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Dietary effects on dental diseases

Published online by Cambridge University Press:  27 September 2007

Aubrey Sheiham*
Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
*Corresponding author: Email
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Dental caries is a highly prevalent chronic disease and its consequences cause a lot of pain and suffering. Sugars, particularly sucrose, are the most important dietary aetiological cause of caries. Both the frequency of consumption and total amount of sugars is important in the aetiology of caries. ‘The evidence establishing sugars as an aetiological factor in dental caries is overwhelming. The foundation of this lies in thenmultiplicity of studies rather than the power of any one.’1. That statement by the British Nutrition Foundation's Task Force on Oral Health, Diet and Other Factors, sums up the relationship between sugars and caries in Europe. There is no evidence that sugars naturally incorporated in the cellular structure of foods (intrinsic sugars) or lactose in milk or milk products (milk sugars) have adverse effects on health. Foods rich in starch, without the addition of sugars, play a small role in coronal dental caries.

The intake of extrinsic sugars beyond four times a day leads to an increase risk of dental caries. The current dose-response relationship between caries and extrinsic sugars suggests that the sugars levels above 60 g/person/day for teenagers and adults increases the rate of caries. For pre-school and young children the intakes should be proportional to those for teenagers; about 30 g/person/day for pre-school children.

Fluoride, particularly in toothpastes, is a very important preventive agent against dental caries. Toothbrushing without fluorides has little effect on caries. As additional fluoride to that currently available in toothpaste does not appear to be benefiting the teeth of the majority of people, the main strategy to further reduce the levels of caries, is reducing the frequency of sugars intakes in the diet.

Dental erosion rates are considered to be increasing. The aetiology is acids in foodsand drinks and to a much lesser extent from regurgitation.

Research Article
Copyright © CABI Publishing 2001


1Arens, U, ed. Oral Health Diet and Other Factors. Amsterdam: Elsevier, 1998.Google Scholar
2Rugg-Gunn, AJ. Nutrition and Dental Health. Oxford: Oxford University Press, 1993.Google Scholar
3Department of Health. Dietary Sugars and Human Disease. Committee on Medical Aspects of Food Policy. COMA. Report No 37. London: H.M. Stationery Office 1989.Google Scholar
4Kohlmeier, L, Kroke, A, Pötzsch, J, Kohlmeier, M, Marin, K. Ernährungsabhängige Krankheiten und ihre Kosten. Nomos Verlagsgesellschaft: Baden-Baden, 1993: 327–8.Google Scholar
5Schneider, M, Beckmann, M, Biene-Dietrich, S, Gabanyi, M, Hofmann, U, Köse, A, Mill, D, Späth, B. Gesundheitssystemeim internationalen Vergleich. Augsburg: Eigenverlag, 1998: 142–3.Google Scholar
6Holst, D, Schuller, AA. Oral Health Changes in an Adult Norwegian Population – A Cohort Analytical Study. Community Dent. Oral Epidemiol. 2000; 28: 102–11.CrossRefGoogle Scholar
7Todd, JE. Children's Dental Health in England and Wales 1973. London: HMSO, 1975.Google Scholar
8Kelly, M, Steele, J, Nuttall, N, Bradnock, G, Morris, J, et al. Adult Dental Health Survey. Oral Health in the United Kingdom 1998. London: The Stationery Office, 2000.Google Scholar
