Vegetarian diets are becoming increasingly popular. Having knowledge on the effects of this diet on oral health is pertinent in providing care for patients that consume a vegetarian diet. A recent systematic review published in June 2019 in the journal Community Dentistry and Oral Epidemiology, the authors aimed to “examine the possible impacts of following a vegetarian diet on dental hard tissues, focusing on caries development, dental erosion, and number of natural teeth.”1
Upon initial search for studies to include in the systematic review 499 studies were identified as possibly relevant. After removing duplicates and those that did not meet the inclusion criteria, 18 studies were included in the systematic review.
The findings in this review show a potential for a 2-fold greater risk of dental erosion in people that follow a vegetarian diet, although the authors note the level of evidence is questionable. However, people that follow a vegetarian diet had slightly lower DMFT scores. There were limited controls for confounders, the authors state, “the findings of this review should be interpreted with caution.”
Mechanisms that were cited for the difference in oral health between vegetarians and non-vegetarians is that people consuming a vegetarian diet tend to eat more fruits and vegetables. These foods are often acidic and may lower the pH level in the mouth leading to erosion and the development of dental caries. Additionally, it has been suggested in previous studies that people eating a vegetarian diet consume too little essential amino acids, reducing the ability to support and maintain healthy structures or repair dental tissues.
There were several limitations noted by the authors including, lack of calibration, methodological quality was poor, lack of adjustments for confounders, and publication bias cannot be ruled out.
The authors conclude by stating, “The main implication of our study comes from the possible two-fold greater risk of dental erosion in vegetarians. Given this observation, it seems sensible to recommend raising awareness of this association among dental professionals and the general public. Our findings are limited and based on studies of mainly lower quality, more and higher quality research (such as longitudinal studies adjusting for possible confounding factors) would be required to confirm the robustness of our findings. If such association can be confirmed, a next step could be to develop and test interventions for raising awareness among vegetarians and improving their dental health behaviors.”
Have you noticed an increase in dental erosion in your patients that eat a vegetarian diet? Is this systematic review enough evidence for you to start a conversation with your vegetarian patients about the possible increased risk of dental erosion? What interventions might you suggest to your patients that are vegetarians that present with dental erosion?
- Smits KPJ, Listl S, Jevdjevic M. Vegetarian diet and its possible influence on dental health: A systematic literature review. Community Dent Oral Epidemiol. 2020 Feb;48(1):7-13. doi: 10.1111/cdoe.12498. Epub 2019 Oct 1. PMID: 31571246; PMCID: PMC6972589.