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Diet, nutrition and the prevention of dental diseases

Published online by Cambridge University Press:  02 January 2007

Paula Moynihan  and
Poul Erik Petersen
Paula Moynihan*
Affiliation:
WHO Collaborating Centre for Nutrition and Oral Health, School of Dental Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
Poul Erik Petersen
Affiliation:
WHO Collaborating Centre for Community Oral Health Programmes and Research, University of Copenhagen, Copenhagen, Denmark
*
*Corresponding author: Email p.j.moynihan@ncl.ac.uk
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Abstract

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Oral health is related to diet in many ways, for example, nutritional influences on craniofacial development, oral cancer and oral infectious diseases. Dental diseases impact considerably on self-esteem and quality of life and are expensive to treat. The objective of this paper is to review the evidence for an association between nutrition, diet and dental diseases and to present dietary recommendations for their prevention. Nutrition affects the teeth during development and malnutrition may exacerbate periodontal and oral infectious diseases. However, the most significant effect of nutrition on teeth is the local action of diet in the mouth on the development of dental caries and enamel erosion. Dental erosion is increasing and is associated with dietary acids, a major source of which is soft drinks.

Despite improved trends in levels of dental caries in developed countries, dental caries remains prevalent and is increasing in some developing countries undergoing nutrition transition. There is convincing evidence, collectively from human intervention studies, epidemiological studies, animal studies and experimental studies, for an association between the amount and frequency of free sugars intake and dental caries. Although other fermentable carbohydrates may not be totally blameless, epidemiological studies show that consumption of starchy staple foods and fresh fruit are associated with low levels of dental caries. Fluoride reduces caries risk but has not eliminated dental caries and many countries do not have adequate exposure to fluoride.

It is important that countries with a low intake of free sugars do not increase intake, as the available evidence shows that when free sugars consumption is <15–20kg/yr (~6–10% energy intake), dental caries is low. For countries with high consumption levels it is recommended that national health authorities and decision-makers formulate country-specific and community-specific goals for reducing the amount of free sugars aiming towards the recommended maximum of no more than 10% of energy intake. In addition, the frequency of consumption of foods containing free sugars should be limited to a maximum of 4 times per day. It is the responsibility of national authorities to ensure implementation of feasible fluoride programmes for their country.

Keywords

Dental diseasesDietary sugarsFluorideRecommendations
Type
Research Article
Information
Public Health Nutrition , Volume 7 , Issue 1a , February 2004 , pp. 201 - 226
Copyright
Copyright © CAB International 2004

References

1Sheiham, A. Dietary effects on dental diseases. Public Health Nutrition 2001; 4: 569–91.CrossRefGoogle ScholarPubMed
2Wang, H-Y, Petersen, PE, Jin-You, B, Bo-Xue, Z. The second national survey of oral health status of children and adults in China. International Dental Journal 2002; 52: 283–90.Google Scholar
3Petersen, PE, Hoerup, N, Poomviset, N, Prommajan, J, Watanapa, A. Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand. International Dental Journal 2001; 51: 95–102.CrossRefGoogle Scholar
4Petersen, PE, Razanamihaja, N. Oral health status of children and adults in Madagascar. International Dental Journal 1996; 46: 41–7.Google ScholarPubMed
5Petersen, PE, Kaka, M. Oral health status of children and adults in the Republic of Niger. International Dental Journal 1999; 49: 159–64.CrossRefGoogle ScholarPubMed
6World Health Organization. Global Oral Health Data Bank. Geneva: World Health Organization, 2001.Google Scholar
7Chen, M, Andersen, RM, Barmes, DE, Leclercq, M-H, Lyttle, SC. Comparing Oral Health Systems. A Second International Collaborative Study. Geneva: World Health Organization, 1997.Google Scholar
8Kelly, M, Steele, J, Nuttall, N, Bradlock, G, Morris, J, Nunn, J, et al. Adult Dental Health Survey. Oral Health in the United Kingdom 1998. London: The Stationery Office, 2000.Google Scholar
9Minquan, D, Petersen, PE, Fan, MW, Tan, BJ, Zhuan, B. Oral health services in PR China as evaluated by dentist and patients. International Dental Journal 2000; 50: 175–83.Google Scholar
