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What we do know:
First, let’s discuss what the current literature on this topic has discovered. As with vitamin supplementation research on bariatric patients, the studies on oral health after bariatric surgery are quite limited. Dr. Boyce’s research on 309 gastric bypass patients is the largest study on the topic of vitamin deficiencies and the efficacy of recommended supplementation after bariatric surgery.
In reviewing the current literature concerning dental manifestations after weight loss surgery we found that all of the literature noted increased dental erosion, increased dental caries (is a breakdown of teeth due to activities of bacteria) and increased dental hypersensitivity after weight loss surgery.
Dental erosion is defined as a chemical dissolution of dental tissues by a chemical process (acid or chelating agents) without bacterial involvement. The acid in the food and drink and gastric acids from vomiting and reflux can lead to the softening of the tooth enamel.
As the dental hard tissues soften, the area is more susceptible to break down from abrasion. The acidic attack is irreversible.
Most articles blame the increase of exposure to gastric juices because of vomiting and reflux as a reason for the increased erosion after bariatric surgery.
You were probably told by your dietitian to eat several small meals throughout the day to fend off hunger – and it does! However, this may be attributing to increasing a bariatric patient’s risk to developing these dental caries by allowing more bacterial growth compared to eating the usual three meals a day.
Dental Hypersensitivity is reported by a large number of patients after weight loss surgery. One study published in Obesity Surgery found that the most common variable associated with visits to the dentist after surgery was dental hypersensitivity. Hypersensitivity represents a condition of presumable complex pathology.
Two processes are essential for its development:
1. Dentin must be exposed through genetic disturbance, enamel defect, loss of enamel (erosion, abrasion, attrition, abfraction), gingival recession with rapid loss of cementum and
2. The dentin tubules must be open to both the oral cavity and the pulp. One interesting study followed 54 patients and found that 25 % of the patients had more tooth decay, erosion, and hypersensitivity than before bariatric surgery.
Vitamin deficiencies can also play a part in tooth decay and erosion. Common deficiencies after bariatric surgery include protein, iron, calcium, vitamin D, vitamin B-12, vitamin A, vitamin K, zinc, magnesium, and vitamin C. These deficiencies can negatively impact the immune system and bone turnover rate as well as increase the risk of periodontal disease. Protein deficiency occurs in 13%-18% of patients after surgery.
The incidence of vitamin D deficiency may be as high as 63% in patients 1-4 years post bariatric surgery. According to Dr. Boyce 75-80% of his patients have vitamin D deficiencies PRIOR to surgery. Vitamin B-12 deficiency is associated with the risk of osteoporosis and anemia. Vitamin C is frequently deficient among this patient population and can lead to gingivitis and increased gingival inflammation.
So most of the research published about the link between increased tooth decay and bariatric surgery points to vomiting, gastric reflux, reduced saliva, more acidic saliva, vitamin deficiencies and frequent meals.
How do we explain the increased tooth decay of those patients who insist they take their vitamins and have no deficiencies and also do not report excessive vomiting and reflux? There are many patients who fall into this category.
Check out the many patient comments found on Bariatric Surgery Source’s website: Dental Problems After Gastric Bypass Surgery
Our question is, “What kind/form of vitamins are these patients taking?” Most bariatric patients have been instructed to take chewable vitamins after surgery because many of the popular bariatric brands promote chewable vitamins.
At the New Life Center for Bariatric Surgery, patients are instructed to use Bari Life’s dissolvable complete bariatric vitamin powder after surgery, and many switch to the Bari Life complete bariatric vitamin tablet after 4-6 weeks. As you will recall, The New Life Center for Bariatric surgery reports very few cases of tooth decay in patients after surgery.
Could chewable vitamins be the culprit or compounding the problem?
Dentists will tell you to avoid gummy vitamins and suggest that chewable vitamins can cause problems for your teeth. One little known disadvantage of chewable supplements is that they may damage tooth enamel. There is some evidence that chewable vitamin C tablets can stain teeth.
The dosage for most bariatric chewable vitamins can be as many as 8-10 large chewable tablets per day. Patients will literally chew their vitamins all day long. Chewable vitamins get stuck in between the teeth and will remain there for long periods of time. According to one article, foods that contain the four fat-soluble vitamins, A, D, E, K as well as vitamin C is good for your teeth if you do not chew the supplements directly.
Curiouser and curiouser…
The information provided by the medical community concerning the correlation of tooth decay and bariatric surgery does not mention chewable vitamins, only vitamin deficiencies as a possible cause. One article states that the medical literature has inadequately reported the potential deleterious effects of such surgery on dental health.
The dental professional community makes it very clear that vitamin and mineral supplementation in the form of gummies, soft chews or tablet chewable vitamins can cause problems that can lead to tooth decay and very poor dental health.
It makes sense that when all of these conditions come together, vomiting, reflux, acidic saliva along with food and vitamins sitting for hours in-between teeth and other bariatric surgery complications, there becomes increased risk for tooth decay. There is no research available discussing the effects of chewable vitamins and tooth decay after weight loss surgery. If you are experiencing excessive tooth decay and have had bariatric surgery you should seek professional medical and dental consultations.
It is extremely important to have your lab work completed at least annually to look for vitamin and mineral deficiencies and have your dentist advise you on the special care for your teeth. You may need to eat less sticky, less acidic foods, and avoid chewable vitamins.
You may need to brush and floss more frequently and have regular fluoride treatments to counteract the acidic saliva. It’s actually been proven in studies that elderly people with better oral health are more resistant to all-cause mortality (death from all causes). What’s more – studies prove that people with chronic periodontal disease and exposure to oral bacteria are at greater risk of developing heart disease!
The Bottom Line:
Clearly, the dental health of patients after bariatric surgery is something that needs more research in order to determine and treat the cause of increased tooth decay after surgery.
It should be noted that proper dental hygiene is key in not only maintaining strong and healthy teeth after surgery but also lower your risk of all-cause mortality and heart disease.
Take care of your teeth, every day!
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