9Shepherd, MA, Nadanovsky, P, Sheiham, A.The Prevalenceand Impact of Dental Pain in Eight Year Old School Children in Harrow, England. Br. Dent. J. 1999; 187: 3841.CrossRefGoogle Scholar
10Davies, GN. Early Childhood Caries: A Synopsis. Community Dent. Oral Epidemiol. 1998; 26(1 Suppl): 106116.CrossRefGoogle ScholarPubMed
11Hinds, K, Gregory, JR. National Diet and Nutrition Survey: Children Aged 11/2 to 41/2 Years. Volume 2. Report of the Dental survey. London: HMSO, 1995.Google Scholar
12Marthaler, TM, O'Mullane, DMO, Vrbic, V.The Prevalence of Dental Caries in Europe 1990–1995. Caries Res. 1996; 30: 237–55.CrossRefGoogle ScholarPubMed
13 WHO WHO Oral Health Country/Area Profile Programme., 1999.Google Scholar
14Pitts, NB, Palmer, J.The Dental Caries Experience of 5-, 12- and 14-Year Old Children in Great Britain. SurveysCoordinated by the Br. Association for the Study ofCommunity Dentistry in 1991/92, 1992/93 and 1990/91. Community Dent. Health 1997; 11: 42–52.Google Scholar
15Pitts, NB, Evans, DJ. The Total Dental Caries Experience of 5 Year-Old Children in the United Kingdom. Community Dent. Health 1997; 14: 4752.Google Scholar
16Pitts, NB, Evans, DJ, Nugent, ZJ. The Total Dental Caries Experience of 12-Year-Old Children in the United Kingdom. Surveys Coordinated by the Br. Association for the Study ofCommunity Dentistry in 1996/7. Community Dent. Health 1998; 15: 4954.Google Scholar
17Fejerskov, O, Baelum, V, Ostergaard, ES. Root Caries in Scandinavia in the 1980s and Future Trends to be Expected in Dental CariesAdults. Advances in Dent. Res. 1993; 7(1): 414.CrossRefGoogle Scholar
18WHO. Monitoring Dental Caries in Adults Aged 35–44 Years. WHO/ORH/Caries.35–44/96.1. Geneva: WHO, 1996.Google Scholar
19O'Mullane, D, Whelton, H. Oral Health of Irish Adults 1989–1990. Dublin: Stationery Office, 1992.Google Scholar
20Bedi, R, Uppal, RDK. The Oral Health of Minority Ethnic Groups in the United Kingdom. Br. Dent. J. 1995; 179: 421–5.CrossRefGoogle ScholarPubMed
21Verrips, GH. Child Dental Health and Ethnicity in the Netherlands. Leiden: TNO Institute for Preventive Health Care TNO, 1993.Google ScholarPubMed
22Meurman, JH, ten Cate, JM. Pathogenisis and Modifying Factors of Dental Erosion. European J. Oral Science 1996; 104: 199206.CrossRefGoogle Scholar
23O'Brien, M. Children's Dental Health in the United Kingdom. London: H.M. Stationery Office, 1994.Google Scholar
24Ten Cate, JM, Imfeld, T, Dental erosion, summary. In: Ten Cate, JM, Imfeld, T, eds. Etiology, Mechanisms and Implications of Dental Erosion. A Workshop Organized by ILSI Europe Oral Health Task Force and ISLI North America Oral Health Technical Committee. European J Oral Sciences, 1996; 104(Part II): 241–4.Google Scholar
25Jarvinen, VK, Rytomaa, II, Heinonen, M.Risk Factors in Dental Erosion. J. Dent. Res. 1991; 70: 942–7.CrossRefGoogle ScholarPubMed
26Smith, AJ, Shaw, L.Baby Fruit Juicd and Tooth Erosion. Br. Dent. J. 1987; 162: 65–7.CrossRefGoogle ScholarPubMed
27Dental Practice Board for England and Wales. National Clinical Guidelines and Policy Documents 1999 Paediatric Dentistry. Eastbourne, UK, 1999: 24–9.Google Scholar
28Millward, A, Shaw, L, Smith, A.Dental Erosion in Four YearOld Children from Differing Socioeconomic Backgrounds. J. Dentistry for Children 1994; 61: 263–6.Google Scholar
29Arends, J, ten Bosch, JJ. In Vivo de- and remineralization of dental enamel. In: Leach, SA, ed. Factors Relating to Demineralization and Remineralization of the Teeth. Oxford: IRL Press, 1985: 111.Google Scholar