10Rajab, LD, Petersen, PE, Bakaeen, G, Hamdan, MA. Oral health behaviour of schoolchildren and parents in Jordan. International Journal of Paediatric Dentistry 2002; 12: 168–76.CrossRefGoogle ScholarPubMed
11Petersen, PE, Poulsen, VJ, Ramahaleo, JJ, Ratsifaritara, C. Dental caries and dental health behaviour situation among 6- and 12-year old urban schoolchildren in Madagascar. African Dental Journal 1991; 5: 1–7.Google Scholar
12Moynihan, PJ, Snow, S, Jepson, NJA, Butler, TJ. Intake of non-starch polysaccharide (dietary fibre) in edentulous and dentate persons: an observational study. British Dental Journal 1994; 177: 243–7.CrossRefGoogle ScholarPubMed
13Steele, JG, Sheiham, A, Marcenes, W, Walls, AWG. National Diet and Nutrition Survey: People Aged 65 Years and Over. Volume 2: Report of the Oral Health Survey. London1: The Stationery Office, 1998.Google Scholar
14Joshipura, KJ, Willett, WE, Douglass, CW. The impact of edentulousness on food and nutrient intake. Journal of the American Dental Association 1966; 129: 1261–9.Google Scholar
15Moynihan, PJ, Butler, TJ, Jepson, NJA. Nutrient intake in partially dentate patients: the effect of prosthetic rehabilitation. Journal of Dentistry 2000; 28: 557–63.Google Scholar
16Navia, JM. Nutrition and dental caries: ten findings to be remembered. International Dental Journal 1996; 46(Suppl. 1): 381–7.Google Scholar
17Arens, U. Oral Health, Diet and Other Factors: Report of the British Nutrition foundation Task Force. Amsterdam: Elsevier, 1998.Google Scholar
18Arends, J, Bosch, JJ. In vivo De- and remineralization of dental enamel. Oxford: IRL Press, 1985.Google Scholar
19Distler, W, Bronner, H, Hickel, R, Petschelt, A. Die Saurefreisetzung beim Verzehr von zukerfreien fruchtbonbons in der mundhohle in vivo. Dtsch Zahnaerztliche Zeitschrift 1993; 48(492).Google Scholar
20Zero, D, Lussi, A. Etiology of Enamel Erosion–Intrinsic and Extrinsic Factors. London: Martin Dunitz Ltd, 2000.Google Scholar
21Meurman, J, tenCate, JM. Pathogenesis and modifying factors of dental erosion. European Journal of Oral Sciences 1996; 104: 199–206.CrossRefGoogle ScholarPubMed
22Enwonwu, CO. Interface of malnutrition and periodontal diseases. American Journal of Clinical Nutrition 1995; 61(Suppl.): 430S–6S.CrossRefGoogle ScholarPubMed
23Enwonwu, CO. Cellular and molecular effects of malnutrition and their relevance to periodontal disease. Journal of Clinical Periodontology 1994; 21: 643–57.CrossRefGoogle Scholar
24Enwonwu, CO, Meeks, VI. Oral candidiasis, HIV, and saliva glucocorticoids. American Journal of Pathology 1996; 148: 1313–8.Google Scholar
25Sidi, AD, Ashley, PF. Influence of frequent sugar intake on experimental gingivitis. Journal of Periodontology 1984; 55: 419–23.CrossRefGoogle ScholarPubMed
26Scheinin, A, Makinen, KK, Ylitalo, K. Turku sugar studies V. Final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man. Acta Odontologica Scandinavica 1976; 34: 179–98.Google Scholar
27Gaengler, P, W, WP, Sproessig, M, Mirgorod, M. The effects of carbohydrate reduced diet on development of gingivitis. Clinical Preventive Dentistry 1986; 8: 17–23.Google ScholarPubMed
28Enwonwu, CO, Phillips, RS, Falkler, WA. Nutrition and oral infectious diseases: state of the science. Compendium of Continuing Education in Dentistry 2002; 23: 431–6.Google ScholarPubMed
29WHO/FDI. Global goals for oral health in the year 2000. International Dental Journal 1982; 23: 74–7.Google Scholar
30Fejerskov, O, Baelum, V. Changes in Prevalence and Incidence of the Major Oral Diseases. Zurich: Karger, 1998.Google Scholar
31Holm, A-K. Caries in the pre-school child: international trends. Journal of Dentistry 1990; 18: 291–5.CrossRefGoogle ScholarPubMed
32Pitts, N, Evans, DJ. The total dental caries experience of 5-year-old children in the United Kingdom. Community Dental Health 1997; 14: 47–52.Google Scholar
33Frencken, JE, Kalsbeck, H, Verrips, GH. Has the decline in dental caries been halted. International Dental Journal 1990; 40: 225–30.Google ScholarPubMed
34Poulsen, S. Dental caries in Danish children and adolescents 1988–1994. Community Dentistry and Oral Epidemiology 1996; 24: 282–5.CrossRefGoogle Scholar
35Marthaler, T, D O'Mullane, D, Vrbic, V. The prevalence of dental caries in Europe 1990–1995. Caries Research 1996; 30: 237–55.CrossRefGoogle ScholarPubMed
36Leous, P, Petersen, PE. Oral Health Status and Oral Health Behaviour of Children in Belarus. Copenhagen: World Health Organization Regional Office for Europe, 2000.Google Scholar
37Szoke, J, Petersen, PE. Evidence of dental caries decline among children in an East European country (Hungary). Community Dentistry and Oral Epidemiology 2000; 28: 155–60.CrossRefGoogle Scholar
38Petersen, PE, Rusu, M. Oral Health Status of Children in Romania, 2000. Copenhagen: World Health Organization Regional Office for Europe, 2001.Google Scholar
