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Dental Tribune United Kingdom Edition | 3/201606 OPINION The sugar tax is finally upon us, but are corner shops or supermarkets for that matterlikely toworryabout this potentially threatening change to their flagship product line? The tax targets all drinks and equates to a tax of 24 pence per litre on those with the most sugar content. This could potentially equate to an in- crease in the price to the consumer, but bearing in mind that soft drinks are more accessible and cost less in the UK than water in many Third World countries, it is doubtful that things will change markedly. There is the argument that tax- ingtobaccohashadaneffectonthe uptake of smoking and the conse- quent addiction, but the evidence for this is relatively sparse and weak. Although a worthy initiative, taxing drinks may result in a greater squeeze on those who can afford it the least and I doubt whether little Jimmy will stop his tearful tantrums for penny sweets as a result of a celebrity chef’s campaign as our sugar saviour. As a child of the eighties, these celebrity-led campaigns remind me of rock bands who decided that African poverty should be on the agenda, but this does not seem to be as important to them now. It would appear that it is easier to tax sugar than to provide funding for dentistry; unfortunately, there is unlikely to be a symbiotic decrease in caries as a result. One could argue that sugar pol- lutes much in the same way that inefficient power stations do. The societal repercussions need to be managed by all, with no or little comeback for the fizz producers. As carbonated drinks are so popu- lar, these juggernaut companies are powerful and, as a result, dent- ing their progress with a tax is un- likely to truly positively affect the general health of the population. In 2014, the UK soft drinks indus- try was worth £15.7 billion, with over 14.8 billion litres in overall consumption, which represents a steady and exponential growth that is likely to continue. One in- teresting observation is the slow demiseofthe330mlcan—itbeing replaced by the 500 ml plastic bottle. The larger bottle may rep- resent better value for money, but is less likely to represent better health value, especially since a re- sealable bottle is more likely to be sipped over hours than a can once opened. Overconsumption of sugar causes an inordinate amount of health problems. Indeed, Type II diabetes and obesity are leading causesofdeathanddisabilityinthe US, the birthplace of the canned, likely red, refreshment. These life- threatening conditions are in addition to our experiences of sugar-laden drink devastation. In contrast, but just as worrying, the emerging evidence shows that low-/no-calorie drinks (49 per cent of drink consumption in 2014) ac- tually fuel hunger and trick one’s stomachintothinkingthatcalories are on the way, only to be disap- pointed, resulting in further food- seeking behaviour. The ordering of diet beverages in all-you-can-eat restaurants may not be as ironic as I first thought! Erosive tooth wear seems to have been forgotten amongst overweight toddlers needing ear- to-ear clearances. From bulimics who like to taste but do not like their waist to the energy drink crew who prefer machismo gothic graphic designs, the younger gen- eration is likely to experience more dissolution of tooth tissue. At the other end of the spectrum, obese patients are more likely to develop diabetes, which in turn makes them more susceptible to periodontal disease. Society’s gluttonous overcon- sumption is manufacturing pa- thology unheard of 50 years ago. Lest we forget the ageing popula- tion among the tabloid’s sugar ma- niaoftheyoung—polypharmacyis likely to increase caries owing to a variety of co-morbidities, such as a dry mouth or heavily sugar-sup- plemented medication. I have seen restorations seemingly intact for generations in hospital notes only to sprout caries at the cavity mar- gin within months of a new medi- cinebeingprescribed.Isthereapill foreveryillordopillsallowillstobe masked by other ills while slowly swelling corporate turnovers? Society is forever changing and food is now at the centre of how we relateandconnectwitheachother. From Instagram posts of freshly cooked home meals to wedding cake bliss after inordinate tastings, it seems to be important to every- one. As a result, food is an emotive issue that affects oral and general health in ways that may not be readily apparent to our patients. I have an old friend in Florida, who I visited last year. He is a specialist in periodontology and runs a suc- cessful, swish, modern referral practice. As a matter of routine, he tells patients they need to stop carbohydrate intake post-surgery. Oncepatientsunderstandthatthis improves outcomes owing to de- creased plaque build-up on the wound edges, they are receptive to this brief change in their diet. Healsoadvocatesperiodontalmed- icine while identifying stress as a risk factor for periodontitis. Research by Prof. Iain Chapple in Birmingham investigating the ef- fect of diet on periodontal disease confirms that one is what one eats andthegingivaefollowsuit.Purely taxing sugar may not impact on its consumption. Patients need to be motivated to take ownership of their health and relate this with foresight to repercussions in the future. It is this lack of responsi- bility and potential blame shifting by patients that not only results in poorer health, but also makes providing National Health Service care for all increasingly impossible if prevention is the best cure. This commonly occurs when patients claim to be unaware of the oral health effects of smoking and the related exacerbation of periodon- tal disease, only for it to become important when teeth are all but heldinbythelasttenuousSharpey fibre. Owing to their own lack of awareness or lack of engagement withatoothbrush,theycanrequest some sort of compensation or pur- sue a litigious course likely to in- volve an expensive implant-based restoration. What may escape the lawyers and the patient is that previous periodontal disease is a significant risk factor for implant failure, and so the cycle is likely to continue. Patients are responsible for their own health and the lack of recognition of this cannot be the fault of the clinician. Successful dental care requires collective effort between the pa- tient and the dentist. Health care is a partnership in which both sides have different responsibilities and activeroles,butiftheclinicianpro- videsaserviceforailmentsthatthe patient could have prevented, the question of self-governance arises. Patients have a right to health care, but they also have responsibilities derived from the principle of au- tonomy. The patient’s physical and mental integrity should always be upheld and respected. In contrast, autonomy identifies the human capacity to self-govern and choose the most appropriate pathway to protect that integrity. As such, capable patients exert some control over lifestyle choices that influence their well-being. Unfortunately, regardless of the imminent extra tax on the already dirt-cheap confectionery, the in- nate responsibility held by the patient to self-govern will always trumpouradvice,treatment,knowl- edge or collective experience. Sugar, sugar…honey, money By Aws Alani,UK “Society’s gluttonous overconsumptionismanufacturing pathology unheard of 50 years ago.” Aws Alani is a Consultant in Restorative Den- tistry at Kings College Hospital in London, UK, and a lead cli- nician for the management of congenital ab- normalities. He can be contacted at awsalani@hotmail.com. “...food is an emotive issue...” DTUK0316_06_Alani 12.04.16 12:05 Seite 1 DTUK0316_06_Alani 12.04.1612:05 Seite 1