Oral health: Case report: Unusual sugar binge

Sir, as in many workplaces, boxes of chocolates and mince pies jostle for space among healthier choices, such as the humble fruit bowl, in the staff kitchen at this time of year. Just this lunchtime as I was catching up on the latest BDJ and eating my quinoa and feta salad, I spied none other than our dental hygienist polishing off two mince pies chased down with a hazel whirl, a strawberry cream and a toffee penny. We were then joined in the staff room by our DCT who had availed himself of the festive options at the coffee shop on the corner with a large gingerbread flavoured milky coffee topped with whipped cream and drizzled with caramel sauce.

This seasonal over-consumption of sugar reminded me of a patient who came into the surgery way back in January: an unusual case which I would like to share with your readers.

The patient in question was an elderly male who presented with a facial swelling and difficulty closing his mouth. This was not immediately apparent, as the gentleman was particularly hirsute, with a thick beard and moustache that partially hid his mouth (Fig. 1).

Figure 1

©James Richards

The patient who reported bingeing on sugar just once a year

On examination, it was noted that the patient's oral hygiene was poor, with generalised severe periodontal disease, many cavities and halitosis. He also had a large dental calculus on the maxilla arch, which explained the facial swelling and lack of labial sealing.

The patient was a non-smoker but it was observed that he was very overweight with a ruddy complexion. When I enquired as to his diet he reported that it was generally healthy for 364 days of the year (365 in leap years), but that over a 24-hour period each December he would binge on sweet treats and short measures of alcohol. The patient, who was a verbose and jovial fellow, was given to outbursts of mirth that shook his whole person, despite the obvious oral discomfort it caused him, such that I was concerned for the stability of my dental chair.

He explained that his annual binge consisted in large proportion of mince pies but that he also consumed slices of chocolate log, rum truffles, biscuits and cookies of every variety, gingerbread, champagne truffles, kirsch cherries, Kendal Mint Cake, boiled sweets, baklava, macaroons, shortbread, fruit cake, panettone and goodness knows what else. This was washed down with an assortment of spirits such as brandy, whisky and sherry. It was noted in the history that the large calculus had been progressively growing over a number of years but that the patient did not recall ever having sought dental evaluation before. He attended my clinic because his oral condition was increasingly affecting his ability to eat, swallow and talk.

At a second appointment, the patient was submitted to deep scaling with periodontal curettes and dental extractions were performed due to the periodontal disease. He was open to discussion on how to improve his diet and his oral hygiene, and he pledged to replace his annual sugar binge with 'crunchy carrots' for the sake of his remaining teeth. I referred him on to our dental hygienist for regular appointments, but am informed the patient has left the country and has not yet returned this year.

Important note to readers

This content has been created for the entertainment of readers in the spirit of seasonal good humour and, on the whole, possesses not an ounce of truth. All persons, products, URLs and email addresses mentioned have been invented by the BDJ Editorial Team.