Working in bariatric surgery, we understand that there are often complications or negative sides to having surgery such as nutritional deficiencies, food intolerance, hair loss, etc. A recent literature review highlighted on of the areas we often overlook: our patients’ dental health. From increased levels of reflux, to eating behaviors, to nutritional status, there are many contributors to negative dental health after surgery to be aware of so that we can help our patients navigate their long-term health.
Acidic Environment
Increased episodes of nausea, vomiting, reflux (after VSG), and regurgitation all create pH imbalances in the mouth and diminish the protective effect of saliva for the teeth. This can lead to demineralization of both the enamel and dentin, especially since when those affected brush their teeth directly after an episode and increase the risk for dental caries. In addition, lower pH negatively affects periodontal (gum) health.
Frequent Eating and Drinking after wls
The need to eat 4-6 meals per day and separate liquids from foods means that patients have very little time during the day when they are not consuming something. In addition, many patients find plain water hard on their stomach. Therefore, they often drink water with juice added – washing the teeth with acids and sugars – or sugar-free alternatives that also lower the pH within the mouth. These combine to create an environment prime for both tooth erosion and bacterial growth increasing the risk of caries and periodontal disease.
Micronutrient Deficiencies after bariatric surgery
As we are well-aware, micronutrient deficiencies are quite common after bariatric surgery. Calcium and Vitamin D – two of the micronutrients that patients are most likely to have deficiencies in – are also of great consequence for dental health. In addition, there is a link between gum disease and anemia. While the direction of this relationship typically goes from gum disease to anemia, it’s still of concern considering that many patients have low iron and vitamin B12 levels.
What can we do as clinicians?
- Educate our patients on the risk factors contributing to poor oral health after bariatric surgery including reflux, vomiting, regurgitation, frequent eating and drinking, and micronutrient deficiencies.
- Encourage dental regimens that account for frequent eating and drinking.
- Create interdisciplinary networks to improve communication with dental health care providers and encourage patients to have frequent visits with their dentist after WLS.
Looking for more? Check out our other blog posts!
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