30Marsh, PD. The control of oral biofilms: new approaches forthe future. In: Guggenheim, B, Shapiro, S, eds. Oral Biology at the Turn of the Century. Basel: Karger, 1998: 22–3.Google Scholar
31Bratthall, D.Dental Caries: Intervened-Interrupted-and Interpreted. Concluding Remarks and Cariography. European J. Oral Sciences 1996; 104: 486–91.CrossRefGoogle ScholarPubMed
32van Palenstein Helderman, WH, Matee, MIN, Van der Hoeven, JS, Mikx, FHM. Cariogenicity Depends more on Diet than the Prevailing Mutans Streptococci Species. J. Dent. Res. 1996; 75: 535–45.CrossRefGoogle Scholar
33van der Hoeven, JS, van Palenstein Helderman, WH. Microbial specificity and dental caries. In: Guggenheim, B, Shapiro, S, eds. Oral Biology at the Turn of the Century. Basel: Karger, 1998: 43–5.Google Scholar
34Mandel, I.Impact of Saliva on Dental Caries. Compendium in Continuing Education Dental Supplement 1989; 13: 476–81.Google Scholar
35Edgar, WM. The Physicochemical Evidence. J. Dentistry 1983; 11: 199205.CrossRefGoogle Scholar
36Murray, JJ. Appropriate Use of Fluorides for Human Health. Geneva: World Health Organization, 1986.Google Scholar
37Sticksen-Blicks, C, Holm, A-K. Dental Caries, Tooth Trauma, Malocclusion, Fluoride Usage, Toothbrushing and Dietaery Habits in 4-Year-Old Swedish Children: Changes Between 1967 and 1992. Int. J. Paediatric Dentistry 1995; 5: 143–8.CrossRefGoogle Scholar
38Mejare, I, Kallestal, C, Stenlund, H, Johansson, HM. Caries Development from 11 to 22 Years of Age: A Prospective Radiographic Study. Caries Res. 1998; 32: 10–6.CrossRefGoogle ScholarPubMed
39Rugg-Gunn, AJ, Hackett, AF, Appleton, DR, Jenkins, GN, Eastoe, JE. Relationship Between Dietary Habits and Caries Increment Assessed over Two Years in 405 English School Children. Arch. Oral Biol. 1984; 29: 983–92.CrossRefGoogle Scholar
40Burt, BA, Eklund, SA, Morgan, KJ, Larkin, FE, Guire, KE, Brown, LO, Weintraub, JA. The Effects of Sugars Intake andFrequency of Ingestion on Dental Caries Increment in a Three Year Longitudinal Study. J. Dent. Res. 1988; 67: 1422–9.CrossRefGoogle Scholar
41Beighton, D, Adamson, A, Rugg-Gunn, A.AssociatiosBetween Dietary intake, Dental Caries Experience and Salivary Bacterial Levels in 12-Year-Old English School children. Arch. Oral Biol. 1996; 41(3): 271–80.CrossRefGoogle Scholar
42Holt, RD. Foods and Drinks at Four Daily Time Intervals in a Group of Young Children. Br. Dent. J. 1991; 170: 137–43.CrossRefGoogle Scholar
43Marthaler, TM. Changes in the Prevalence of Dental Caries: How Much Can Be Attributed to Changes in Diet? Caries Res. 1990; 24(Suppl. 1): 315.CrossRefGoogle ScholarPubMed
44Weaver, R.Fluorine and Wartime Diet. Br. Den. J. 1950; 88: 231–9.Google ScholarPubMed
45Fejerskov, O, Manji, F, Baelum, V, Moller, IJ. Dental Fluorosis – a Handbook for Health workers. Copenhagen: Munksgaard, 1988.Google Scholar
46Szpunar, SM, Burt, BA. Trends in the prevelence of Dental Fluorosis in the United States. A Review. J. Public Health Dentistry 1987; 47: 71–9.CrossRefGoogle Scholar
47Ismail, AL, Brodeur, J-M, Kavanaugh, M, Boisclair, G, Tessier, C, Picotte, L.Prevalence of Dental Caries and Dental Fluorosis in Students, 11–17 Years of Age in Fluoridated and non-Fluoridated cities in Quebec. Caries Res. 1990; 24: 290–7.CrossRefGoogle ScholarPubMed
48Clark, DC. Trends in Prevalence of Dental Fluorosis in North America. Community Dent. Oral Epidemiol. 1994; 22: 148–52.CrossRefGoogle ScholarPubMed
