Message in a Bottle Mailbag: High caries risk and gluten-free diets

The Message in a Bottle Mailbag is a monthly feature of the e-newsletter, Pearls for Your Practice: The Product Navigator. Each month, Editorial Director Joshua Austin, DDS, FAGD, answers reader-submitted questions to help you navigate your dental product decisions (and more!). This month, he responds to a question about the role of gluten-free diets in high caries risk, and he shares his thoughts on Super Bowl LI.

Question:

Laura from Wisconsin wrote: I am a registered dental hygienist in Wisconsin. I saw your article about Sydney and her high caries risk a few weeks ago. I have children with high caries risk, and I was thinking that Sydney might share some health attributes with my children. Was she ever diagnosed with any GI issues? Was she on a gluten-free diet? I feel that my kids' caries risk is worsened by their GI issues and gluten-free diet. The flours in gluten-free foods are high in sugars and are tenaciously sticky from the time of consumption. I would love any insight on this.

Answer:

Thanks for sharing your story with me, Laura. I can imagine that watching your kids struggle with caries is frustrating. Sydney did not report any GI issues, but you make some really fascinating points. Certainly we know that GI issues can lead to dental issues in the way of GERD, but I have never considered the types of sugars in gluten-free diets.

Your anecdotal information about the stickiness of the carbohydrates in gluten-free foods is alarming. Many people are going on gluten-free diets for legitimate health reasons, but some are doing so without diagnoses. A good friend of mine does this. Chris insists that he feels better when he avoids gluten, yet he tested negative for celiac disease. Patients who have celiac disease and gluten sensitivities should not be advised to change their diets, but patients who are simply following the gluten-free fad should be made aware of the impact on their oral health.

I have a good relationship with the perio residency director at UT Health here in San Antonio, Brian Mealey, DDS. He has a saying: “Trust your something-ain’t-right meter.” While seeing Sydney over the years, my something-ain’t-right meter definitely went off. I even emailed a cardiologist at UT Health, and we discussed it briefly over e-mailed photos. We thought that Sydney may have an underlying health issue, but she moved before I was able to pursue that thread.

I am glad that Sydney’s case stirred up as much discussion as it did. I received many e-mails about it, which helped me realize that we all have these patients in our offices and worry about them deeply. We really do care about our patients, and cases like this leave us feeling helpless, which isn’t fun. The important thing is that we continue to care!

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Question:

Arnold from Connecticut wrote: Was Super Bowl LI the best Super Bowl ever?

Answer:

I think the answer has to be yes. It was the only overtime game in Super Bowl history, which helps support that fact.

There have been some great ones, especially over the last 15 years or so. I grew up during the era of Super Bowl blowouts. Short of the Giants-Bills Super Bowl, there was a solid decade or more of nasty blowouts. Starting with the Rams-Titans Super Bowl, we had a pretty solid run of mostly good games. This one was a little different because of the comeback. I don’t remember a Super Bowl game that looked like it was going to get out of hand early but then ended with an unexpected finish.

If you’re a Falcons fan (since you are in Connecticut, I assume you are not), this game must have felt like a horrible gut punch and heartbreaker. Maybe they can rebound, but psychologically, it has to have been a huge blow. If you're a Patriots fan, this was the icing on the Bill Belichick–Tom Brady cake, right? I doubt it will ever get any better than that. Father Time will close the book on the Patriots at some point. With five Super Bowl rings and seven appearances, Tom Brady has to be at the top of the list of greatest players of all time. Love him or hate him, he has a handful of hardware that's hard to argue with. Congrats, Patriots fans. Enjoy this. It probably won’t ever be any better!

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