Adult dental caries and sugar intake

Adult dental caries and sugar intake

Yoriko Matsuoka,Kakuhiro Fukai
Fukai Institute of Health Science

Abstract: Dental caries affect people throughout their lives, but few previous studies are available on therelationship between dental caries and sugar intake in adults.
The aim of this study was to review the existing evidence concerning the association between
dental caries and sugar consumption in adults.
A literature search resulted in 25 studies (including eleven reviews). A positive association wasidentified between 4-year DMFT increment and intake frequency of sugar-sweetened beverages.
Soft drinks in particular had a positive relationship with dental caries. Dental caries are reduced
when intake of free sugars is less than 10% of total energy consumption, or less than 15–20
kg/person/yr (40–55 g/day).
Limiting the frequency and amount of sugary food and beverage consumption is an effective measure to prevent dental caries. In the dental field, advising patients to reduce their sugar intake inorder to prevent dental caries also indirectly contributes to weight loss and decreased obesity, as
well as other non-communicable diseases, in the community.
Key words : Sugar, dental caries, adults

Introduction(Moynihan P, et al., 2004). Most studies relating to

Dental caries is one of the most common child-dental caries and sugars have investigated caries

hood diseases, but it is a chronic and cumulativein children. Evidence from previous studies sug-disease that affects people in all stages of life. The

gests that caries rates correlate with the amountseverity of dental caries increases with ageof sugar consumed and the frequency of intake ofsugary products (Sheiham A, 2001).
Sugars are an essential source of daily energy【著者連絡先】〒341-0003 埼⽟県三郷市彦成 3-86
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intake. Nicklas TA, et al. (2001), however, showedthat high-calorie foods or beverages such as
sweets, snacks, sugar-sweetened beverages, condiments, and carbohydrate food groups are positively associated with high energy intake and bodyfatness. Overweight children have a 1.5 to two-fold̶ 22 ̶ヘルスサイエンス・ヘルスケア Volume 15,No.1(2015)higher risk of remaining overweight up to 20

AND“caries”[All Fields]) OR“dental caries”

years of age (Nicklas TA, et al., 2001). Overweight[All Fields]) AND (“adult” [MeSH terms] OR

youth have 2.4 times higher serum total choles-“adult”[All Fields] OR“adults”[All Fields]) NOT

terol level and 43.5 times the rate of cardiovascu-“child”[MeSH(terms] OR“child”[All Fields] OR

lar risk factors (Nicklas TA, et al. 2001).

“children”[All Fields]). Additionally, articles cited

Obesity is connected with many chronic diseases including hypertension, type 2 diabetes melli-in the studies selected from Medline were handsearched and added to the list if relevant.

tus, gallbladder disease, cardiovascular diseases,and hypercholesterolemia (Greenwood JLJ, et al.,Results2008). In 2015, a new WHO guideline to prevent

The search strategy resulted in 131 studies. The

non-communicable diseases and dental caries

following cases were excluded: subjects under 19

strongly recommends children and adults reduce

years old and case reports or studies that did nottheir daily intake of free sugars to less than 10% of

examine dental caries in adults. In the end, a total

their total energy or roughly 50 grams (12 tea-of 25 studies were identified.

spoons) per day (WHO, 2015). As an additional rec-

Table 1 summarizes the results of the reviews

ommendation, WHO suggests a further reduction

and meta-analyses reviewed in this study. In theof the intake of free sugars to below 5% of total

studies by Moynihan P, et al. (2004, 2014), it wasenergy intake or roughly 25 grams (6 teaspoons)demonstrated that consumption of less than 15–per day.

20kg/yr (<40–55g/day, <10% total energy) of free

Since sugar consumption is a common risk fac-sugars correlates with lowered risk of dental

tor in both medical and dental fields, controllingcaries. Hendriksen MA, et al. (2011) showed thatsugar consumption would provide both general

consumption of carbonated soft drinks containing

and dental health benefits under the common risksugar substitutes was linked with reduced dental

factor approach. Little evidence from previous

caries and body weight.

studies has found a significant correlation between

As seen in Table 2, a 4-year cohort study bydental caries and frequency and amount of sugar

Bernabé E, et al. (2014) showed an association

consumption in adults. The aim of this report is tobetween dental caries and consumption frequency

review the previous studies in order to clarify theof sugar-sweetened beverages (sugary coffee orrelationship between sugar and dental caries intea, sugared juices, fizzy drinks, or cocoa) inadults.

