• More than a third of Singaporeans aged 21 and above have untreated dental cavities and 94 percent suffer from gum disease 
  • The popularity of crunchy, sugar-laden snacks and drinks are taking a toll on oral health 
  • Habits such as clenching and grinding of teeth, chewing on hard foods can also cause significant dental problems 
  • Dental experts gave tips on how to take better care of and preserve natural teeth
She loved drinking bubble tea and whenever she felt stressed at work, sheoften snacked on “healthy” granola bars and fruit snacks.

Even though she told her dentist that she always chose reduced-sugar food items and thatshe was diligent about her oral hygiene routine, she was having several oral healthproblems at the age of 30.

Dr James Ho, founder and chief executive officer of GPlus Dental Center and G DentalCenter, said that despite the young officer worker was having cavities and guminflammation, which made her swollen gums bleed easily whenever she brushed her teeth. 

The enamel surface of her teeth also showed signs of erosion, leading to tooth sensitivity. 

For many Singaporeans, snacking throughout the day is not just a casual indulgence; it is away of life. However, the frequent consumption of sugar-laden treats and beverages hascome at a cost to their oral health.

Coupled with poor dental habits, it is no wonder that asignificant proportion of adults here have to deal with oralhealth problems and retaining their natural teeth as they age.

The latest National Adult Oral Health Survey in 2019revealed that around a third (35 per cent) of Singaporeans aged 21 and above suffer from untreated dental caries.

Additionally, a staggering 94 per cent of adults were found to have gum disease, which if left untreated, can progress to more severe conditions and even tooth loss. 

In 2020, the National Dental Centre Singapore (NDCS) launched the Oral Health Movement 8020, a pilot programme that encourages people aged 40 and above to maintain at least 20 of their natural teeth beyond the age of 80. 

Its pilot study involving 780 adults aged 40 and above found that around 17 per cent were in the orally pre-frail or had tipped into the orally frail state. This means that a decline in oral function affects their ability to chew, swallow and speak.

A key factor contributing to oral frailty is the number of remaining teeth.

Dr Chan Pei Yuan, the programme lead for the Oral Health Movement 8020, noted that the programme has brought attention to the low awareness and prioritisation of oral health among Singaporeans.

Dr Chan also pointed out that the National Adult Oral Health Survey found that more than a third (34.4 per cent) of the adults surveyed visited the dentist only when they experienced a problem with their teeth, mouth or dentures.

Regular cleaning and preventive care are key to keeping your teeth and gums healthy. 

Dr Lee Wan Zhen, head of the periodontics unit with the department of restorative dentistry at NDCS, said: “Those who neglect regular dental check-ups and fail to address cavities in their early stages are at risk of losing their natural teeth permanently.”

Dr Ho cautioned: “Delaying dental care can worsen cavities, requiring invasive treatments like root canals or extractions, while untreated gum disease may lead to costly procedures such as preventable gum surgery or tooth loss.

“Similarly, ignoring a cracked tooth can result in infections, necessitating expensive treatments like dental crowns or root canals.”

The dental experts listed below some common habits that are bad for your teeth and gums, along with what you can do to save your teeth and improve your oral health.

Some people who are trying to lose weight believe that snacking or grazing on small meals throughout the day helps to boost metabolism rate. 

Not only is this not a proven claim, it is bad for your teeth because taking frequent small meals or snacks throughout the day does not give saliva enough time to neutralise acids in the mouth. 

However, being constantly on the move and juggling demanding work and personal schedules may mean that many younger adults tend to snack, rather than adhere to proper mealtimes, he said.

“They also have a higher tendency to skip meals or have irregular meal patterns, since they eat when they feel is convenient to them. 

“Saliva production typically increases during meal times. Skipping meals or frequent snacking, especially when you snack outside of regular mealtimes, means there will be less saliva to help rinse away food particles and neutralise acids in the mouth, increasing the risk of cavities and gum disease,” he said.

Dr Lee from NDCS explained that while eating or drinking, especially foods high in sugar or acids, the pH level in the mouth becomes more acidic, meaning the pH level becomes lower. 

When the pH levels fall below a certain critical level, the enamel that is the hard outer structure of teeth starts to dissolve. 

“Snacking throughout the day exposes teeth to a constant source of sugars that can be used by the oral bacteria to produce acids.

“With frequent snacking, this acidic environment can persist for an extended period below the critical pH level (of 5.5), thereby providing ample time for acids to erode enamel and dentine (the middle layer of the tooth) and weaken teeth. 

“If snacking replaces meals or if snacks are low in water content, it can result in low salivary flow. Reduced saliva flow means less protection against acid attacks, increasing the risk of tooth decay,” Dr Lee added.