49Jackson, RD, Kelly, SA, Katz, BP, Hull, JR, Stookey, GK. Dental Fluorosis and Caries Prevalence in Children Residing in Communities with Different Levels of Fluoride in the Water. J. Public Health Dent. 1995; 55: 7984.CrossRefGoogle ScholarPubMed
50Pendrys, DG, Katz, RV, Morse, DE. Risk Factors for Enamel Fluorosis in a non Fluoridated Population. Am. J. Epidemiol. 1996; 143: 305–15.CrossRefGoogle Scholar
51Holloway, PJ, Ellwood, RP. The Prevalence, Causes and Cosmetic Importance of Dental Fluorosis in the United Kingdom: A Review. Community Dent. Health 1997; 14: 148–55.Google ScholarPubMed
52Selwitz, RH, Nowjack-Raymer, RE, Kingman, A, Driscoll, WS. Dental Caries and Dental Fluorosis Among Children Who Were Lifetime Residents of Communities Having Either Low or Optimal Levels of Fluoride in Drinking Water. J. Public Health Dentistry 1998; 58: 2635.CrossRefGoogle ScholarPubMed
53Wang, NJ, Gropen, AM, Øgaard, B.Risk Factors Associated with Fluorosis in a non-Fluoridated Population in Norway. Community Dent. Oral Epidemiol. 1997; 25: 396401.CrossRefGoogle Scholar
54Mascarenhas, AK, Burt, BA. Fluorosis Risk From Early Exposure to Fluoride Toothpaste. Community Dent. Oral Epidemiol. 1998; 26: 241–8.CrossRefGoogle Scholar
55Fejerskov, O, Baelum, V. Changes in prevalence and incidence of the major oral diseases. In: Guggenheim, B, Shapiro, S, eds. Oral Biology at the Turn of the Century. Basel: Karger, 1998; 111.Google Scholar
56Pollard, MA, Toumba, KJ, Curzon, MEJ. Diet and DentalCaries. Leeds Dental Institute, Mimeo 55 pages. Submission to COMA, 1996.Google Scholar
57Rose, G. The Strategy of Preventive Medicine. 2nd Edition. Oxford: Oxford University Press, 1993.CrossRefGoogle Scholar
58Batchelor, PA. The Scientific Basis for the Modelling of Caries Preventive Strategies. PhD Thesis. University of London: 1998.Google Scholar
59Scheutz, F, Poulsen, S.Determining Causation in Epidemiology. Community Dent. Oral Epidemiol. 1999; 27: 161–70.CrossRefGoogle ScholarPubMed
60Rothman, KJ, Greenland, S. Modern Epidemiology. Philadelphia, PA: Lippincott-Raven Publishers, 1998.Google Scholar
61Köni, KG, Navia, JM. Nutritional role of Sugars in Oral Health. Am. J. Clin. Nutrition 1995; 62(Supp. 1): 275–83S.CrossRefGoogle Scholar
62Burt, BA, Ismail, AI. Diet, Nutrition, and Food Cariogenicity. J. Dent. Res. 1986; 65(Sp Iss): 1475–84.Google Scholar
63Department of Health. Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Committee on Medical Aspects of Food Policy. COMA. Report No 41. London: H.M. Stationery Office, 1991.Google Scholar
64Gustafsson, BE, Quensel, CE, Sweander Lanke, L, Lundqvist, C, Grahnen, H, Bonow, BE, Krasse, B.The Effect of Different Levels of Carbohydrate Intake on Caries Activity in 436 Individuals Observed for Five Years. The Vipeholm Dental Caries Study. Acta Odontologika Scandinavika 1954; 11: 232364.CrossRefGoogle ScholarPubMed
65Rodrigues, CS. Dietary Guidelines, Sugar Intake and Caries Increment: A Study in Brazilian Nursery School Children. PhD Thesis. University of London: 1997.Google Scholar
66Garn, SM, Cole, PE, Solomon, MA, Schaefer, AE. Relationships Between Sugar-Foods and the DMFT in 1968–1970. Ecology of Food and Nutrition 1980; 9: 135–8.CrossRefGoogle Scholar
67Sreebny, LM. Sugar Availability, Sugar Consumption and Dental Caries. Community Dent. Oral Epidemiol. 1982; 10: 17.CrossRefGoogle ScholarPubMed
