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# Sugar promotes dental caries, fluoride may not help much
- URL: https://www.foodconsumer.org/sugar_promote_dental_caries/
- Published: 2014-11-26T12:26:00.000Z
- Updated: 2026-09-22T16:10:33.000Z
- Description: A re-analysis of the dose-response between sugar and tooth decay suggests capping sugar at 3 percent of energy, about 17 grams a day, rather than the WHO's 10 percent. In fluoridated areas, nearly half the teeth of people over 65 were still affected by caries.
- Author: Food Consumer
- Tags: Food, Nutrition, #vivvo-import

*Editor's note: The study seems to suggest that sugar intake should be limited to less than 3% of energy, which means for an adult, no more than 17 grams per day may be used. The study finds that of people over 65 years who lived in areas where fluoridation was practiced and most of whom also used fluoride toothpaste, nearly half of teeth were affected by dental caries. This means that fluoridation may not be as effective as thought in preventing dental caries. To maximally reduce the risk of dental caries, sugar intake should be no more than 3% of total energy or 17 grams per day. It should be noted that the study per se could not prove that sugar actually causes dental caries although the possibility could not be excluded either.*

*According to a* [*report* ](http://www.forbes.com/sites/alicegwalton/2012/08/30/how-much-sugar-are-americans-eating-infographic/?ref=foodconsumer.org)*published on forbes.com, added sugar is linked to obesity, nervous tension, hypertension, aching limbs, high blood pressure, diabetes, hypoglycemia, acne, depression, skin irritation, headaches, stiffness of arteries, fatigue, and violent behavior.* 

# 

# Abstract

#### Background

There is a clear relation between sugars and caries. However, no analysis has yet been made of the lifetime burden of caries induced by sugar to see whether the WHO goal of 10% level is optimum and compatible with low levels of caries. The objective of this study was to re-examine the dose-response and quantitative relationship between sugar intake and the incidence of dental caries and to see whether the WHO goal for sugar intake of 10% of energy intake (E) is optimum for low levels of caries in children and adults.

#### Methods

Analyses focused on countries where sugar intakes changed because of wartime restrictions or as part of the nutritional transition. A re-analysis of the dose-response relation between dietary sugar and caries incidence in teeth with different levels of susceptibility to dental caries in nationally representative samples of Japanese children. The impact of fluoride on levels of caries was also assessed.

#### Results

Meticulous Japanese data on caries incidence in two types of teeth show robust log-linear relationships to sugar intakes from 0%E to 10%E sugar with a 10 fold increase in caries if caries is assessed over several years’ exposure to sugar rather than only for the first year after tooth eruption. Adults aged 65 years and older living in water fluoridated areas where high proportions of people used fluoridated toothpastes, had nearly half of all tooth surfaces affected by caries. This more extensive burden of disease in adults does not occur if sugar intakes are limited to <3% energy intake.

#### Conclusions

There is a robust log-linear relationship of caries to sugar intakes from 0%E to 10%E sugar. A 10%E sugar intake induces a costly burden of caries. These findings imply that public health goals need to set sugar intakes ideally <3%E with <5%E as a pragmatic goal, even when fluoride is widely used. Adult as well as children’s caries burdens should define the new criteria for developing goals for sugar intake.

##### Keywords: 

Caries; Sugar; Dose-response; Goals

# A reappraisal of the quantitative relationship between sugar intake and dental caries: the need for new criteria for developing goals for sugar intake

**Aubrey Sheiham**[1](http://www.biomedcentral.com/1471-2458/14/863/?ref=foodconsumer.org#ins1)\* and **W Philip T James**[2](http://www.biomedcentral.com/1471-2458/14/863/?ref=foodconsumer.org#ins2)

- \*Corresponding author: Aubrey Sheiham [a.sheiham@ucl.ac.uk](mailto:a.sheiham@ucl.ac.uk)

[Author Affiliations](http://www.biomedcentral.com/1471-2458/14/863?utm%5Fcampaign=BMC00024N&utm%5Fmedium=BMCemail&utm%5Fsource=Teradata#)

1Emeritus Professor of Dental Public Health, Department of Epidemiology & Public Health, University College London, London, UK

2Honorary Professor of Nutrition, London School of Hygiene and Tropical Medicine, London, UK

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*BMC Public Health* 2014, **14**:863 doi:10.1186/1471-2458-14-863

The electronic version of this article is the complete one and can be found online at:[http://www.biomedcentral.com/1471-2458/14/863](http://www.biomedcentral.com/1471-2458/14/863?ref=foodconsumer.org)

| Received:  | 12 May 2014       |
| ---------- | ----------------- |
| Accepted:  | 18 August 2014    |
| Published: | 16 September 2014 |

© 2014 Sheiham and James; licensee BioMed Central Ltd.   

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ([http://creativecommons.org/licenses/by/4.0](http://creativecommons.org/licenses/by/4.0?ref=foodconsumer.org)), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.