Tooth Decay and Sugar

Sugar is one of the main causes of tooth decay.

To prevent tooth decay, reduce the amount of food and drinks you have that contain free sugars – such as sweets, chocolates, cakes, biscuits, sugary breakfast cereals, jams, honey, fruit smoothies and dried fruit – and limit them to mealtimes.

The sugars found naturally in fruit and vegetables are less likely to cause tooth decay because they are contained within the structure.

But when fruit and vegetables are juiced or blended into a smoothie, the sugars are released. Once released, these sugars can damage teeth.

Limit the amount of fruit juice and smoothies you drink to a maximum of 150ml (a small glass) in total per day, and drink it with meals to reduce the risk of tooth decay.

Squashes sweetened with sugar, fizzy drinks, soft drinks and juice drinks have no place in a child’s daily diet.

If you’re looking after children, swap any sugary drinks for water, lower-fat milk or sugar-free drinks.

Dried fruit and your teeth

It’s better for your teeth to eat dried fruit as part of a meal, such as added to your breakfast cereal, tagines and stews, or as part of a healthy dessert – a baked apple with raisins, for example – and not as a between-meal snack.

Tooth decay

Tooth decay is damage to a tooth caused by dental plaque turning sugars into acid.

If plaque is allowed to build up, it can lead to problems, such as holes in the teeth (dental caries) and gum disease.

Dental abscesses, which are collections of pus at the end of the teeth or in the gums, may develop.

Symptoms of tooth decay

Tooth decay may not cause any pain.

But if you have dental caries, you might have:

• toothache– either continuous pain keeping you awake, or occasional sharp pain without an obvious cause; it can sometimes be painless
• tooth sensitivity – you may feel tenderness or pain when eating or drinking something hot, cold or sweet
• grey, brown or black spots appearing on your teeth
• bad breath
• an unpleasant taste in your mouth

Early-stage tooth decay

Early-stage tooth decay, which is before a hole (or cavity) has formed in the tooth, can be reversed by:

• reducing how much and how frequently you have sugary foods and drinks
• brushing your teeth at least twice a day with fluoride toothpaste

Your dentist may apply a fluoride gel or fluoride paste to the affected tooth.

Fluoride helps to protect teeth by strengthening the enamel, making teeth more resistant to the acids from plaque that can cause tooth decay

Sugars and tooth decay

What is tooth decay?

Tooth decay, or ‘dental caries’, occur when acid from within the mouth attacks the enamel and dentine of the teeth causing holes or cavities to form. The acid is produced by bacteria that are found within the plaque – a sticky and thin film that repeatedly forms over the teeth. When sugar is consumed it interacts with the bacteria within the plaque to produce acid. This acid is responsible for tooth decay because it slowly dissolves the enamel creating holes or cavities in the teeth. Tooth decay can lead to tooth abscesses, which may result in the tooth having to be removed.

Despite the decreasing levels of tooth decay over the past decades, it still remains one of the most common problems in the UK, second only to the common cold. It is estimated that 1 in 3 adults suffers from dental caries and close to 1 in 4 children equally suffer from some form of tooth decay.

Sugar and tooth decay:

Sugars in food and drinks play a major role in the development of dental caries. Bacteria within the plaque use the sugar as energy and release acid as a waste product, which gradually dissolves the enamel in the teeth.

In 2010, the World Health Organisation (WHO) commissioned a systematic literature review to answer a series of questions relating to the effects of sugars on dental caries. The systematic review showed consistent evidence of moderate quality supporting a relationship between the amount of sugars consumed and dental caries development. There was also evidence of moderate quality to show that dental caries is lower when free sugars intake is less than 10% of energy intake. Dental caries progresses with age, and the effects of sugars on the dentition are lifelong. Even low levels of caries in childhood are of significance to levels of caries throughout the life-course. Analysis of the data suggests that there may be a benefit in limiting sugars to less than 5% of energy intake to minimise the risk of dental caries throughout the life course.

Furthermore, the Scientific Advisory Committee on Nutrition (SACN) in the UK recently published a draft report in 2014 indicating a clear link between the consumption of sugar-containing foods and sugars-containing beverages and the incidence of dental caries both in deciduous and permanent teeth. SACN reviewed 11 cohort studies that identified a relationship between consumption of sugars-containing foods and the incidence of dental caries in deciduous dentition in children. They also reviewed seven cohort studies that presented evidence on the relationship between dental decay in children and sugar-sweetened beverages. A greater frequency of consumption was also found to be associated with a higher incidence of dental caries.
Free sugars are now found in almost all food and are the most important factor in the deterioration of oral health. It is especially problematic in children who have become accustomed to sugar at an early age. Tooth decay is the leading cause for hospitalisation among 5-9 year olds in the UK, with 26,000 children being hospitalised each year due to tooth decay – in other words, 500 each week.

Who is at risk of tooth decay?

Everyone is at risk of tooth decay, but children and adolescents are most at risk. Dental caries are the most common cause of tooth loss in young people. Plaque begins to build up on teeth only 20 minutes after we begin eating and if it is not removed effectively, tooth decay starts. People who regularly consume sugar have a higher risk of developing dental caries, particularly if the food they eat is sticky or consumed in between mealtimes. Sugars-containing snacks and sugar-sweetened beverages have particularly bad effects on teeth. People who smoke and consume alcohol are also more at risk. The prevalence of dental caries is also associated with social factors – where adults from lower-income households are more likely to suffer from dental caries than those from higher-income households (37% compared with 26%).

Dietary Advice:

We currently consume far too much sugar in our diets. The report published by the WHO and by the SACN highlights the need for a reduction in sugars intake to 5% of our energy intake. This is the equivalent of 7 teaspoons/cubes or 30g of sugar per day for an adult. The recommendation for children is 24g for children aged 5-11 and 19g for children aged 4-6. This 5% limit is far below the current intake which is 11.9% in children aged 1.5 to 3; 14.7% in children aged 4 to 10; and 15.6% in children 11 to 18. It is also thought that adherence to the 5% recommended sugar intake would halt the increase in obesity.

Other ways to reduce dental caries include:

• Brushing teeth thoroughly twice a day with fluoride-containing toothpaste as well as
  flossing daily.
• Reducing the amount of sugars-containing sticky food, and rinsing the mouth with water if they are consumed.
• Reduce snacking; which helps reduce the production of acid in the mouth.
• Reduce the consumption of sugar-sweetened beverages.
• Only eat sugary foods at mealtimes.

NB. Whole fruit is not harmful to your teeth.