39Kuzmina, EM. Oral health status of children and adults in the Russian Federation. Moscow: Ministry of Health and WHO Collaborating Centre for Preventive Oral Care, 1999.Google Scholar
40Fejerskov, O, Baelum, V, Ostergaard, ES. Root caries in Scandinavia in the 1980s and future trends to be expected in dental caries in adults. Advances in Dental Research 1993; 7: 4–14.CrossRefGoogle Scholar
41Holst, D, Schuller, AA. Oral health changes in a adult Norwegian population—a cohort analytical study. Community Dentistry and Oral Epidemiology 2000; 28: 102–11.CrossRefGoogle Scholar
42O'Mullane, D, Whelton, H. Oral Health of Irish Adults 1989–1990. Dublin: Stationery Office, 1992 vol 1989.Google Scholar
43O'Mullane, D. Oral Health Systems in European Union Countries—Biomed Project. Cork: University College Cork, Ireland, 1996.Google Scholar
44Services USDoHaH. Oral Health in America: A report of the Surgeon General. Rockville, MD: Department of Health and Human Services, National Institute of Dental and Cranio-Facial Research, National Institute of Health, 2002.Google Scholar
45Petersen, PE. Oral health behaviour of 6-year old Danish children. Acta Odontologica Scandinavica 1992; 50: 57–64.CrossRefGoogle Scholar
46Jarvinen, VK, Rytomaa, I, Heinonen, OP. Risk factors in dental erosion. Journal of Dental Research 1991; 70: 942–7.Google Scholar
47Millward, A, Shaw, L, Smith, AJ, Rippin, JW, Harrington, E. The distribution and severity of tooth wear and the relationship between erosion and dietary constituents in a group of children. International Journal of Paediatric Dentistry 1994; 4: 152–7.CrossRefGoogle Scholar
48Shaw, L, Smith, AJ. Dental erosion–the problem and some practical solutions. British Dental Journal 1999; 186: 115–8.Google ScholarPubMed
49ten Cate, JM, Imfeld, T. Dental erosion, summary. European Journal of Oral Sciences 1996; 104: 241–4.Google Scholar
50Hinds, K, Gregory, J. National Diet and Nutrition Survey: Children Aged 1.5–4.5 Years. Volume 2: Report of the Dental Survey. London: HM Stationery Office, 1995.Google Scholar
51O'Brien, M. Children's Dental Health in the United Kingdom. London: H M Stationery Office, 1994.Google Scholar
52Walker, A, Gregory, J, Bradnock, G, Nunn, J, White, D. National Diet and Nutrition Survey: young people aged 4 to 18 Years. Volume 2: Report of the Oral Health Survey. London: The Stationery Office, 2000.Google Scholar
53Sreebny, LM. Sugar availability, sugar consumption and dental caries. Community Dentistry and Oral Epidemiology 1982; 10: 1–7.CrossRefGoogle ScholarPubMed
54Marthaler, T. Changes in the prevalence of dental caries: how much can be attributed to changes in diet? Caries Research 1990; 24: 3–15.CrossRefGoogle ScholarPubMed
55Woodward, M, Walker, ARP. Sugar and dental caries: The evidence from 90 countries. British Dental Journal 1994; 176: 297–302.CrossRefGoogle ScholarPubMed
56Nadanovsky, P. Letter. British Dental Journal 1994; 177(8): 280.Google Scholar
57Ruxton, CHS, Garceau, FJS, Cottrell, RC. Guidelines for sugar consumption in Europe. Is a qualitative approach justified? European Journal of Clinical Nutrition 1999; 53: 503–13.CrossRefGoogle Scholar
58Sognnaes, RF. Analysis of wartime reduction of dental caries in European children. American Journal of Diseases of Childhood 1948; 75: 792–821.Google Scholar
59Takeuchi, M. Epidemiological study on Japanese children before, during and after World War II. International Dental Journal 1961; 11: 443–57.Google Scholar
60Marthaler, TM. Epidemiological and clinical dental findings in relation to intake of carbohydrates. Caries Research 1967; 1: 222–38.CrossRefGoogle ScholarPubMed
61Weaver, R. Fluorine and war-time diet. British Dental Journal 1950; 88: 231–9.Google Scholar
62Miyazaki, H, Morimoto, M. Changes in caries prevalence in Japan. European Journal of Oral Sciences 1996; 104: 452–8.CrossRefGoogle ScholarPubMed
63Bang, G, Kristoffersen, T. Dental caries and diet in an Alaskan Eskimo population. Scandinavian Journal of Dental Research 1972; 80: 440–4.Google Scholar
64Emslie, DR. A dental health survey in the Republic of Sudan. British Dental Journal 1966; 120: 167–78.Google Scholar
65Olsson, B. Dental health situation in privileged children in Addis Ababa Ethiopia. Community Dentistry and Oral Epidemiology 1979; 7: 37–41.Google Scholar
66MacGregor, AB. Increasing caries incidence and changing diet in Ghana. International Dental Journal 1963; 13: 516–22.Google Scholar
67Sheiham, A. The prevalence of dental caries in Nigerian populations. British Dental Journal 1967; 123: 144–8.Google Scholar
68Fisher, FJ. A field study of dental caries, periodontal disease and enamel defects in Tristan da Cunha. British Dental Journal 1968; 125: 447–53.Google Scholar
