Is there a link between sugar consumption and the development of dental caries (cavities)?

Sugar Consumption is a Primary Cause of Dental Caries

Yes, there is a direct causal relationship between sugar consumption and the development of dental cavities (caries), with strong evidence showing that limiting free sugars intake to less than 5% of total energy intake can significantly reduce cavity formation. 1

The Sugar-Caries Connection: Mechanism and Evidence

• Dental caries is caused by the fermentation of sugar by oral bacteria that accumulate as dental plaque, generating acids that erode dental enamel 1
• Cohort studies consistently demonstrate a positive correlation between sugar consumption and dental caries development, with higher sugar intake leading to increased cavity formation 1
• Each additional 5g of sugar consumption is associated with a 1% increase in the probability of developing dental caries 1
• Participants with free sugar intake of 16% of energy (53.3g) were 2.99 times more likely to develop caries compared to those consuming less than 10% of energy from free sugars 1

Dose-Response Relationship

• There is a log-linear dose-response relationship between sucrose intake and the progressive lifelong development of caries 2
• Studies show that children with sugar intake below 10% of energy (approximately 46g/day of added sugars) developed significantly fewer cavities than those with higher intakes 1
• In Finnish children, when sucrose intake was below 10% of energy, the mean dmft (decayed, missing, filled teeth) was 1.1, compared to 2.7 when sucrose intake exceeded 10% of energy 1

Impact of Sugar Reduction

• WHO guidelines recommend limiting free sugars to less than 10% of total energy intake, with further benefits when reduced to below 5% 1
• Population studies consistently show lower dental caries rates when sugar availability/intake is below 15-20 kg/person/year (approximately 10% of energy) 1
• Even at lower sugar consumption levels (below 10% energy), some caries still develop, suggesting that further reduction to 5% energy or less provides additional benefits 1

Risk Factors and Modifying Factors

• While sugar is the primary cause, several factors influence the sugar-caries relationship:
  • Frequency of sugar consumption (number of sugar-containing eating occasions) 3
  • Presence of acidogenic bacteria in dental plaque 4
  • Fluoride exposure and salivary flow that can counteract bacterial acids 5
  • Oral hygiene practices that remove plaque 1

Special Considerations

• Sugar-containing drinks are particularly harmful as they combine sugar with acidity, accelerating enamel erosion 1
• Allowing toddlers to have trainer cups or dummies containing sugary drinks significantly increases caries risk 1
• Dental caries is a progressive disease - being cavity-free in childhood does not mean being caries-free for life 1
• Even with good fluoride exposure, high sugar intake continues to cause significant caries 1

Practical Recommendations

• Limit free sugars to less than 5% of total energy intake for optimal dental health 1
• Restrict sugar-containing eating occasions to no more than four times daily 1
• Avoid sugar-containing drinks in sippy cups and bottles, especially at bedtime 6
• Use fluoride toothpaste and maintain good oral hygiene to help mitigate, but not eliminate, the effects of sugar 1
• Consider water and dairy products as protective alternatives to sugary beverages 6