Carbonated soft drinks and dental caries in the primary dentition

Carbonated beverages and gastrointestinal system: between myth and reality

A wealth of information has appeared on non-scientific publications, some suggesting a positive effect of carbonated beverages on gastrointestinal diseases or health, and others a negative one. The evaluation of the properties of carbonated beverages mainly involves the carbon dioxide with which they are charged. Scientific evidence suggests that the main interactions between carbon dioxide and the gastrointestinal system occur in the oral cavity, the esophagus and the stomach. The impact of carbonation determines modification in terms of the mouthfeel of beverages and has a minor role in tooth erosion. Some surveys showed a weak association between carbonated beverages and gastroesophageal reflux disease; however, the methodology employed was often inadequate and, on the overall, the evidence available on this topic is contradictory. Influence on stomach function appears related to both mechanical and chemical effects. Symptoms related to a gastric mechanical distress appear only when drinking more than 300 ml of a carbonated fluid. In conclusion there is now sufficient scientific evidence to understand the physiological impact of carbonated beverages on the gastrointestinal system, while providing a basis for further investigation on the related pathophysiological aspects. However, more studies are needed, particularly intervention trials, to support any claim on the possible beneficial effects of carbonated beverages on the gastrointestinal system, and clarify how they affect digestion. More epidemiological and mechanistic studies are also needed to evaluate the possible drawbacks of their consumption in terms of risk of tooth erosion and gastric distress.

Healthy eating index is a predictor of early childhood caries

Early childhood caries (ECC) is a preventable form of dental caries that affects very young children, particularly among low-income families and certain racial/ethnic minorities. The current study examined the relationship of dietary quality, as measured by the Healthy Eating Index (HEI), to the prevalence of ECC in 2- to 5-year-old children. Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used for the study. We used logistic regression to compute adjusted odds ratios (OR) for ECC and 95% confidence intervals (CI). Children with the best dietary practices (uppermost tertile of the HEI) were 44% less likely to exhibit severe ECC compared with children with the worst dietary practices (lowest tertile of the HEI). A healthy eating pattern geared for promotion of optimal child development and prevention of chronic disease in later life may also reduce the risk of early childhood caries, particularly severe early childhood caries.

A longitudinal study of dental caries risk among very young low SES children

OBJECTIVES

Early childhood caries (ECC) is a challenging public health problem in the United States and elsewhere; however, there is limited information concerning risk factors in very young children. The purpose of this study was to assess baseline risk factors for 18-month caries prevalence as part of a longitudinal study of high-risk children.

METHODS

About 212 children, 6-24 months of age were recruited from a rural community in Iowa. Subjects were enrolled in the WIC program, which provides nutritional support for low-income families with children. Dental examinations using d1, d2-3 criteria were conducted at baseline and after 18 months. Caries prevalence was determined at the frank decay level (d2-3 or filled surfaces), as well as at the noncavitated level (d1), and combined (d1, d2-3 or f surfaces). Risk factor data were collected at baseline and after 9- and 18- months. These data included beverage consumption data, presence of visible plaque, and use of fluoride toothpaste for children as well as mutans streptococci (MS) levels of mothers and children and family sociodemographic factors.

RESULTS

About 128 children (60%) remained in the study after 18 months. Among these children, prevalence of d1,d2-3/f level caries increased from 9% to 77%, while d2-3/f level caries increased from 2% to 20%. Logistic regression models for baseline predictors of d2-3f caries at the 18-month follow-up found the presence of MS in children (OR=4.4; 95% CI: 1.4, 13.9) and sugar-sweetened beverages (OR=3.0; 95% CI: 1.1, 8.6) to be the only significant risk factors. Sociodemographic factors and the use of fluoride toothpaste were not significant in these models.

CONCLUSIONS

Results suggest that early colonization by MS and consumption of sugar-sweetened beverages are significant predictors of ECC in high-risk populations.

When adults with diabetes attempt to drink less soda: resulting adult-child interactions and household changes

OBJECTIVE

To examine adult-child interactions related to soda consumption in families where 1 inner-city African-American or Latino adult with diabetes is attempting lifestyle changes.

METHODS

The study used semistructured individual interviews of adults and a child (age 10-17) in their home. Interviews were audiotaped, transcribed, coded and analyzed for themes.

