Sugar consumption and dental caries

Sugar intake and the frequency of intake of sugars are particularly relevant for dental caries. The curve of pH in the oral cavity demonstrates why frequency is important. It illustrates how demineralisation (area coloured yellow) of tooth surfaces occurs after every sugar intake and the subsequent drop in pH that takes place in the mouth as oral bacteria convert sugar to acid. This process stops as the buffering action of saliva returns the pH to normal (20 to 40 minutes). Saliva production varies across a 24-hour day, being stimulated at mealtimes whereas it is much reduced during sleep.

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The impact of frequent sugar intake is mentioned below. In this case, sugar intakes are experienced on many occasions during the day, so demineralisation occurs more often and the time between drops in pH is not long enough for effective remineralisation to take place. When sugar intakes are spaced some hours apart, there is a good opportunity for remineralisation, which is also more effective in the presence of fluoride.

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Effect of repeated sugars consumption on plaque biofilm pH. Reproduced from Chestnut IG, Dental Public Health at a Glance, Wiley Blackwell, with permission. The pH of the fluid in the plaque biofilm falls rapidly on eating sugar (within one minute). Slowly recovers over 20 to 40 minutes as pH rises due to buffering and washing effect of saliva, sugar used up. Repeated intakes of sugar mean that pH remains for a prolonged period below the point which favours demineralisation.

Prospective cohort studies conducted in children and adolescents indicate that higher consumption (that is, the amount) of sugars, sugar-containing foods and sugar-sweetened beverages is associated with a greater risk of dental caries in the deciduous and permanent dentitions. There is less available evidence on adults. A higher frequency of consumption of free sugar-containing foods and beverages, but not total sugars, is also associated with a greater risk of dental caries in deciduous and permanent dentitions. There is evidence that drinking sugar-sweetened beverages on a daily basis are related to greater dental caries risk in adults.

Recommendations to prevent tooth decay are as follows:

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• minimise the amount and frequency of consumption of sugar-containing foods and drinks

• avoid sugar-containing foods and drinks at bedtime when saliva flow is reduced, and buffering capacity is reduced

All food and drink containing sugars should be consumed as part of a meal and not as a between-meal snack. It is important to recognise that honey, fruit smoothies, fresh fruit juice and dried fruit all contain cariogenic sugars and should not be consumed as a between-meal snack. Neither should fruit in sugary syrup. Fresh fruit (or alternatively frozen fruit, or fruit canned in juice) are recommended snacks between meals.

Fizzy drinks, soft drinks, juice drinks and squashes sweetened with sugar have no place in a child’s daily diet.

Most free sugars in the diet are contained in processed and manufactured foods and drinks. Consumers should check labels carefully to find out how much sugar a product contains. The Change4Life food scanner App is a helpful resource.

Similar messages should be reinforced throughout life, and this is particularly important as people enter later life when diet and health behaviours change, and risks increase under a variety of influences.

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