69Roberts, IF, Roberts, GJ. Relation between medicines sweetened with sucrose and dental disease. British Medical Journal 1979; 2: 14–16.Google Scholar
70Anaise, JZ. Prevalence of dental caries among workers in the sweets industry in Israel. Community Dentistry and Oral Epidemiology 1978; 8: 142–5.CrossRefGoogle Scholar
71Katayama, T, Nagagawa, N, Honda, O, Tani, H, Okado, S, Suzuki, S. Incidence and distribution of Strep mutans in plaque from confectionery workers. Journal of Dental Research 1979; 58(Special issue): 2251.Google Scholar
72Petersen, PE. Dental health among workers at a Danish chocolate factory. Community Dentistry and Oral Epidemiology 1983; 11: 337–41.CrossRefGoogle Scholar
73Masalin, K, Murtamaa, H, Meurman, JH. Oral health of workers in the modern Finnish confectionery industry. Community Dentistry and Oral Epidemiology 1990; 18: 126–30.CrossRefGoogle ScholarPubMed
74Bradford, EW, Crabb, HSM. Carbohydrates and the incidence of caries in the deciduous dentition. London: Pergamon Press, 1963.Google Scholar
75Harris, R. Biology of the children of Hopewood House, Bowral, Australia, 4. Observations on dental caries experience extending over 5 years (1957–61). Journal of Dental Research 1963; 42: 1387–99.Google Scholar
76Silverstein, SJ, Knapp, JF, Kircos, L, Edwards, H. Dental caries prevalence in children with a diet free of refined sugar. American Journal of Public Health 1983; 73: 1196–9.Google Scholar
77Newbrun, E, Hoover, C, Mettraux, G, Graf, H. Comparison of dietary habits and dental health of subjects with hereditary fructose intolerance and control subjects. Journal of the American Dental Association 1980; 101: 619–26.CrossRefGoogle ScholarPubMed
78Gustafsson, BE, Quensel, CE, Lanke, LS, Lundquiat, C, Grahnen, H, Bonow, BE, et al. The Vipeholm dental caries study. The effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for 5 years. Acta Odontologica Scandinavica 1954; 11: 232–364.CrossRefGoogle Scholar
79Rugg-Gunn, AJ. Nutrition and Dental Health. Oxford: Oxford Medical Publications, 1993.Google Scholar
80Granath, L-E, Rootzen, H, Liljegren, E, Holst, K, Kohler, L. Variation in caries prevalence related to combinations of dietary and oral hygiene habits and chewing fluoride tablets in 4-year old children. Caries Research 1978; 12: 83–92.CrossRefGoogle Scholar
81Hausen, H, Heinomen, OP, Paunio, I. Modification of occurrence of caries by children by toothbrushing and sugar exposure in fluoridated and non-fluoridated area. Community Dentistry and Oral Epidemiology 1981; 9: 103–7.Google Scholar
82Kleemola-Kujala, E, Rasanen, L. Relationship of oral hygiene and sugar consumption to risk of caries in children. Community Dentistry and Oral Epidemiology 1982; 10: 224–33.CrossRefGoogle ScholarPubMed
83Schroder, U, Granath, L. Predictive value of dietary habits and oral hygiene for the occurrence of caries in 3-year-olds. Community Dentistry and Oral Epidemiology 1983; 11: 308–11.CrossRefGoogle Scholar
84Stecksen-Blicks, C, Arvidsson, S, Holm, A-K. Dental health, dental care and dietary habits in children in different parts of Sweden. Acta Odontologica Scandinavica 1985; 43: 59–67.CrossRefGoogle ScholarPubMed
85Garn, SM, Cole, PE, Solomon, MA, Schaefer, AE. Relationships between sugar-foods and DMFT in 1968–1970. Ecology of Food and Nutrition 1980; 9: 135–8.CrossRefGoogle Scholar
86Marques, APF, Messer, LB. Nutrient intake and dental caries in the primary dentition. Pediatric Dentistry 1992; 14: 314–21.Google ScholarPubMed
87Persson, L-A, Holm, A-K, Arvidsson, S, Samuelson, G. Infant feeding and dental caries, a longitudinal study of Swedish children. Swedish Dental Journal 1985; 9: 201–6.Google ScholarPubMed
88Stecksen-Blicks, C, Holm, A-K. Dental caries, tooth trauna, malocclusion, fluoride usage, toothbrushing and dietary habits in 4-year-old Swedish children: changes between 1967 and 1992. International Journal of Paediatric Dentistry 1995; 5: 143–8.Google Scholar
89Al-Tamimi, S, Petersen, PE. Oral health situation of schoolchildren, mothers and schoolteachers in Saudi Arabia. International Dental Journal 1998; 48: 180–6.Google Scholar
90Peng, B, Petersen, PE, Fan, MW, Tai, BJ. Oral health status and oral health behaviour of 12-year-old urban schoolchildren in PR China. Community Dental Health 1997; 14: 238–44.Google Scholar
91Sundin, B, Granath, L, Birkhed, D. Variation of posterior approximal caries incidence with consumption of sweets with regard to other caries-related factors in 15–18-year-olds. Community Dentistry and Oral Epidemiology 1992; 20: 76–80.Google Scholar
92Lachapelle-Harvey, D, Sevigny, J. Multiple regression analysis of dental status and related food behaviour of French Canadian adolescents. Community Dentistry and Oral Epidemiology 1985; 13: 226–9.Google Scholar
