Malnutrition and Dental Caries

Gerald Phoon

Figure 1. A diagram showing the percentage of mulnourished children under 5 years old,
taken from


When there are pre or post natal deficiencies in nutrition, there are increased levels of caries, showing an association between Protein-Energy Malnutrition (PEM) and dental caries . (Harris & Navia, 1980; Johansson, Ericson, Bowen, & Cole, 1985; Menaker & Navia, 1973). This link is noted to be with proteins, rather than with caloric intake.


Studies have shown that:

  • a "single, prolonged, mild to moderate malnutrition episode" by the age of one may result in higher rate of caries in the primary dentition, an increase in caries of the permanent dentition. (The caries risk may be mediated by means other than enamel hypoplasia.) (Alvarez,et al., 1993; Alvarez, 1995)
  • children with moderate to severe PEM had a "reduced salivary secretion rate, reduced buffering capacity, lower calcium, and lower protein secretion in stimulated saliva, and reduced agglutinating defense factors" in unstimulated saliva than children with no or mild PEM. (Johansson, Ericson, Bowen, & Cole, 1992) [1]
  • ‘moderate malnutrition, particularly lack of protein and deficiencies of certain micronutrients such as vitamins, zinc and iron, can influence the amount and composition of saliva limiting the protective effects it has in the oral cavity’. (Navia,1996)

Enamel Hypoplasia

Figure 2. A picture of a person with enamel hypoplasia,
taken from:

Enamel hypoplasia, which can lead to increase caries risk, can be due to:

  • vitamin A (Mellanby, 1941), vitamin D, and calcium deficiencies (Jontell & Linde, 1986).
  • micronutrient and general malnutrition (Suckling, Elliot, & Thurley, 1983)
A correlation was therefore suggested between the "timing of the malnutrition and the disruption of enamel maturation and development."(Suckling, Elliot, & Thurley, 1983)


In summary

Malnutrition in early childhood is associated with enamel hypoplasia (EH) of the primary dentition both of the classic, structural hypoplasia and with more limited evidence, for enamel opacities. Due to to the limited number of studies, confounding, and potential mis-classification of potential malnutrition,there is a weaker support for an association between EH and the permanent dentition.

The few studies of EH properties, and those of hypoplasia/hypomineralization not associated with known nutritional deficiencies in humans, suggest a decreased mineralization surface and subsurface of enamel affected by PEM. (Psoter, Reid, & Katz, 2005)

An effect on permanent dentition caries is as yet not established because of the small number of scientific studies. Investigations of PEM and the primary dentition need to take delayed eruption into account. Studies of PEM and the permanent dentition need to be aware of possible altered eruption timing of the permanent teeth. This creates a challenge in the analysis of age-specific caries rates. (Psoter, Reid, & Katz, 2005)
Only one study (Alvarez, et al., 1993; Alvarez, 1995) provides the sole evidence of a relationship between early childhood PEM and permanent dentition caries. (Psoter, Reid, & Katz, 2005)


For more information about the importance of saliva in caries prevention, please go to
done by the Saliva group.



1. Alvarez, J. O. (1995). Nutrition, tooth development, and dental caries. Am J Clin Nutr, 61(2), 410S-416S.

2. Alvarez, J. O., Caceda, J., Woolley, T. W., Carley, K. W., Baiocchi, N., Caravedo, L., et al. (1993). A longitudinal study of dental caries in the primary teeth of children who suffered from infant malnutrition. J Dent Res, 72(12), 1573-1576.

3. Alvarez, J. O., Eguren, J. C., Caceda, J., & Navia, J. M. (1990). The effect of nutritional status on the age distribution of dental caries in the primary teeth. J Dent Res, 69(9), 1564-1566.

4. Alvarez, J. O., Lewis, C. A., Saman, C., Caceda, J., Montalvo, J., Figueroa, M. L., et al. (1988). Chronic malnutrition, dental caries, and tooth exfoliation in Peruvian children aged 3-9 years. Am J Clin Nutr, 48(2), 368-372.

5. Aponte-Merced, L., & Navia, J. M. (1980). Pre-eruptive protein-energy malnutrition and acid solubility of rat molar enamel surfaces. Arch Oral Biol, 25(11-12), 701-705.

6. Cleaton-Jones, P., Richardson, B. D., Granath, L., Fatti, L. P., Sinwell, R., Walker, A. R., et al. (2000). Nutritional status and dental caries in a large sample of 4- and 5-year-old South African children. S Afr Med J, 90(6), 631-635.

7. Harris, S. S., & Navia, J. M. (1980). Vitamin A deficiency and caries susceptibility of rat molars. Arch Oral Biol, 25(6), 415-421.

8. Johansson, I., Ericson, T., Bowen, W., & Cole, M. (1985). The effect of malnutrition on caries development and saliva composition in the rat. J Dent Res, 64(1), 37-43.

9. Johansson, I., Saellstrom, A. K., Rajan, B. P., & Parameswaran, A. (1992). Salivary flow and dental caries in Indian children suffering from chronic malnutrition. Caries Res, 26(1), 38-43.

10. Jontell, M., & Linde, A. (1986). Nutritional aspects on tooth formation. World Rev Nutr Diet, 48, 114-136.

11. Li, Y., Navia, J. M., & Bian, J. Y. (1996). Caries experience in deciduous dentition of rural Chinese children 3-5 years old in relation to the presence or absence of enamel hypoplasia. Caries Res, 30(1), 8-15.

12. Mellanby, H. (1941). The effect of maternal dietary deficiency of vitamin A on dental tissues in rats. J Dent Res, 20, 489-509.

13. Menaker, L., & Navia, J. M. (1973). Effect of undernutrition during the perinatal period on caries development in the rat. 11. Caries susceptibility in underfed rats supplemented with protein or caloric additions during the suckling period. J Dent Res, 52(4), 680-687.

14. Moynihan, P. (2002). Annex 6: the scientific basis for diet, nutrition, and the prevention of dental diseases, Background paper for the Joint FAO/WHO Expert Consultation on diet, nutrition, and the prevention of chronic diseases. Geneva: World Health Organization.

15. Navia, J. M. (1996). Nutrition and dental caries: ten findings to be remembered. International Dental Journal 46(Suppl. 1), 381-387.

16. Psoter, W. J., Reid, B. C., & Katz, R. V. (2005). Malnutrition and dental caries: a review of the literature. Caries Res, 39(6), 441-447.

17. Sheiham, A. (2001). Dietary effects on dental diseases. Public Health Nutr, 4(2B), 569-591.

18. Suckling, G., Elliott, D. C., & Thurley, D. C. (1983). The production of developmental defects of enamel in the incisor teeth of penned sheep resulting from induced parasitism. Arch Oral Biol, 28(5), 393-399.


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