Finnish adults. A positive association was identified between 4-year DMFT increment and intake
Methods

frequency of sugar-sweetened beverages. Adults

Medline databases from 1970 to June 2015 weredrinking 1–2 sweetened drinks per day had 31%

searched with a combination of MeSH and text-greater (Incidence Rate Ratio: 1.31; 95% CI: 1.02–

based terms: “carbohydrates”[MeSH(terms] OR1.67), and those drinking 3+ sweetened drinks per“carbohydrates” [All Fields] OR “sugar” [Allday had 33% greater (Incidence Rate Ratio: 1.33;Fields])

95%DI: 1.03–1.72) DMFT increments comparedAND “snacks”([MeSHterms] OR“snacks”[All Fields]) AND “beverages”[MeSH(with those who did not drink such beverages.

terms] OR“beverages”[All Fields]) AND “dental(In the ten cross-sectional studies, sugar-sweet-caries” [Mesh terms] OR “dental”([All Fields]

ened beverages such as sweetened tea or coffee̶ 23 ̶

Table 1 Reviews on the association between dental caries and consumption of sugar in adults

Adult dental caries and sugar intake̶ 24 ̶Table 2 Studies on the relationship between dental caries and sugar intake in adults

ヘルスサイエンス・ヘルスケア Volume 15,No.1(2015)̶ 25 ̶

Table 2 Studies on the relationship between dental caries and sugar intake in adults[continued]

Adult dental caries and sugar intake̶ 26 ̶

ヘルスサイエンス・ヘルスケア Volume 15,No.1(2015)

and particularly soft drinks were shown to have a2002; Du MQ et al., 2009; Issa AI, et al., 2011;

positive relationship with dental caries. Heller KE

Scaramucci T, et al., 2012).

et al. (2001), identified significant associations
between DMFS increments and more frequent

Discussion

daily consumption of sugary soda in Americans

WHO (2015) remarks that “sugars” includes

over 25 years old (p<0.05). In the report of Forshee

intrinsic sugars like intact fruit and vegetables;

RA, et al. (2004), regular carbonated soft drinks

sugars from milk (lactose and galactose); and freewere correlated with higher DMFS for the 25–40

sugars which include monosaccharides and disac-year and over 60 year age groups of Americans

charides added to foods and beverages by the(p<0.05). Burt BA, et al. (2006) identified that

manufacturer, the cook, or the consumer. Free

DMFS scores were significantly associated withsugars also include the sugars naturally present insoft drink consumption (p<0.01). Additionally, fre-syrups, honey, fruit juices, and fruit juice concen-

quency of soft drink intake and presence of gingi-

trates. Oral bacteria mainly utilize sucrose, glu-

val plaque were positively correlated with caries

cose, and fructose to produce acids.
The studies reviewed in this article examinedprevalence and severity (p<0.05).
Acidic soft drinks including sports drinks had nofoods such as biscuits, chocolates, cake, cookie,

association with dental caries or erosive tooth

chocolate candies, tartar sauce, and snack foods aswear (Milosevic A, et al., 1997; Mathew T, et al.,well as beverages such as sweetened tea or coffee,

2002; Coombes JS, 2005). Though the causes ofsoft drinks, cola, fruit juice, milk, diet soda, anddental caries are multifactorial, Jain P, et al. (2014)

cocoa. Of these possible factors, the search results

concluded that sugar-sweetened beverage con-suggest that sugar-sweetened beverages promote

sumption was a much stronger indicator of dental

dental caries development and excessive weightcaries than oral hygiene or snack food consump-

gain in children and adults (Malik VS, et al., 2013).

tion.

This is because it is easier to consume larger

Eight studies have examined the consumption

amounts of sugars in liquid form, despite poor sat-frequency of sugar-sweetened beverages (Milose-isfaction in terms of appetite reduction compared

vic A et al., 1997; Heller KE, et al., 2001; Mathew

with chewing solid foods.

T, et al., 2002; Sirimaharaj V, et al., 2002; Forshee

Concerning the effectiveness on dental caries ofRA, et al., 2004; Burt BA, et al., 2006; Tseveenjav

restricting sugar intake as per the WHO guideline,B, et al., 2011; Bernabé E, et al., 2014). Two studies

Moynihan PJ et al. (2004, 2014) show evidence thatexamined the intake quantity of sugar-sweetened

dental caries are reduced when intake of free sug-beverages (Mathew T, et al., 2002; Jain P, et al.,ars is less than 10% of total energy intake or less2014). Three studies were conducted regarding

than 15 to 20 kg/person/yr (<40–55 g/day orconsumption type, terms, concentration, and tim-

<10% total energy). Burt BA, et al. (1988) reported

ing.

that every 5 g of additional sugar consumption
Eight studies included dental erosion, tooth

was resulted in a 1% increase in the probability ofwear, root caries, and remineralization or deminer-developing dental caries. Additionally, reduction ofalization of enamel and dentin (Johansson A-K, etsugar consumption is associated with a decreaseal., 1996; Milosevic A, et al., 1997; Jensen ME, et al.,in body weight, which is reported in five of the2000; Mathew T, et al., 2002; Sirimaharaj V, et al.,studies in this meta-analysis (0.80 kg, 95% Confi-̶ 27 ̶Adult dental caries and sugar intake

dence Interval: 0.39–1.21; p<0.001) (Morenga LT, etReferencesal., 2012). The study durations were from ten

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