93Grindefjord, M, Dahllof, G, Nilsson, B, Modeer, T. Stepwise prediction of dental caries in children up to 3.5 years of age. Caries Research 1996; 30: 256–66.Google Scholar
94Stecksen-Blicks, C, Gustafsson, L. Impact of oral hygiene and use of fluorides on caries increment in children during one year. Community Dentistry and Oral Epidemiology 1996; 14: 185–9.CrossRefGoogle Scholar
95Rugg-Gunn, AJ, Hackett, AF, Appleton, DR, Jenkins, GN, Eastoe, JE. Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent schoolchildren. Archives of Oral Biology 1984; 29: 983–92.CrossRefGoogle Scholar
96Burt, BA, Eklund, SA, Morgan, KJ, Larkin, FE, Guire, KE, Brown, LO, et al. The effects of sugars intake and frequency of ingestion on dental caries increment in a 3-year longitudinal study. Journal of Dental Research 1988; 67: 1422–9.Google Scholar
97Burt, B, Szpunar, SM. The Michigan Study: relationship between sugars intake and dental caries over 3 years. International Dental Journal 1994; 44: 230–40.Google Scholar
98Rose, G. The Strategy of Preventive Medicine. Oxford: Oxford University Press, 1993.Google Scholar
99Konig, KP, Schmid, P, Schmid, R. An apparatus for frequency-controlled feeding of small rodents and its use in dental caries experiments. Archives of Oral Biology 1968; 13: 13–26.CrossRefGoogle ScholarPubMed
100Firestone, AR, Imfeld, T, Muhlemann, HR. Effect of the length and number of intervals between meals on caries in rats. Caries Research 1984; 18: 128–33.Google Scholar
101Karlsbeek, H, Verrips, GH. Consumption of sweet snacks and caries experience of primary school children. Caries Research 1994; 28: 477–83.CrossRefGoogle Scholar
102Holbrook, WP, Arnadottir, IB, Takazoe, I, Birkhed, D, Frostell, G. Longitudinal study of caries, cariogenic bacteria and diet in children just before and after starting school. European Journal of Oral Sciences 1995; 103: 42–5.CrossRefGoogle ScholarPubMed
103Holbrook, WP, Kristinsson, MJ, Gunnarsdottir, S, Briem, B. Caries prevalence, Streptococcus mutans and sugar intake among 4-year-old urban children in Iceland. Community Dentistry and Oral Epidemiology 1989; 17: 292–5.Google Scholar
104Holt, RD, Joels, D, Winter, GB. Caries in preschool children; the Camden study. British Dental Journal 1982; 153: 107–9.Google Scholar
105Hankin, JH, Chung, CS, Kau, MCw. Genetic and epidemiological studies of oral characteristics in Hawaii's school children: dietary patterns and caries prevalence. Journal of Dental Research 1973; 52: 1079–86.Google Scholar
106Bjarnason, S, Finnbogason, SY, Noren, JG. Sugar consumption and caries experience in 12- and 13-year-old Icelandic children. Acta Odontologica Scandinavica 1989; 47: 315–21.CrossRefGoogle ScholarPubMed
107Bagramian, RA, Russell, AL. Epidemiological study of dental caries experience and between-meal patterns. Journal of Dental Research 1973; 52: 342–7.Google Scholar
108Bergendal, B, Hamp, SE. Dietary pattern and dental caries in 19-year-old adolescents subjected to preventive measures focused on oral hygiene and/or fluorides. Swedish Dental Journal 1985; 9: 1–7.Google ScholarPubMed
109Larsson, B, Johansson, I, Ericson, T. Prevalence of caries in adolescents in relation to diet. Community Dentistry and Oral Epidemiology 1992; 20: 133–7.CrossRefGoogle ScholarPubMed
110Mikx, FHM, Hoevel, JSvd, Plasschaert, AJM, Konig, KG. Effect of Actinomyces viscosus on the establishment and symbiosis of Streptococcus mutans and Streptococcus sanguis on SPF rats on different sucrose diets. Caries Research 1975; 9: 1–20.Google Scholar
111Guggenheim, B, Konig, KG, Herzog, E, Muhlemann, HR. The cariogenicity of different dietary carbohydrates tested on rats in relative gnotobiosis with a streptococcus producing extracellular polysaccharide. Helvetica Odontologica Acta 1966; 10: 101–13.Google Scholar
112Hefti, A, Schmid, R. Effect on caries incidence in rats of increasing dietary sucrose levels. Caries Research 1979; 13: 298–300.Google Scholar
113Szpunar, SM, Eklund, SA, Burt, BA. Sugar consumption and caries risk in schoolchildren with low caries experience. Community Dentistry and Oral Epidemiology 1995; 23: 142–6.Google Scholar
114Jamel, HA, Sheiham, A, Watt, RG, Cowell, CR. Sweet preference, consumption of sweet tea and dental caries: studies in urban and rural Iraqi populations. International Dental Journal 1996; 47: 213–7.Google Scholar
115Cleaton-Jones, P, Richardson, BD, Winter, GB, Sinwell, R, Rantsho, HM, Jodaikin, A. Dental caries and sucrose intake in five South African pre-school groups. Community Dentistry and Oral Epidemiology 1984; 12: 381–5.Google Scholar
116Rodriguez, CS, Watt, RG, Sheiham, A. The effects of dietary guidelines on sugar intake and dental caries in 3-year-olds attending nurseries. Health Promotion International 1999; 14: 329–35.CrossRefGoogle Scholar
