Article information
Year 2019 Volume 69 Issue 2 Page 110-125
Title:
Free Sugars: The Cause of Dental Caries
Keyword(s):
sugars, prevention and control, dental caries, non-communicable chronic diseases, health promotion
Abstract:
Dental caries is the most important oral disease, the main cause of oral impacts on quality of life. Treating
new and recurrent caries throughout life requires huge amount of dental resources. Caries is preventable. Free
sugars or non-milk extrinsic sugars (NMES) are the main cause of caries. Free sugars are all mono/disaccharides in
processed grain, vegetables and fruits, including honey, natural syrup and fruit juice; with an exception of sugars
naturally present in milk. Free sugars are mostly presented as added or table sugars. Toothbrushing is inadequate for caries prevention because caries generally occurs in small grooves and concave areas on proximal surfaces
which are not reachable by toothbrush and dental floss. Fluoride can help reducing caries, however, with a limitation.
Reducing sugars consumption is therefore, the key to caries prevention. Studies on sugars and caries have been
conducted for nearly 80 years which provides the established evidence on sugars as the cause of caries. Sugars
lead to the change of oral environment which increase the proportion of cariogenic microorganism in dental plaque.
Sugars are also the cause of non-communicable chronic diseases (NCD) such as obesity, diabetes and hypertension.
World Health Organization published guideline on sugar consumption for preventing caries and NCDs. The relationship
between sugars and caries is linear. Caries increases by the increase of sugars consumption, without safe zone.
Moreover, caries increases continuously by age. Thus, to reduce caries for the whole lifespan, sugar consumption
should be as low as possible, particularly in children. A maximum of sugar consumed is 25 gram per day. Controlling
the amount of sugars consumed is necessary for general health, however, limiting the frequency of consumption
is more practical and directly relevant to caries control. Sugar-added snacks and drinks should be consumed during
mealtimes. Consumption between meals should be limited to once a day. Sweetness or sugar concentration should
also be reduced, particularly in drinks which are the main source of sugar overly consumed. Drinks should be no
sugar-added or not more than 6 % sugar content. Water and plain milk are the best choices.