Sugar Restriction for Caries Prevention: Amount and Frequency. Which Is More Important?

The World Health Organization guideline to use less sugar may be an opportunity and support for dentistry in its goal to get the message of using less sugar across to the public. Two ways (with all the combinations of these) to achieve a reduction of sugar consumption are the reduction of the amount of sugar in products or the reduction of the frequency of consumption of sugar-containing products. Which sugar-reducing strategy is best for caries prevention? To answer this question, this manuscript discusses the shape of the dose-response association between sugar intake and caries, the influence of fluoridated toothpaste on the association of sugar intake and caries and the relative contribution of frequency and amount of sugar intake to caries levels. The results suggest that when fluoride is appropriately used, the relation between sugar consumption and caries is very low or absent. The high correlation between amount and frequency hampers the decision related to which of both is of more importance, but frequency (and stickiness) fits better in our understanding of the caries process. Reducing the amount without reducing the frequency does not seem to be an effective caries preventive approach in contrast to the reciprocity. Goals set in terms of frequency may also be more tangible for patients to follow than goals set in amount. Yet, in sessions of dietary counselling to prevent dental caries, the counsellor should not forget the importance of quality tooth brushing with fluoride toothpaste.

[1]  P. Petersen,et al.  Implications of WHO Guideline on Sugars for dental health professionals , 2018, Community dentistry and oral epidemiology.

[2]  E. Feskens,et al.  Total, Free, and Added Sugar Consumption and Adherence to Guidelines: The Dutch National Food Consumption Survey 2007–2010 , 2016, Nutrients.

[3]  J. Radford,et al.  The shape of the dose-response relationship between sugars and caries in adults , 2015, BDJ.

[4]  A. Schuller,et al.  Impact of lifestyle factors on caries experience in three different age groups: 9, 15, and 21-year-olds. , 2015, Community dentistry and oral epidemiology.

[5]  M. Masood,et al.  Impact of National Income and Inequality on Sugar and Caries Relationship , 2012, Caries Research.

[6]  M. Duggal,et al.  Comparison of the Effects of Whole and Juiced Fruits and Vegetables on Enamel Demineralisation in situ , 2011, Caries Research.

[7]  C. Currie,et al.  Adolescent toothbrushing and the home environment: sociodemographic factors, family relationships and mealtime routines and disorganisation. , 2010, Community dentistry and oral epidemiology.

[8]  H. Szajewska,et al.  Systematic Review Demonstrating that Breakfast Consumption Influences Body Weight Outcomes in Children and Adolescents in Europe , 2010, Critical reviews in food science and nutrition.

[9]  H. McNulty,et al.  Is Sugar Consumption Detrimental to Health? A Review of the Evidence 1995—2006 , 2009, Critical reviews in food science and nutrition.

[10]  J. Klenk,et al.  Determinants of obesity in the Ulm Research on Metabolism, Exercise and Lifestyle in Children (URMEL-ICE) , 2009, European Journal of Pediatrics.

[11]  M. Downer,et al.  Correlates of dental caries in 12-year-old children in Europe: a cross-sectional analysis. , 2008, Community Dental Health.

[12]  L. Tenuta,et al.  Effect of starch on the cariogenic potential of sucrose , 2005, British Journal of Nutrition.

[13]  S Twetman,et al.  Eating habits, smoking and toothbrushing in relation to dental caries: a 3-year study in Swedish female teenagers. , 2005, International journal of paediatric dentistry.

[14]  J. M. ten Cate,et al.  Efficacy of Fluoride Toothpaste in Preventing Demineralization of Smooth Dentin Surfaces and Narrow Grooves in situ under Frequent Exposures to Sucrose or Bananas , 2005, Caries Research.

[15]  C. Leclercq,et al.  The relationship between frequency of carbohydrates intake and dental caries: a cross-sectional study in Italian teenagers† , 2002, Public Health Nutrition.

[16]  A. Sheiham,et al.  The relationships between dietary guidelines, sugar intake and caries in primary teeth in low income Brazilian 3-year-olds: a longitudinal study. , 2001, International journal of paediatric dentistry.

[17]  B. Burt,et al.  Sugar consumption and caries risk: a systematic review. , 2001, Journal of dental education.

[18]  HaraldA.B. Linke,et al.  Effect of Increasing Sucrose Concentrations on Oral Lactic Acid Production , 2000, Annals of Nutrition and Metabolism.

[19]  Chs Ruxton,et al.  Guidelines for sugar consumption in Europe: Is a quantitative approach justified? , 1999, European Journal of Clinical Nutrition.

[20]  S. Gibson,et al.  Dental Caries in Pre–School Children: Associations with Social Class, Toothbrushing Habit and Consumption of Sugars and Sugar–Containing Foods , 1999, Caries Research.

[21]  D. Kandelman,et al.  Sugar, alternative sweeteners and meal frequency in relation to caries prevention: new perspectives , 1997, British Journal of Nutrition.

[22]  I. Macgregor,et al.  Toothbrushing schedule, motivation and 'lifestyle' behaviours in 7,770 young adolescents. , 1996, Community dental health.

[23]  H. Sundberg,et al.  Reasons for the caries decline: what do the experts believe? , 1996, European journal of oral sciences.

[24]  D. Bratthall,et al.  Restoring oral health. On the rise and fall of dental caries in Iceland. , 1996, European journal of oral sciences.

[25]  M. Woodward,et al.  Sugar consumption and dental caries: evidence from 90 countries , 1994, British dental journal.

[26]  A. Sheiham.  Why free sugars consumption should be below 15 kg per person per year in industrialised countries: the dental evidence , 1991, British Dental Journal.

[27]  K. Guire,et al.  The Effects of Sugars Intake and Frequency of Ingestion on Dental Caries Increment in a Three-year Longitudinal Study , 1988, Journal of dental research.

[28]  T. Imfeld.  Identification of low caries risk dietary components. , 1983, Monographs in oral science.

[29]  A. Sheiham.  SUGARS AND DENTAL DECAY , 1983, The Lancet.

[30]  L. Sreebny,et al.  Sugar availability, sugar consumption and dental caries. , 1982, Community dentistry and oral epidemiology.

[31]  B. F. Miller,et al.  A Quantitative Method for Evaluating Physical and Chemical Agents which Modify Production of Acids in Bacterial Plaques on Human Teeth , 1943 .

[32]  A. B. Cinar,et al.  Clustering of obesity and dental caries with lifestyle factors among Danish adolescents. , 2011, Oral health & preventive dentistry.

[33]  Kia orana,et al.  Early feeding practices and severe early childhood caries in four-year-old children from southern Brazil : a birth cohort study , 2011 .

[34]  D. Appleton,et al.  Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent school children. , 1984, Archives of oral biology.

[35]  M. Takeuchi.  Epidemiological study on dental caries in Japanese children, before, duration and after World War II , 1961 .

[36]  C. Lundqvist,et al.  The Vipeholm dental caries study; the effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. , 1954, Acta odontologica Scandinavica.