117Ismail, AI, Burt, BA, Eklund, SA. The cariogenicity of soft drinks in the United States. Journal of the American Dental Association 1984; 109: 241–5.Google Scholar
118Jenkins, GN, Ferguson, DB. Milk and dental caries. British Dental Journal 1966; 120: 472–7.Google Scholar
119Frostell, G, Birkhed, D, Edwardsson, S, Goldberg, P, Petersson, L-P, Priwe, C, et al. Effect of partial substitution of invert sugar from sucrose in combination with duraphat treatment on caries development in pre-school children: the Malmo Study. Caries Research 1991; 25: 304–10.Google Scholar
120Murray, JJ. Appropriate Use of Fluorides for Human Health. Geneva: World Health Organization, 1986.Google Scholar
121Beighton, D, Adamson, A, Rugg-Gunn, A. Associations between dietary intake, dental caries experience and salivary bacterial levels in 12-year-old English schoolchildren. Archives of Oral Biology 1996; 41: 271–80.Google Scholar
122Holt, RD. Foods and drinks at four daily time intervals in a group of young children. British Dental Journal 1991; 170: 137–43.Google Scholar
123Kunzel, W, Fischer, T. Rise and fall of caries prevalence in German towns with different F concentrations in drinking water. Caries Research 1997; 31: 166–73.Google Scholar
124Burt, B, Pai, S. Sugar consumption and caries risk: a systematic review. Journal of Dental Education 2001; 65(10): 1017–23.Google Scholar
125Edgar, WM. Prediction of the cariogenicity of various foods. International Dental Journal 1985; 35: 190–4.Google Scholar
126Brudevold, F, Goulet, D, Terani, A, Attarzadeh, F, Houte, Jv. Intraoral demineralisation and maltose clearance from wheat starch. Caries Research 1985; 19: 136–44.Google Scholar
127Koulourides, T, Bodden, R, Keller, S, Manson-Hing, L, Lastra, J, Housch, T. Cariogenicity of nine sugars tested with an intraoral device in man. Caries Research 1976; 101: 427–41.CrossRefGoogle Scholar
128Grenby, TH. The effects of some carbohydrates on experimental dental caries in the rat. Archives of Oral Biology 1963; 8: 27–30.Google Scholar
129Grenby, TH. The effects of starch and sugar diets on dental caries. British Dental Journal 1970; 128: 575–8.Google Scholar
130Bowen, WH, Amsbaugh, SM, Monnell-Torens, S, Brunelle, S, Kuzmiak-Jones, J, Cole, MF. A method to assess cariogenic potential of foodstuffs. Journal of the American Dental Association 1980; 100: 677–81.CrossRefGoogle ScholarPubMed
131Firestone, AR, Schmid, R, Muhlemann, HR. Cariogenic effects of cooked wheat starch alone or with sucrose and frequency-controlled feeding in rats. Archives of Oral Biology 1982; 27: 759–63.CrossRefGoogle ScholarPubMed
132Mundorff, SA, Featherstone, JDB, Eisenberg, AD, Cowes, E, Curzon, MJE. Cariogenicpotential of foods. II. Relationship of food composition, plaque microbial counts and salivary parameters to caries in the rat model. Caries Research 1994; 28: 106–15.Google Scholar
133Toverud, G. The influence of war and post war condition on the teeth of Norwegian school children II and III. Milbank Memorial Fund Quarterly 1957; 35: 127–96.Google Scholar
134Russell, AL, Littleton, NW, Leatherwood, EC, Syndow, GE, Green, JC. Dental surveys in relation to nutrition. Public Health Reports 1960; 75: 717–23.Google Scholar
135Alfonsky, D. Some observations on dental caries in central China. Journal of Dental Research 1951; 30: 53–61.Google Scholar
136Sreebny, LM. Cereal availability and dental caries. Community Dentistry and Oral Epidemiology 1983; 11: 148–55.Google Scholar
137Magrill, DS. The reduction of the solubility of hydroxyapatite in acid by adsorption of phytate from solution. Archives of Oral Biology 1973; 18: 591–600.Google Scholar
138Nizel, AE, Harris, RS. The effects of phosphates on experimental dental caries: a literature review. British Dental Journal 1964; 43: 1123–36.Google Scholar
139Ludwig, TG, Bibby, BG. Acid production from different carbohydrate foods in plaque and saliva. Journal of Dental Research 1957; 36: 56–60.Google Scholar
140Hussein, I, Pollard, MA, Curzon, MEJ. A comparison of the effects of some extrinsic and intrinsic sugars on dental plaque pH. International Journal of Paediatric Dentistry 1996; 6: 81–6.CrossRefGoogle ScholarPubMed
141Imfeld, TN. Identification of low caries risk dietary components. Monographs in Oral Science 1983; 11: 1–198.Google Scholar
142Imfeld, TN, Schmid, R, Lutz, F, Guggenheim, B. Cariogenicity of Milchschmitte (Ferrero-GmbH) and apple in programme-fed rats. Caries Research 1991; 25: 352–8.Google Scholar
143Stephan, RM. Effects of different types of foods on dental health in experimental animals. Journal of Dental Research 1966; 45: 1551–61.CrossRefGoogle ScholarPubMed
144Savara, BS, Suher, T. Dental caries in children one to six years of ages as related to socio-economic level, food habits and toothbrushing. Journal of Dental Research 1955; 34: 870–5.Google Scholar
