes almost continuous throughout the day? What happens when children are exposed to marketing for sugary foods from an early age? And what happens when oral health advice is given in isolation from everything else that is happening in someone’s life?
These are much bigger questions than simply asking someone whether they are brushing their teeth.
Oral health isn’t separate from the rest of the body
One of the things I find most fascinating about dentistry is that the mouth is not an isolated system, rather it is part of the same human body. The tissues in our mouth are exposed to what we eat and drink every day, our saliva interacts with our teeth and oral microbiome, our gums are living tissues with an immune response, and our diet provides the nutrients required to build and maintain those tissues. And our lifestyle influences all these things.
This doesn’t mean that every oral health problem is caused by diet, or that changing your diet will magically prevent every dental disease – it won’t. Oral disease is multifactorial. But it does mean that it makes little sense to think about oral health completely separately from nutrition and metabolic health.
Consider tooth decay
Dental caries is driven by a complex interaction between bacteria, dietary carbohydrates, the tooth surface, saliva and time. One particularly important factor is frequency. It isn’t simply about how much sugar someone consumes in a day. How often the teeth are exposed to fermentable carbohydrates matters too. Repeated exposures can create repeated periods where the environment around the tooth becomes more favourable to demineralisation. This is one reason why constant grazing or frequent sugary drinks can be problematic for teeth, even when someone considers each individual snack or drink to be relatively small. The modern food environment can make this pattern remarkably easy to fall into.
A snack here. A coffee with something sweet. A fizzy drink. A cereal bar. Something in the afternoon. Something after dinner.
Suddenly the teeth have been exposed to carbohydrates many times throughout the day.
And then there is the oral microbiome
Our mouths are home to an incredibly complex microbial ecosystem. The goal of good oral health isn’t necessarily to eliminate bacteria – it is to maintain a healthy balance within that ecosystem. Diet can influence the environment in which these microorganisms live.
Frequent exposure to fermentable carbohydrates can favour organisms and metabolic processes associated with dental caries, while changes in the oral environment can also influence the health of the gums.
This is one reason why I think the future of dentistry needs to become increasingly interested in biology rather than simply mechanics. Instead of thinking only about fillings, crowns and cleanings, we should also be asking:
What environment are we creating in the mouth?
And perhaps even more importantly:
What is creating that environment?
The mouth can be an early warning system
One of the reasons oral health is so interesting in the wider health conversation is that the mouth is often one of the first places where lifestyle and environmental factors become visible. A patient’s diet may be reflected in their caries risk. Their oral hygiene and smoking habits may be reflected in their periodontal health. Dry mouth may be associated with medication, dehydration or other health factors. Changes in the mouth can sometimes prompt conversations that go well beyond dentistry. This doesn’t mean dentists should attempt to diagnose every systemic health problem. But it does mean that we have an opportunity to see patients regularly and to have conversations about health that perhaps extend beyond the traditional dental check-up.
Prevention needs to become more than “brush your teeth”. For decades, much of our oral health messaging has essentially revolved around a relatively simple formula:
Brush your teeth + use fluoride toothpaste + visit your dentist.
These are important foundations, but prevention can be much broader.
We can talk about:
- How frequently someone eats
- The types of foods they consume
- Sugary drinks
- Snacking habits
- Hydration
- Saliva
- Sleep
- Smoking and alcohol
- Stress
- Oral hygiene
- The oral microbiome
- Nutritional status
- The wider environment in which health choices are being made
None of these factors exists in isolation, and importantly, prevention shouldn’t mean blaming people when they become unwell.
Responsibility and environment aren’t mutually exclusive, and I think this is one of the most important points in the wider obesity debate. We don’t have to choose between saying “individuals are responsible for their health” and “the environment influences health.”
Both can be true – people have agency. But people also live within systems. And the same applies to oral health.
We can empower individuals to make better choices while simultaneously asking whether we are creating an environment that makes those choices realistic. For children in particular, this is hugely important. Children don’t choose the food environment they grow up in. They don’t decide what is available in the kitchen, what is bought during the weekly shop or what advertisements they see. Teaching children good oral health habits is therefore about much more than telling them to brush their teeth. It is about helping establish healthy behaviours early, making healthier choices normal and giving children the knowledge and tools to look after their teeth for life.
What does this mean for toothpaste?
Toothpaste is only one small part of the bigger picture. No toothpaste can compensate for a highly cariogenic diet, poor oral hygiene or constant sugar exposure. But the products we use every day still matter.
At Dimples, this is one of the reasons we have always been interested in looking at oral care through the lens of prevention and biology. Hydroxyapatite is a mineral naturally found in teeth and bone and has attracted increasing interest as a biomimetic approach to remineralisation and enamel care. Our aim isn’t to suggest that toothpaste is a magic solution – because it isn’t.
Instead, we believe oral care should be part of a broader approach to looking after the mouth: supporting the teeth, respecting the oral environment and making daily oral hygiene as straightforward as possible.
For me, that philosophy sits alongside a much bigger belief:
Good healthcare shouldn’t only be about repairing damage. It should be about helping people avoid unnecessary damage in the first place.
We need to join the dots
Obesity, type 2 diabetes, cardiovascular disease, dental caries, periodontal disease… These are obviously different conditions, with different causes and different treatments, but that doesn’t mean we should consider them completely independently.
There are common themes running through many modern health problems:
- Diet
- Physical activity
- Sleep
- Stress
- Smoking
- Alcohol
- Socioeconomic circumstances
- The food environment
- Health literacy
- Access to preventative healthcare
- Habits we establish early in life
Healthcare has traditionally been divided into specialties: Dentists look after teeth, Doctors look after the rest of the body, Dietitians look at nutrition, public health professionals look at populations.
But the human body doesn’t recognise those professional boundaries. The mouth is part of the body, and perhaps our healthcare systems should become much better at reflecting that.
Prevention isn’t always exciting. There is reason new treatments tend to generate more excitement than prevention. A new drug, procedure or piece of technology is tangible. Prevention is often invisible. If you successfully prevent someone from developing dental disease, there is no dramatic before-and-after image. If a child grows up without developing extensive tooth decay, there is no procedure to celebrate. If someone avoids developing metabolic disease because they changed their lifestyle years earlier, we don’t necessarily know what would have happened otherwise.
But that doesn’t make prevention less important. In fact, it may make it considerably more important. The most successful intervention is sometimes the one that means an intervention is never needed.
A different way of thinking about healthcare
As a dentist, I don’t think the answer is to stop treating disease. People will always need fillings, periodontal treatment, root canals, crowns and other interventions. The answer is to put prevention alongside treatment, rather than treating it as an optional extra.
And perhaps we need to start asking better questions.
Not just “How do we treat this?”, but “Why did this happen?”.
And then: “What could we do differently so that it is less likely to happen again?”
That shift sounds simple. But I think it could fundamentally change the way we approach healthcare. The mouth gives us a very visible example of what happens when we repeatedly treat the consequences of disease without fully addressing the factors contributing to it. Perhaps the lessons from dentistry can now contribute to a much bigger conversation.
Because ultimately, good healthcare shouldn’t simply help us live longer with disease. It should help more people stay healthier in the first place. And that, to me, is where the future of healthcare becomes really interesting.