Hidden Sugars and Dental Caries Risk
by Dr. V Kim Kutsch
Of course sugar consumption plays a large role in our patient’s caries risk. However even practicing 30+ years, I am still surprised to find new places sugar is showing up in my patients’ diets.
Sports drinks, friend or foe?
Over the years people have begun to understand the link between sugary soda and poor oral and systemic health. Many, in an effort to make healthier choices have migrated from soda to sports drinks, thinking they are doing themselves a favor. However, drinking sports drinks or supplements like GU are doing themselves a disservice.
For optimal athletic performance, an athlete requires good oral health to reduce the risk of oral pain, inflammation, and infection and thereby minimize the use of analgesics and antimicrobial agents. Increased intake, frequency, and dental contact time of carbohydrate-rich foods, sports nutrition products, and acidic carbohydrate-containing sports and energy drinks may contribute to risks of dental erosion, caries, and inflammatory periodontal conditions in the athlete, especially when he or she also exhibits dehydration and poor oral hygiene habits. Examining the athlete before he or she begins participating in a sport allows the dental care provider to determine the patient’s existing oral health, hygiene, and susceptibility to risk factors for erosion, caries, and inflammatory periodontal disease. This oral profile, in conjunction with the individual athlete’s dietary needs, can be used to establish a treatment and preventive program, including oral health education. Good oral hygiene practices and application of topical fluoride, especially via fluoridated toothpastes and topical fluoride varnishes, must be available to the athlete. Rinsing with water or a neutral beverage after exposure to carbohydrates or acidic sports nutrition products may reduce carbohydrate contact time and bring oral pH levels back to neutral more quickly, reducing the risk of caries and erosion. Finally, the dentist should encourage the athlete to consult with an experienced sports dietitian to ensure that principles of sports nutrition are being appropriately applied for the type, frequency, and duration of exercise in consideration of the individual’s oral health needs.(Broad EM, Rye LA. Do current sports nutrition guidelines conflict with good oral health? Gen Dent. 2015 Nov-ec;63(6):18-23)
“Rinsing with water or a neutral beverage after exposure to carbohydrates or acidic sports nutrition products may reduce carbohydrate contact time and bring oral pH levels back to neutral more quickly, reducing the risk of caries.”
What do we know about Sugar Sweetened Beverages?
What about 100% fruit juice?
This study that hit the NY Times and stated that 100% fruit juice would NOT contribute to dental caries. However, in the study it was a 4-6 oz can. it was consumed one time with a meal. People took the idea and ran with it. We need to be very careful about our recommendations with regard to juice. The below image shows how much juice was consumed in the study.
The results of several studies conducted in the United States show no association between intake of 100 percent fruit juice and early childhood caries (ECC). The authors examined this association according to poverty and race/ethnicity among U.S. preschool children.
The authors analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) for 2,290 children aged 2 through 5 years. They used logistic models for caries (yes or no) to assess the association between caries and intake of 100 percent fruit juice, defined as consumption (yes or no), ounces (categories) consumed in the previous 24 hours or usual intake (by means of a statistical method from the National Cancer Institute).
The association between caries and consumption of 100 percent fruit juice (yes or no) was not statistically significant in an unadjusted logistic model (odds ratio [OR], 0.76; 95 percent confidence interval [CI], 0.57-1.01), and it remained nonsignificant after covariate adjustment (OR, 0.89; 95 percent CI, 0.63-1.24). Similarly, models in which we evaluated categorical consumption of 100 percent juice (that is, 0 oz; > 0 and ≤ 6 oz; and > 6 oz), unadjusted and adjusted by covariates, did not indicate an association with ECC.
Our study findings are consistent with those of other studies that show consumption of 100 percent fruit juice is not associated with ECC.
Dental practitioners should educate their patients and communities about the low risk of developing caries associated with consumption of 100 percent fruit juice. Limiting consumption of 100 percent fruit juice to 4 to 6 oz per day among children 1 through 5 years of age should be taught as part of general health education.
“Dental practitioners should educate their patients and communities about the low risk of developing caries associated with consumption of 100% of 100% fruit juice to 4 to 6 oz. per dayfruit juice. Limiting consumption among children 1 through 5 years of age should be taught as part of general health education.”(Vargas CM, Dye BA, Kolasny CR, Buckman DW, McNeel TS, et al. Early childhood caries and intake of 100 percent fruit juice: Data from NHANES, 1999-2004. J Am Dent Assoc. 2014 Dec;145(12):1254-61. 2,290 2-5 yo) SSB/Medications
Another important area to consider is sugary medication.
AIM:An investigation was conducted in a population of pediatric patients with a high risk of caries in order to assess the association between caries history (CH) and the number of early carious lesions (ECLs) and the frequency and timing of cariogenic food and beverage intake, sugar-containing medication, the frequency and efficacy of tooth brushing, and the use of topical fluorides.
MATERIALS AND METHODS:
Study design: descriptive study. One hundred children aged 6-15 years with≥ ECL of a permanent tooth and not enrolled in any dental health educational or preventive programme were selected. For diagnosis it was used an explorer according to the ICDAS II criteria. The participants completed a closed-list questionnaire on the frequency and timing of cariogenic food intake.
There was a nonsignificant tendency to present more ECLs and a greater CH among patients who consumed cariogenic foods and beverages. A significant relationship (p<0.05) was observed between cariogenic beverages and the number of ECL or CH. Using the number of ECLs as dependent variable, regular fluoridated rinses (p=0.003), frequent sugar-containing medication (p=0.007), and cariogenic beverage consumption (p=0.024) were identified as explanatory parameters in the linear regression model.
The Student t-test was used to compare ECL and CH with dietetic factors, fluoridated rinses, sugar- containing medicines, and the frequency and efficacy of tooth brushing. Linear regression analysis correlated the number of ECLs to the mentioned explanatory variables.
The frequent consumption of sugary beverages and medications, and failure to regularly use fluoridated rinses, were positively correlated to an increased number of ECLs in patients with a high prevalence of caries.
“The frequent consumption of sugary beverages and medications, and failure to regularly use fluoridated rinses, were positively correlated to an increased number of early caries lesions (ECL)s in patients with a high prevalence of caries.”(Llena C, Leyda A, Forner L, Garcet S. Association between the number of early carious lesions and diet in children with a high prevalence of caries. Eur J Paediatric Dent. 2015 Mar;16(1):7-12. 100 6-15 yo)
In my experience, both amount and frequency of sugar consumption contribute to dental caries–not one or the other. We as practitioners need to be vigilant in our risk assessment to determine if there are sugary substances being consumed that may be putting our patients at risk.