145Kleemola-Kujala, E, Rasanen, L. Dietary pattern of Finnish children with low and high caries experience. Community Dentistry and Oral Epidemiology 1979; 7: 199–205.Google Scholar
146Martinsson, T. Socio-economic investigation of school children with high and low caries frequency. Odontological Review 1972; 23: 93–114.Google Scholar
147Clancy, KL, Bibby, BG, Goldberg, HJV, Ripa, LW, Barenie, J. Snack food intake of adolescents and caries development. Journal of Dental Research 1977; 56: 568–73.Google Scholar
148Grobler, SR, Blignaut, JB. The effect of a high consumption of apples or grapes on dental caries and periodontal disease in humans. Clinical Preventive Dentistry 1989; 11: 8–12.Google Scholar
149Grenby, TH. The effect of glucose syrup on dental caries in the rat. Caries Research 1972; 6: 52.Google Scholar
150Moynihan, PJ, Gould, MEL, Huntley, N, Thorman, S. Effect of glucose polymers in water, milk and a milk substitute on plaque pH in vitro. International Journal of Paediatric Dentistry 1996; 6: 19–24.CrossRefGoogle Scholar
151Grenby, TH, Mistry, HM. Properties of maltodextrins and glucose syrups in experiments in vitro and in the diets of laboratory animals relating to dental health. British Journal of Nutrition 2000; 84: 565–74.CrossRefGoogle ScholarPubMed
152Roberts, PG, Hayes, ML. Effects of 20-deoxy- d -glucose and other sugar analogues on acid production from sugars by human dental plaque bacteria. Scandinavian Journal of Dental Research 1980; 88: 201–9.Google Scholar
153Ooshima, T, Fujiwarra, T, Taki, T, Izumintani, A, Sobue, S, Hamada, S. The caries inhibitory effects of GOS-sugar in vitro and in rat experiments. Microbiology and Immunology 1998; 32: 1093–105.Google Scholar
154Koga, T, Horikoshi, T, Fujiwarra, T, Hamada, S. Effects of pannose on glucan synthesis and cellular adherence by Streptococcus mutans. Microbiology and Immunology 1988; 32: 25–31.Google Scholar
155Hartmink, R, Quataert, MCJ, Leare, KMJV, Nout, MJR, Rombouts, FM. Degradation and fermentation of fructooligosaccharides by oral streptococci. Journal of Applied Bacteriology 1995; 79: 551–7.Google Scholar
156Moynihan, PJ, McIlmoyle, S, Rowshanaei, R, Moxon, R, Russell, RRB. Acidogenic potential of fructooligosaccharides: incubation studies and plaque pH studies. Caries Research 2001; 35: 275.Google Scholar
157Rugg-Gunn, AJ, Edgar, WM, Geddes, DAM, Jenkins, GN. The effect of different meal patterns upon plaque pH in human subjects. British Dental Journal 1975; 139: 351–6.Google Scholar
158Gedalia, I, Ben-Mosheh, S, Biton, J, Kogan, D. Dental caries protection with hard cheese consumption. American Journal of Dentistry 1994; 7: 331–2.Google Scholar
159Frostell, G. Effects of milk, fruit juices and sweetened beverages on the pH of dental plaques. Acta Odontologica Scandinavica 1970; 28: 609–22.Google Scholar
160Rugg-Gunn, AJ, Roberts, GJ, Wright, WG. The effect of human milk on plaque in situ and enamel dissolution in vitro compared with bovine milk, lactose and sucrose. Caries Research 1985; 19: 327–34.Google Scholar
161Reynolds, EC, Johnson, IH. Effect of milk on caries incidence and bacterial composition of dental plaque in the rat. Archives of Oral Biology 1981; 26: 445–51.CrossRefGoogle ScholarPubMed
162Bowen, WH, Pearson, SK, Wuyckhuyse, BC, Tabak, LA. Influence of milk, lactose-reduced milk, and lactose on caries in desalivated rats. Caries Research 1991; 25: 283–6.Google Scholar
163Silver, DH. A longitudinal study of infant feeding practice, diet and caries related to social class in children aged 3 and 8–10 years. British Dental Journal 1987; 163: 296–300.Google Scholar
164Craig, GC. The use of a calcium sucrose phosphates-calcium orthophosphate complex as a cariostatic agent. British Dental Journal 1975; 138: 25–8.CrossRefGoogle ScholarPubMed
165Linke, HAB, Salgado, T, Retino, M, Legeros, RZ. Effect of black tea on caries formation in hamsters. Journal of Dental Research 2000; 79: 594.Google Scholar
166Lingstrom, P, Wu, CD, Wefel, JS. In vivo effects of black tea infusion on dental plaque. Journal of Dental Research 2000; 79: 594.Google Scholar
167Gibney, M. Consumption of sugars. Workshop on the evaluation of the nutritional and health aspects of sugars. American Journal of Clinical Nutrition 1995; 62(Suppl.): 178S–94S.CrossRefGoogle Scholar
168Fletcher, E, Adamson, A, Rugg-Gunn, A. Twenty years of change in the dietary intake and BMI of Northumbrian adolescents. Proceedings of the Nutrition Society 2001; 80: 210A.Google Scholar
169Alexy, U, Sichert-Hellert, W, Kersting, M. Fifteen year time trends in energy and macronutrient intake in German children and adolescents: results of the DONALD study. British Journal of Nutrition 2002; 87: 595–604.Google Scholar