Have regular meals at fixed timings. This results in fewer acid attacks on the teeth, compared to continuous snacking, Dr Lee said. 

“Meals consumed at regular hours are followed by a period of time before the next meal, allowing time for saliva to neutralise acids and re-mineralise teeth between eating episodes,” she explained. 

Dr Ho said that continuous chewing — for at least 20 minutes — during regular mealtimes stimulates higher saliva flow.

“Saliva contains essential minerals like calcium and phosphate, which help in the re-mineralisation process, repairing early signs of enamel erosion and decay.” 

Dr Lee advised having three balanced meals a day and if needed, to take oral health-friendly snacks in between (see point below).

Popular sugary snacks and drinks that are sticky and chewy such as kueh, glutinous rice balls, mochi and bubble tea with its add-on gelatinous items in the form of jelly and tapioca balls tend to adhere to teeth, filling crevices and spaces for extended periods of time, promoting bacterial growth.

Even dishes such as fried carrot cake with sweet dark soya sauce, mee siam and mee rebus has high sugar content. 

A diet high in sugar, acidic foods and beverages can contribute to tooth decay and erosion. This can weaken the enamel surface of teeth, making teeth more susceptible to cracking and also lead to tooth loss over time. 

The types of food and drinks considered acidic are citrus fruit such as oranges, vinegar-based salad dressings and health products such as apple cider vinegar.

Dr Lee said that people who engage in an active lifestyle or play sports regularly might consume isotonic energy drinks, which can be high in sugars and acids. 

People may also drink sweetened caffeinated beverages such as instant coffee or caffeinated energy drinks to stay awake, most of which contain sugars, she added. 

Besides weakening tooth enamel, excessive sugar intake fuels bacteria in the mouth that can cause cavities. 

Pick nutritious snacks that are low in sugar and acids, while high in nutrients such as fibre, calcium and vitamins. Some examples are:

  • Fruits and vegetables such as apples, carrots, pears, watermelon, celery and cucumber slices. These are low in sugar and acids. The fibres in fruit and vegetables also provide mechanical cleansing to remove dental plaque from smooth surfaces of teeth 
  • Unsweetened dairy products such as plain yoghurt or Greek yoghurt. They are rich in calcium and phosphorus, which strengthen tooth enamel 
  • Whole grain crackers and bread 
  • Hard-boiled eggs 
  • Plain popcorn 
  • Dark chocolate with a high cocoa content (70 per cent or more) and minimal added sugars 
Dr Ho also said that although the choice of snacks may be important, it is not just acidic or sugary foods and beverages that may solely and directly affect oral health. 

“In the aftermath of snacking, take care of food particles that can become lodged between teeth, which promote bacterial growth and increase the risk of dental issues. 

“Post-snacking oral hygiene practices can help to reduce potential oral health problems. Do what is practically possible, like swishing water in your mouth after meals.

“To minimise direct contact between sweet drinks and teeth, consider using a straw, which can reduce the risk of enamel erosion and tooth decay.

“To minimise plastic, there are eco-friendly stainless steel straws and bamboo straws alternatives,” he added. 

The dentists also suggested consuming sugary or acidic food and drinks as part of a meal — for example, at the end of the meal — rather than as snacks throughout the day or a standalone snack. The increased saliva production during meals would help neutralise the acids. 

“Try to avoid snacking right before bedtime because saliva production decreases during sleep, leaving teeth more vulnerable to acids.

“If you must snack at night, opt for a small low-sugar snack, drink water and brush your teeth afterward,” Dr Lee advised. 

Dr Ho pointed out that some research suggested that brushing teeth immediately after consuming something acidic can damage the enamel, so it may be advisable to wait around 30 minutes before brushing. 

However, removing food that stick between teeth should be done right after meals, either by flossing or even using a toothpick, he said.

If you do not drink enough plain water throughout the day, it can lead to a dry mouth, increasing the risk of cavities due to reduced salivary flow, Dr Lee said.

Staying adequately hydrated — with plain water — is essential for maintaining saliva production and good oral health. 

Rinsing the mouth with water after consuming sweet beverages and food can also reduce teeth’s exposure to sugars and acids. 

“It helps to dilute and to wash away some of the sugar and acid residues, which can lessen the risk of tooth decay and enamel erosion,” Dr Ho advised.

When munching on hard, crunchy food, it is advisable to exercise caution because that is a common cause of dental emergencies such as cracked teeth or lost fillings.

“Hard, crunchy snacks can be detrimental to dental health as they can cause microscopic fractures in tooth enamel. In this hot weather, I also caution my patients against chewing on ice cubes,” Dr Ho said. 

