Dental health

There are not many studies on dental health after bariatric surgery, but the results from them and experiential knowledge indicate that there is reason to educate and pay close attention to dental health both before and after surgery. 

Changes in pH levels in the mouth

It is normal for the pH level in the mouth to fluctuate somewhat, but as a rule, we should not have a prolonged pH level below 5.5 PH. When we eat, the pH level fluctuates, but at a low pH level (under 5.5 PH), calcium is released from the enamel, which makes the teeth more vulnerable to tooth decay. Usually, the pH level recovers quickly after a meal and the calcium that left the enamel returns back to its place. However, there are various things that can cause the pH level to remain low for a long time, thus increasing the risk of tooth decay.  

The most common reasons for a change in pH levels in the mouth in individuals who have undergone bariatric surgery:

1. Snacking and multiple meals throughout the day.  

After surgery, it is recommended that you eat more often during the day because the stomach is much smaller than it was before the surgery. Even if the food you eat is not acidic, the pH level drops due to substances that bacteria in the mouth produce while digesting the food. Sweets and some fruits can also have a low pH level, which extends even more the time with an unfortunately low pH value in the mouth.  A low pH level weakens the teeth and increases the likelihood of tooth decay.  

1. Acidic drinks 

Many people enjoy drinking beverages that have added carbonation and some flavor. Carbonation causes the drink to drop slightly in pH level (although not by much). Flavorings often lower the pH level even more, but a typical flavoring in drinks is citric acid which has a very low pH value. To reduce the acidic taste, sugar or artificial sweetener is sometimes added. The pH level may still be very low.  

Examples of drinks and pH levels: 

• Coca-Cola 2.5 PH 

• Pepsi Max 2.9 PH 

• Gatorade/orange 3.28 PH 

• Apple juice 3.6 PH 

• Orange juice 3.8 PH 

• Whole milk 6.78 PH 

• Coffee 4.8 – 5.1 PH 

• Water 7.7 PH  

It matters a lot whether you are drinking low PH drinks all day long or over a short period of time.  

If you already have tooth decay or erosion of  enamel, you should avoid acidic drinks and if you consume them, it is better to drink with a straw. It can help to rinse the mouth with water afterwards. 

1. Changes in stomach acid 

Acid reflux both as a cause of obesity and as a complication after bariatric surgery can cause increased acidity in the mouth.  Reflux is stomach acid that flows up the oesophagus and sometimes into the oral cavity with or without a heartburn sensation. Individuals who vomit frequently are also at an increased risk of experiencing tooth decay due to a persistent low pH level. 

If you have reflux, it is important to treat it with appropriate medication both to protect the areas that the acid from the stomach can irritate and your teeth.  

If you vomit, you should not brush your teeth immediately afterwards – because the acid from the stomach weakens the enamel and brushing your teeth abrades it even further. It is better to rinse the mouth with water and then brush after about an hour. 

1. Changes in saliva production 

Saliva serves an important purpose for our dental health. The saliva maintains the pH level of the mouth and teeth at around 7.0 PH, and the saliva contains, among other things, calcium, which is important for the maintenance and health of the enamel. Many people who have undergone bariatric surgery experience considerable dry mouth, and low saliva can prolong the acid period after eating/drinking and thus increase the likelihood of tooth decay.  

Decreased saliva production can also be a side effect of medication. Lozenges and sprays are available over the counter and can help with dry mouth. 

Take good care of your teeth – you want to have them for a lifetime 

References: 

Quintella MCM, Farias T, SoutoMaior JR, Casado B, Leão RS, Moraes SLD. Relationship between bariatric surgery and dental erosion: a systematic review. Surg Obes Relat Dis. 2020;16(9):1283-90 

Brochure on dental health after surgery by G.Mjøen, E. Romstad, L.Myran, and M.Strømmen https://uploads-ssl.webflow.com/5fb63fd41d6bd704a16a0d9a/642538c6c7e054641b730b25_Bar-oral-brochure-for-pasienter.pdf