The Usual Suspects- Diet

This post is part of a 4-part series from Dr. Kim Kutsch on CAMBRA, risk assessment, and the usual suspects that are causing this disease. If you would also like to watch the video, click here.


Seventeen years ago, we overthought the CAMBRA process. It was, with the benefit of hindsight, overly complex to implement CAMBRA principles into daily practice. After sixteen years of work, we’ve simplified the process and made it easier for your staff and patients to understand the disease process and for you to use CAMBRA effectively in your practice to help your patients fight caries disease.


One of the tools that can help simplify understanding and speed identification of disease risk factors is to think of the usual suspects. These are specific patterns that correlate strongly to dental caries and are readily identifiable in your patients. With data from over 12,000 caries risk assessments, we see 55%  of patients self identify that they have a diet issue–they eat too frequently or consume too much sugar in their diet.

In patients with a dietary issue, caries are distributed all over the mouth. They are not localized to a specific area–the cavities are everywhere.


A lot of these issues come from sugar sweetened beverages. It makes sense if you think about it. Sugar in a solution will spread evenly throughout the mouth and the cavities are appearing throughout the mouth.


The scientific research on diet and caries supports this. A study from Brazil found children and adolescents who consumed the highest amounts of sugar experienced the highest decay rates, despite the use of fluoride. Another study out of Puerto Rico found that children who consumed more than 10% of their daily calories in the form of sugars, even natural sugars, had a significantly increased risk of dental caries. This study found that natural fruit juice was as damaging as other sugar sweetened beverages.


A large study in the United States looking at young adults found that not only did sugar sweetened beverages increase the risk of caries, it also increased the frequency of tooth loss. The sugar sweetened beverages also are associated with increased enamel erosion, and the carbonation added to so many of them seems to further exacerbate these issues. It seems clear, when considering the body of research as a whole, that sugar sweetened beverages pose a real challenge for dental health.


Another interesting study, this one from India, backed up existing research that children with high BMI’s were at increased caries risk. However, it also found that children who had low BMI and were malnourished had an increased risk as well.


We know that maternal risk for caries is strongly correlated to a child’s risk for caries. The good news here is that breastfeeding during the first 12 months does not increase a child’s caries risk. There is an increased risk after 12 months, though it may be because after 12 months, children are more likely to consume breastmilk from a bottle. Regardless of the contents of the bottle, bottle feeding where the child is left with the bottle is associated with increased caries risk.


It’s important to remember that patients see a lot of conflicting information about what they should be eating. Frequently, the information, even from what should be authoritative bodies, is not based on research done in keeping with principles of good scientific research. What is increasingly clear is that Americans consume large amounts of sugar and that sugar sweetened beverages are proving a detriment to multiple areas of health.


At the end of the day, this is a pH driven disease. It’s about prolonged periods of low pH that causes mineral loss in the teeth. Correcting the dietary issues can aid in correcting the conditions that cause low pH and caries. If you see carious lesions throughout the entire mouth, you are probably looking at dietary causes of caries in that patient.

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