RESULTS

We completed 28 interviews (14 adult-child pairs). Most adults in this group reduced or stopped drinking nondiet soda. Some parents included their children in that change by removing nondiet soda from the household and by delivering messages regarding soda to their children. Some children obtained soda outside the home. Sweetened fruit drinks remained in some households even after nondiet soda was removed. Nonetheless, many children reported adjusting to the lack of soda in the household and a lower intake of nondiet soda and sweetened fruit drinks, in contrast to continued high consumption of sweets and fried food.

CONCLUSIONS

These in-depth family interviews suggest that interventions intended to change adult consumption of sugar-sweetened beverages may also benefit their children, and this hypothesis merits further investigation in larger studies. A new diabetes diagnosis may motivate adults toward dietary change and provide opportunities to improve overall family health. Healthcare providers should emphasize decreasing availability of soda for everyone in the home.

Cariogenicity of soft drinks, milk and fruit juice in low-income african-american children: a longitudinal study

BACKGROUND

The authors conducted a study to test the hypothesis that high consumption of soft drinks, relative to milk and 100 percent fruit juice, is a risk factor for dental caries in low-income African-American children in Detroit.

METHODS

Trained dentists and interviewers examined a representative sample of 369 children, aged 3 to 5 years, in 2002-2003 and again two years later. The authors used the 2000 Block Kids Food Frequency Questionnaire (NutritionQuest, Berkeley, Calif.) to collect dietary information. They assessed caries by using the International Caries Detection and Assessment System.

RESULTS

Soft drinks, 100 percent fruit juice and milk represented the sugared beverages consumed by the cohort. A cluster analysis of the relative proportion of each drink at baseline and follow-up revealed four consumption patterns. Using zero-inflated negative binomial models, the authors found that children who changed from being low consumers of soft drinks at baseline to high consumers after two years had a 1.75 times higher mean number of new decayed, missing and filled tooth surfaces compared with low consumers of soft drinks at both time points.

CONCLUSION

Children who consumed more soft drinks, relative to milk and 100 percent fruit juice, as they grew older were at a greater risk of developing dental caries.

CLINICAL IMPLICATIONS

Health promotion programs and health care providers should emphasize to patients and caregivers the caries risk associated with consumption of soft drinks.

Resilience to urban poverty: theoretical and empirical considerations for population health

OBJECTIVES

To better understand the trajectory that propels people from poverty to poor health, we investigated health resilience longitudinally among African American families with incomes below 250% of the federal poverty level.

METHODS

Health resilience is the capacity to maintain good health in the face of significant adversity. With higher levels of tooth retention as a marker of health resilience, we used a social-epidemiological framework to define capacity for health resilience through a chain of determinants starting in the built environment (housing quality) and community context (social support) to familial influences (religiosity) and individual mental health and health behavior.

RESULTS

Odds of retaining 20 or more teeth were 3 times as likely among adults with resilience versus more-vulnerable adults (odds ratio=3.1; 95% confidence interval [CI]=1.3, 7.4). Children of caregivers with resilience had a lower incident rate of noncavitated tooth decay at 18- to 24-month follow-up (incidence risk ratio=0.8; 95% CI=0.7, 0.9) compared with other children.

CONCLUSIONS

Health resilience to poverty was supported by protective factors in the built and social environments. When poverty itself cannot be eliminated, improving the quality of the built and social environments will foster resilience to its harmful health effects.

Association between dietary and beverage consumption patterns in the SUN (Seguimiento Universidad de Navarra) cohort study

OBJECTIVE

The objective of the present study was to determine the dietary patterns of a Mediterranean cohort and relate them to the observed patterns of beverage consumption.

DESIGN

Prospective cohort study. Dietary habits were assessed with a semi-quantitative FFQ validated in Spain. A principal components factor analysis was used to identify dietary patterns and to classify subjects according to their adherence to these patterns. The association between adherence to each dietary pattern and beverage consumption was assessed cross-sectionally. In a longitudinal analysis (2-year follow-up), the relationship between adherence to the baseline dietary patterns and the likelihood of changing alcohol consumption was ascertained.

SETTING

The SUN (Seguimiento Universidad de Navarra) study is conducted in Spain.

SUBJECTS

In total, 15 073 university graduates were included in the analyses.