Examples of hard food items that can cause such tiny fractures over time include nuts, potato chips or certain types of biscuits such as pretzel biscuits. 

That said, the extent of damage can vary, based on other factors such as dental health, enamel strength and some eating habits.

For instance, teeth grinding, trauma from accidents or sports injury may weaken the tooth structure. Or habits such as cracking open chicken bone or crab shells using teeth can also cause stress fractures to accumulate on teeth, which may result in cracked or split teeth over time, Dr Lee said. 

For denture wearers, consuming hard, crunchy snacks can be problematic as well. 

“These snacks can exert excessive pressure on dentures, leading to discomfort, soreness or even damage to the dentures. 

“Also, hard food may cause dentures to become dislodged or loosen, increasing the risk of injury to the mouth or throat,” Dr Ho said.

And on one other point, Dr Ho emphasised that “teeth are not tools”. Use the proper tools intended for opening packages and bottles or to crack hard nuts. 

“Once, a patient told me that whenever she could not rip a snack packaging apart, she would use her teeth instead. 

 “I strongly advise not to use your teeth to open bottles, packages or perform other tasks because it can lead to chipping or other damage,” he said.

Dr Ho has the following tips for minimising the risk of cracked teeth while eating harder or crunchy food.

  • Cut hard or crunchy foods into smaller, more manageable pieces. This reduces the force exerted on teeth 
  • If you have dental restorations such as fillings, crowns or veneers, be mindful and avoid biting into hard food items with excessive force. Consider choosing softer alternatives such as nut butters or sliced apples 
  • Consuming foods rich in calcium such as dairy products of milk, cheese and yoghurt may help strengthen tooth enamel and make teeth more resistant to cracks and fractures
Dr Chan, a consultant at the department of restorative dentistry in NDCS, said that for people with teeth grinding or clenching habits, managing stress or using a mouthguard can help prevent cracked teeth and preserve natural teeth. 

Then, there are parafunctional habits such as clenching of teeth, frequently chewing on hard foods, which can cause problems. 

Wearing a mouthguard when playing sports or doing high-impact activities such as skateboarding is also helpful. 

Regular dental check-ups are essential to detect and treat any emerging problems, which can prevent dental problems from progressing and leading to tooth loss later in life, Dr Chan added.

Not brushing and flossing properly, or missing spots when cleaning allow plaque to build up on teeth and gums. 

Brushing and flossing are integral in preventing tooth decay because they remove the “food source” for the bacteria that causes tooth decay. 

If there is a thick biofilm of dental plaque, saliva cannot penetrate between teeth to help re-mineralise and reverse some of the acid damage on teeth, Dr Lee said.

Urging young adults not to delay or neglect routine dental check-ups due to their busy schedules, Dr Ho said that this group of adults may have the perception that they are healthy and do not see the need to visit their dentist regularly. 

This is not true at all. 

Improving oral health requires a joint effort between home oral care and guidance provided by a dentist, he added. 

Besides detecting and treating issues early, a dentist can also give personalised instruction on how to brush and floss your teeth properly based on the person’s dental profile.

Dr Ho advised dedicating three to four minutes to oral care routine at least twice a day using a fluoride toothpaste. 

Incorporate flossing into your daily routine to clean between teeth and remove plaque from areas that your toothbrush may not reach. 

Selecting the right dental products matter, too. 

Use a toothpaste with fluoride to help neutralise harmful acid and strengthen the enamel.

Dr Ho advised choosing a toothbrush with soft bristles and consider using an antiseptic or fluoride mouthwash as a form of supplementary oral care. 

Addressing the misconception that brushing harder or using a hard bristle brush removes more plaque, he said: “We sometimes hear dentists say, ‘Don't brush your teeth like you are scrubbing the kitchen floor’. 

“This is to emphasise to patients the need for gentle, circular motions rather than harsh scrubbing. 

“Using hard bristle brushes and brushing too vigorously can be harmful to oral health rather than beneficial.”

Dr Ho also said that although some studies may suggest potential risks of long-term mouthwash use, such as cancer, the evidence is inconclusive. 

“Using mouthwash with fluoride regularly is beneficial after brushing and flossing. If you have just had oral surgery, and your dentist advises that you use mouthwash containing chlorohexidine, then you should do so. 

“Always consult your dentist and voice out any concerns that you may have. It is important to cultivate a trusting relationship with your dentist by having open communication,” he said. 

Schedule regular dental visits at least once a year, or as advised by your dentist. Dr Ho said that it is advisable to, where possible, try to stick with a regular dentist. 

“Dentist-hopping could perhaps lead to delay in detecting and treating dental issues and cause more permanent damage down the road.”