170Cole-Hamilton, I, Gunner, K, Loeverkus, C, Starr, J. A study among dietitians and adult members of their households of the practicalities and implications of following proposed dietary guidelines in the UK. Human Nutrition Applied Nutrition 1986; 40A: 365–89.Google Scholar
171Thomas, AK. Further observations on the influence of citrus fruit juices on human teeth. New York State Dental Journal 1957; 23: 424–30.Google Scholar
172Stabholz, A, Raisten, J, Markitziu, A. Tooth enamel dissolution from erosion or etching and subsequent caries development. Journal of Periodontology 1983; 7: 100–8.Google Scholar
173Linkosalo, E, Markkanen, H. Dental erosions in relation to lactovegetarian diet. Scandinavian Journal of Dental Research 1985; 93: 436–41.Google Scholar
174Millward, A, Shaw, L, Smith, AJ. Dental erosion in 4 year old children from differing socio-economic backgrounds. Journal of Dentistry for Children 1994; 61: 263–6.Google Scholar
175Gedalia, I, Dakuar, A, Shapiro, H, Leminstein, I, Goultschin, J, Rahamin, E. Enamel softening with coca-cola and rehardening with milk or saliva. American Dental Journal 1991; 4: 120–2.Google Scholar
176Gedalia, I, Lonat-Bendat, D, Ben-Moshek, S, Shapiro, H. Tooth enamel softening with a cola type drink and rehardening with hard cheese or stimulated saliva in situ. Journal of Oral Rehabilitation 1991; 18: 501–6.Google Scholar
177Holloway, PJ, Mellanby, M, Stewart, RJC. Fruit drinks and tooth erosion. British Dental Journal 1958; 104: 305–9.Google Scholar
178Miller, CD. Erosion of molar teeth by acid beverages. Journal of Nutrition 1950; 41: 63–71.Google Scholar
179Fuller, JL, Johnson, WW. Citric acid consumption and the human dentition. Journal of the American Dental Association 1977; 95: 80–8.Google Scholar
180High, AS. An unusual pattern of dental erosion. British Dental Journal 1977; 143: 403–4.CrossRefGoogle ScholarPubMed
181Guggenheimer, J, Schneider, LG. Tooth erosion associated with excessive use of an artificially sweetened cola beverage. Journal of Preventive Dentistry 1980; 6: 261–2.Google Scholar
182Smith, AJ, Shaw, L. Baby fruit juice and tooth erosion. British Dental Journal 1987; 162: 65–7.Google Scholar
183Giunta, JL. Dental erosion resulting from chewable vitamin C tablet. Journal of the American Dental Association 1983; 107: 253–6.Google Scholar
184Grenby, TH, Mistry, HM, Desai, T. Potential dental effects of infants' fruit drinks studied in vitro. British Journal of Nutrition 1990; 64: 273–83.Google Scholar
185Meurman, J, Rytomaan, I, Kari, K, Laakso, T, Murtomaa, H. Salivary pH and glucose after consuming various beverages including sugar-containing drinks. Caries Research 1987; 21: 353–9.Google Scholar
186Rugg-Gunn, AJ, Nunn, JH. Nutrition, Diet and Oral Health. Oxford: Oxford Medical Publications, 1999.Google Scholar
187Newbrun, E. Sucrose in the dynamics of the carious profess. International Dental Journal 1982; 32: 13–23.Google Scholar
188Sheiham, A. Sugars and dental caries. Lancet 1983; 1: 282–4.Google Scholar
189Sheiham, A. Why sugars consumption should be below 15kg per person per year in industrialised countries; the dental evidence. British Dental Journal 1991; 171: 63–5.Google Scholar
190WHO. Diet, Nutrition and the Prevention of Chronic Diseases Technical Report Series No 797. Geneva: World Health Organization, 1990.Google Scholar
191Freire, MDCM, Cannon, G, Sheiham, A. Sugar and Health in One Hundred and Fifteen Authoritative Scientific Reports on Food Nutrition and Public Health Published Throughout the World in Thirty Years Between 1961 and 1991. Department Monograph Series No 1. London: University College London, 1961.Google Scholar
192Bellini, H, Arneberg, P, Fehr, Fvd. Oral hygiene and caries. A review. Acta Odontologica Scandinavica 1981; 39: 257–65.Google Scholar
193Authority, HE. The Scientific Basis of Dental Health Education. A Policy Document. 4th Ed. London: Health Education Authority, 1996.Google Scholar
194Sutcliff, P. Oral cleanliness and dental caries. Oxford: Oxford University Press, 1996.Google Scholar
195Takahashi, K. Statistical study on caries incidence in the first molar in relation to the amount of sugar consumption. Bulletin of the Tokyo Dental College 1961; 2: 44–57.Google Scholar
196Takeuchi, M. On the epidemiological principles in dental caries attack. Bulletin of the Tokyo Dental College 1962; 3: 96–111.Google Scholar
197Knowles, EM. The effects of enemy occupation on the dental condition of children in the Channel Islands. Monthly Bulletin of the Ministry of Health 1946 (08): 161–72.Google Scholar
198Schulerud, A. Dental Caries and Nutrition During Wartime in Norway. Oslo: Fabritius and Sonners Trykkeri, 1950.Google Scholar
199Buttner, . Zuckeraufnahme und Karies [Sugar and Caries].Basel: Karger, 1971.Google Scholar