RESULTS

Two major dietary patterns were identified. We labelled them as 'Western dietary pattern' (WDP) and 'Mediterranean dietary pattern' (MDP). Higher adherence to the WDP was associated with higher consumption of carbonated beverages and whole-fat milk (P for trend <0.001), while higher adherence to the MDP was associated with higher consumption of decaffeinated coffee, orange juice, other natural juices, diet carbonated drinks, low-fat milk and bottled water (P for trend <0.001). Participants with higher adherence to the WDP were less likely to decrease their alcohol consumption during follow-up (OR between extreme quintiles = 0.68; 95 % CI 0.56, 0.84). By contrast, participants with higher adherence to the MDP were less likely to increase their alcohol consumption (OR = 0.66, 95 % CI 0.46, 0.95).

CONCLUSION

In this cohort of university graduates, a healthier dietary pattern was associated with a healthier pattern of beverage consumption.

Position of the American Dietetic Association: Oral Health and Nutrition

It is the position of the American Dietetic Association that nutrition is an integral component of oral health. The American Dietetic Association supports the integration of oral health with nutrition services, education, and research. Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease. Oral health and nutrition have a synergistic bidirectional relationship. Oral infectious diseases, as well as acute, chronic, and terminal systemic diseases with oral manifestations, impact the functional ability to eat as well as diet and nutrition status. Likewise, nutrition and diet may affect the development and integrity of the oral cavity as well as the progression of oral diseases. As we advance in our discoveries of the links between oral and nutrition health, practitioners of both disciplines must learn to provide screening, baseline education, and referral to each other as part of comprehensive client/patient care. Dietetics practice requires registered dietitians to provide medical nutrition therapy that incorporates a person's total health needs, including oral health. Inclusion of both didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in both dental and dietetic education programs. Collaborative endeavors between dietetics and dentistry in research, education, and delineation of health provider practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.

Dental caries prevalence and risk factors among 12-year old schoolchildren from Baghdad, Iraq: a post-war survey

AIM

To examine the prevalence of dental caries in 12-year-old schoolchildren from Baghdad after the end of the United Nations' economic sanctions and to investigate related dental caries risk factors including gender, socio-demographic factors, oral hygiene and sugar intake.

DESIGN

A cross-sectional dental caries examination and questionnaire survey was conducted in 10 schools from west Baghdad.

METHODS

Dental examinations based on WHO criteria and questionnaire surveys were performed on 392 children. Water samples were collected and fluoride concentration assessed.

RESULTS

The mean DMFT and DF were 1.7 and 1.3. The rate of caries experience (DMFT > 0) was 62%. DMFT increased significantly with higher education of the mother, not being embarrassed to smile, missing school due to dental pain and between-meals mode of drinking. Increased sugar consumption was associated with being a boy, having mothers with low education, living in a low socio-economic area and brushing at least once-a-day. Positive oral hygiene practices were higher for girls. Western sweet snacks were preferred and sweet tea was frequently consumed. The fluoride content in drinking water was too low for caries prevention.

CONCLUSION

It is important to maintain the low prevalence of caries among children by increasing awareness and promoting oral health care strategies.

Comparison of the intakes of sugars by young children with and without dental caries experience

BACKGROUND

Relationships among sugars and dental caries in contemporary societies are unclear. The authors describe young children's intakes of nonmilk extrinsic (NME) and intrinsic/milk sugars and relate those intakes to dental caries.

METHODS

The authors conducted cross-sectional analyses of dietary data collected from the Iowa Fluoride Study using three-day diaries for subjects at ages 1, 2, 3, 4 and 5 years and for subjects aged 1 through 5 years according to dental caries experience at 4.5 to 6.9 years of age. They categorized foods and beverages as containing NME or intrinsic/milk sugars.

RESULTS

Subjects' total, NME, food NME and intrinsic/milk sugars intakes at ages studied did not differ between subjects with and without caries experience. Beverage NME sugars intakes at age 3 years predicted caries (P < .05) in logistic regression models adjusted for age at dental examination and for fluoride intake.

CONCLUSIONS

Dental caries is a complex, multifactorial disease process dependent on the presence of oral bacteria, a fermentable carbohydrate substrate and host enamel. A simple NME-intrinsic/milk sugars categorization appears insufficient to capture the complex dietary component of the caries process.

CLINICAL IMPLICATIONS

Cariogenicity is more likely a function of the food and/or beverage vehicle delivering the sugar and the nature of exposure-that is, frequency and length of eating events-than of the sugar's categorization.