A couple of days ago, we broached the subject of fluoride (29th). This contained some advice for toothpaste and mouthwashes, however fluoride is only one means of reducing decay. The approach must also tackle diet.
Dental decay remains at high levels in the UK. Recent studies show 40% of 4 – 6 year olds and 67% of 14 – 18 year olds have decay. A number of factors are involved in the development of decay, including composition of the teeth, presence or absence of fluoride and type and quantity of oral bacteria. It is recognised that by far the most important factor is diet, and that sugars are undoubtedly the most important dietary factor in causing dental decay.
The sugars associated with decay are the refined sugars e.g. sucrose, glucose and fructose. The sugar found in milk (lactose) has a low potential for causing decay.
Raw starch has a low potential for causing decay, but most starch is cooked or refined for consumption, and in this form it has the potential to cause decay.
The following list shows those foods that have a high potential to cause decay.
Decay causing foods and drinks
Sugar and chocolate confectionary
Cakes and biscuits Buns, pastries, fruit pies.
Sponge puddings and other puddings
Sugared breakfast cereals
Jams, preserves, honey.
Fruit in syrup
Fresh fruit juices
Sugared soft drinks
Sugared, milk-based beverages
Sugar-containing alcoholic beverages (Alcopops)
There are a number of non-decay causing, non-sugar sweeteners that are permitted for use in the UK e.g Sorbitol, Mannitol, Xylitol, Hydrogenated glucose syrup (Lycasin), saccharin and Aspartame (Nutrasweet, canderel). However sorbitol, Mannitol and Xylitol have only a limited use due to their laxative effect.
Foods and drinks with a low risk of causing decay are those with low sugar or have starch that is not highly refined or cooked. The following list gives example of these food and drinks.
Foods and drinks with low potential for dental decay
Low/No caries risk
Bread (sandwiches, toast, crumpets and pitta bread)
Pasta, rice and starchy staple foods.
Unsweetened or artificially sweetened yogurt.
Low-sugar breakfast cereals (e.g. shredded wheat)
Fresh fruit (whole and not juices)
Some foods even have a potential to counteract the effects of dietary sugars. These can help by neutralising the acids produced, or stimulating saliva production. The following list has some of these foods and drinks.
Possible anti-cariogenic effect
Sugar-free chewing gum
Fibrous foods (e.g. raw vegetables)
Xylitol sweeteners, gum and mints
Tea (unsweetened) – contains fluoride.
The following are KEY dietary recommendations to control dental decay and dental erosion.
Key dietary recommendations to safeguard dental health
ü Reduce the frequency and amount of sugary and acidic food and drinks and try to limit these to mealtimes.
ü When a structured meal plan is not followed, limit the consumption of sugary foods to 3-4 times a day.
ü Avoid sugary and acidic foods and drinks close to bedtime.
ü Consume foods and drinks that do not cause, or are known to protect against, dental decay and erosion.
ü Consumption of some sugar-free products may help achieve these goals in practice.
ü Avoid brushing immediately after consuming acidic food and drinks.
ü Chew sugar-free gum for 20 minutes immediately after meals. (Adults and older children only)
ü Use a straw for drinking any acidic drinks.
ü Read manufacturers labels to identify hidden sugars and acids and follow recommendations on the dilution of squashes and the use of products.
ü Do not add any drink or food to a baby’s bottle, except formula milk, expressed breast milk, cow’s milk or water.
ü Provide all drinks (including formula) in a cup or beaker to infants from the age of 6 months and cease bottle-feeding by 1 year.