You will all be aware of the recent announcement by the World Health Organisationʼs International Agency for Research on Cancer that aspartame is (and I use quotation marks to stress that these are not MY words!) “potentially carcinogenic to humans”. What they mean is, that oneʼs risk of contracting cancer might be increased if one consumes aspartame…but this applies only to those who consume it in excessive amounts. The word potentially is important here. It means that the relationship between the sweetener and the disease is not yet unequivocally established. It also denotes that the risk posed by excessive amounts of aspartame is considerably less than the cancer risk posed by the consumption of alcohol, the use of tobacco and the eating of processed meats. So, the precise relationship between aspartame and cancer is far from clear. Without doubt, further research is needed before anything like a firm conclusion can be reached.
You will perhaps recall that back in December my Editorial pointed out that if any intervention is to be given, or in this case potentially withdrawn, we need to know what the costs of doing so are. We also need to try to gauge the amount of health benefit there is to be lost, or gained, by continuing with, or departing from, the status quo. In the case of aspartame, this means that, if it were ever to be suggested that its use should be curtailed, we would need, first, to be able to count the cost of the increase in oral disease (not to mention obesity, diabetes and cardiovascular problems) that might result. That is, could the benefits of withdrawing aspartame i.e. a small reduction in cancer risk for people who drink more than 14 or more cans of aspartame-sweetened drink per day, possibly outweigh the benefits and pleasure that aspartame brings to people? Of course, the best course would be that everyone drink only water. But given people’s love of sweetness and their willingness to trade immediate pleasure and gratification for poor outcomes in the long-term future, that seems like a very unlikely proposition.
And herein lies the importance of evidence, which is what Evidence-Based Dentistry is all about. Unless we are able to describe, define and quantify the benefits which artificial sweeteners (or indeed any other health-promoting intervention) offer, we will not be able to defend their use in the face of potential threats to general health, however small or unlikely those threats may be. So, every piece of data we collect, every trial that is conducted, every observational study, particularly long-term ones, enable us to help decision makers weigh all possible alternative actions. Without such science, decisions which may affect entire populations will be made by guesswork, personal preference, or the persuasiveness of the sender of the message, all of which are known to be highly influenced by the language used, and the mode of presentation.
Emotive words like cancer incite alarm and promote avoidance action. Words such as wellbeing, health and happiness are almost considered a norm, and a right, so we forget to consider the factors that produce them. Having clear, unequivocal evidence about the nature of oral ill health and having available data to demonstrate the benefits of good oral health is vital. Equally, having a clear grasp of the costs of failing to focus on oral health, in terms of both economics and the impact of quality of life, is the task researchers must address if oral health is not to be forgotten every time there is a health scare or a new announcement about the risks life presents to us.
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Kay, E. Dentistry’s need for a strong evidence base. Evid Based Dent 24, 97 (2023). https://doi.org/10.1038/s41432-023-00920-5