Areas of new knowledge

We constantly make new observations linking food to dental caries. Experiments up till today are being carried out on different categories of food, and new information is always being collected: Different types of fruits prove to have different degrees of association with caries, but substituting fruits for sweets will benefit our teeth; milk appears to possess non-cariogenic qualities due to the presence of calcium, phosphorus, fats and casein. The modern diet seems to be more cariogenic than a vegetarian low-sugar diet; there appears to be a positive correlation between the amount of sugar intake and caries increment.

Although it has long been known that sweet foods had adverse effects on the teeth, only recently has there been more knowledge on the mechanism through which sugars promote the occurrence of dental caries. It has been shown that sucrose is the most cariogenic of the common sugars. Interestingly, though, it has also been shown that not just type of sugars, but different consumption patterns affect the incidence of caries: Starches have different effects on caries, depending on how they were processed (cooked starches are far more cariogenic than uncooked starches, and unrefined starches possess ‘protective factors’ which curb its cariogenicity); sugar-rich food taken in between meals has a higher cariogenicity than when taken during meals; sugars taken in sticky form appear to cause a greater increase in caries incidence than sugar taken in non-sticky form.

More light has also been shed on protective mechanisms. The natural mechanisms include the buffering capacity of saliva and consumption of dairy products and protein-rich food such as cheese and peanuts, which help to reduce the cariogenic properties of cariogenic food. Then there are other mechanisms, in terms of research and development, where products that are active against tooth decay are engineered. There is a lot of interest on the different types of non-sugar sweeteners such as polyols for their potential in reducing caries. Fluoridation may not have eliminated caries, but evidently, it has reduced the linear relationship between sugars and caries drastically.


Areas of controversy

Due to the difficulty of conducting well-controlled experiments, different studies tend to give different conclusions. For example, it is still debatable whether frequency of sugar intake or amount of sugar is the most important determinant of the incidence of dental caries; the effects of malnutrition on the permanent dentition are unclear. Even within a study itself, there may arise results that are inconclusive, a classic example would be whether the caries incidence in normal subjects would be greater or less than that of the mentally deficient patients used as subjects in the Vipeholm Study.


Areas for further research

My group was surprised that even in this day and age, we have been unable to determine with confidence the exact mechanism of the formation of streptococci mutans. Rather than just knowing that there is a ‘positive correlation”, finding out exactly all the different contributing factors of the proliferation of streptococci mutans would go a long way in modern dentistry.

The ongoing research about non-sugar sweeteners seems to carry massive potential as well. Although we have discovered evidence of protection against tooth decay, the mechanisms through which the different non-sugar sweeteners work have to be researched on for more clarity on the matter, before it can be effectively used in the market to promote public dental health. Then, feasibility research also has to be carried out on the implementation of these sweeteners on a scale that will actually make a difference to the public, or at least people with higher risks of caries.


Areas which were fascinating and stirred your desire to learn more

The buffering capacity of saliva is really quite ingenious, it really reflects nature's complexity and effectiveness. It was also intriguing how different foods can affect the cariogenic properties of cariogenic food. The potential of sugar polyols as noncariogenic sweeteners is also very interesting, because such sweeteners may be packaged, with a lot of creativity, to help different groups very specifically, which really opens up many possibilities.

Diet and Dental Caries | Types of Sugar | Cariogenicity of Other Foods | Evidence Linking Sugar and Dental Caries in Humans | Influence of Consumption Pattern | Malnutrition and Dental Caries | Influence of Fluoride on the Sugar/Caries Relationship | Protective Factors in Foods | Non-Sugar Sweeteners |Dietary Control and Dental Caries | Summary

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