Dental Problems After Bariatric Surgery: The Impact of Bariatric Surgery on Oral Health

Any surgery brings risks and potential complications. Bariatric surgery is no different, with complications including, but not limited to, dumping syndrome, hernias, ulcers, bowel obstructions and gallstones. There is a hidden complication that has not received much press or research, yet still exists: dental problems and oral health issues after bariatric surgery. Little is known about oral health after weight loss surgery, so let's first look at the research that has piqued the interest of many patients and professionals.

What we know

The current literature on dental problems after bariatric surgery is quite limited. Studies have found an increase in dental erosion, dental caries and dental hypersensitivity after surgery.

• Dental erosion is the irreversible loss of dental hard tissue by a chemical process without bacterial involvement. Acid in food and drinks, as well as gastric acid from vomiting and reflux, can soften tooth enamel, making it more susceptible to wear from abrasion. Most research blames the increased exposure to gastric juices from vomiting and reflux for the increased risk of oral health issues.
• Dental caries: general guidelines for bariatric patients are to consume food and liquids separately, at least 30 minutes apart, and to take at least 20 minutes over small meals to allow satiety and thorough chewing. Although these meal patterns help reduce post-surgical complications, they increase how often teeth are exposed to food, which may increase the risk of dental caries and long-term oral health issues.
• Dental hypersensitivity is reported by a large number of patients after bariatric surgery and is the most common reason for visiting the dentist after surgery. Two processes are essential for it to develop: first, the dentine must be exposed through enamel defects, loss of enamel (erosion, abrasion, attrition or abfraction), genetic disturbance or gum recession; second, the dentine tubules must be open to both the mouth and the pulp. One study found that 25% of patients had more tooth decay, hypersensitivity and erosion than before bariatric surgery.

Vitamin and mineral deficiencies

Vitamin and mineral deficiencies can play a part in tooth erosion and decay. Common deficiencies after surgery include protein, iron, calcium, vitamin D, vitamin B12 and zinc. These deficiencies can negatively affect the immune system and bone turnover rate and increase the risk of periodontal disease. Calcium and vitamin D deficiency occurs in up to 100% of patients after bariatric surgery.

Most published research on the link between increased tooth decay and bariatric surgery points to vitamin deficiencies, vomiting, gastric reflux, reduced saliva, more acidic saliva and frequent meals. Proper supplementation is vital for the overall health of bariatric patients; however, reducing how often and how long acids are in contact with the teeth is recommended to prevent and treat these conditions early and to avoid non-systemic effects.

What this means for the bariatric patient

After bariatric surgery, patients show an increase in dental caries and in the severity of tooth wear; however, these changes in oral health do not influence quality of life, essentially because of the significant improvement in the patient's general health. On the other hand, maintaining good oral health may be a good strategy for preventing some side effects of bariatric surgery. The dental professional community clearly states that vitamin and mineral supplements in the form of gummies can cause problems that may lead to tooth decay and poor dental health. When all these conditions come together (vomiting, reflux, acidic saliva and food stuck between teeth for hours), there is clearly an increased risk of tooth decay. If you experience oral health issues after bariatric surgery, seek professional medical and dental help.

Things to remember

1. Get your labs drawn regularly (at least annually) to rule out vitamin and mineral deficiencies.
2. Brush and floss your teeth frequently (preferably after each meal).
3. Have regular fluoride treatments to counteract the more acidic saliva.
4. Take care of your teeth to reduce tooth decay after surgery.

This article is for general information only and does not replace personal medical advice. Always discuss your situation, blood test results and supplementation with your bariatric team or healthcare provider.