68Downer, MC. Caries Experience and Sucrose Availability: An Analysis of the Relationship in the United Kingdom Over Fifty Years. Community Dent. Health 1999; 16: 1821.Google ScholarPubMed
69Hackett, AF, Rugg-Gunn, AJ, Appleton, DR, Allinson, M, Eastoe, JE. Sugars-Eating Habits of 405 11- to 14-Year-Old English Children. Br. J. Nutrition 1984; 51: 347–56.CrossRefGoogle ScholarPubMed
70Árnadóttir, IB, Rozier, RG, Saemundsson, SR, Sigurjons, H, Holbrook, WP. Approximal Caries and Sugar Consumption in Icelandic Teenagers. Community Dent. Oral Epidemiol. 1998; 26: 115–21.CrossRefGoogle ScholarPubMed
71Burt, BA, Szpunar, SM. The Michigan Study: the Relationship Between Sugars Intake and Dental Caries Over Three Years. Int. Dent. J. 1994; 44: 230–40.Google Scholar
72Miyazaki, H, Morimoto, M.Changes in Caries Prevalence in Japan. European J. Oral Science 1996; 104: 452458.CrossRefGoogle ScholarPubMed
73Downer, MC. The Changing Pattern of Dental Disease Over 50 Years. Br. Dent. J. 1998; 185: 3641.CrossRefGoogle ScholarPubMed
74Woodward, M, Walker, ARP. Sugar and Dental Caries:The Evidence From 90 Countries. Br. Dent. J. 1994; 176: 297302.CrossRefGoogle ScholarPubMed
75Nadanovsky, P. Letter. Br. Dent. J. 1994; 177(8): 280.CrossRefGoogle Scholar
76Ruxton, CHS, Garceau, FJS, Cottrell, RC. Guidelines for Sugar Consumption in Europe: Is a Quantitative Approach Justified? European J. Clin. Nutrition 1999; 53: 503–13.CrossRefGoogle ScholarPubMed
77WHO. Diet, Nutrition and Prevention of Chronic Diseases. Geneva: World Health Organization, 1990.Google Scholar
78Ismail, AI, Burt, BA, Eklund, SA. The Cariogenicity of Soft Drinks in the United States. J. the Am. Dent. Association 1984; 109: 241–5.CrossRefGoogle ScholarPubMed
79Cleaton-Jones, P, Richardson, BD, Sreebny, LM, Fatti, P, Walker, AR. The Relationship Between the Intake Frequency and the Total Consumption of Sucrose Among Four South African Ethnic Groups. J. Dentistry for Children 1987; 54: 251–4.Google ScholarPubMed
80Rodrigues, CS, Watt, RG, Sheiham, A.The Effects of Dietary Guidelines on Sugar Intake and Dental Caries in 3 Year Olds Attending Nurseries. Health Promotion Int. 1999; 14: 329–35.CrossRefGoogle Scholar
81Rodrigues, CS, Sheiham, A.The Relationships Between Dietary Guidelines, Sugar Intake and Caries in Primary Teeth in Low Income Brazilian 3 Year Olds: A Longitudinal Study. Int. J. Paedodontics 2000; In press.Google ScholarPubMed
82Szpunar, SM, Eklund, SA, Burt, BA. Sugar Consumption and Caries Risk in Schoolchildren with Low Caries Experience. Community Dent. Oral Epidemiol. 1995; 23: 142–6.CrossRefGoogle ScholarPubMed
83Grindefjord, M, Dahllof, G, Nilsson, B, Modeer, T.Prediction of Dental Caries Development in 1-Year-Old Children. Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Karolinska Institutet, Stockholm, Sweden. Caries Res. 1995; 29: 343–8.CrossRefGoogle Scholar
84Grindefjord, M, Dahllof, G, Nilsson, B, Modeer, T.Stepwise Prediction of Dental Caries in Children up to 3.5 Years of Age. Caries Res. 1996; 30: 256–66.CrossRefGoogle ScholarPubMed
85Holbrook, WP, Árnadóttir, IB, Takazoe, I, Birkhed, D, Frostell, G.Longitudinal Study of Caries, Cariogenic Bacteria and Diet in Children Just Before and After Starting School. European J. Oral Science 1995; 103(1): 42–5.CrossRefGoogle ScholarPubMed
86Holbrook, WP, Kristinsson, MJ, Gunnarsdóttir, S, Briem, B.Caries Prevalence, Streptococus Mutans and Sugar Intake Among 4-Year-Old Urban Children in Iceland. Community Dent. Oral Epidemiol. 1989; 17: 292–5.CrossRefGoogle Scholar
87Bjarnason, S, Finnbogason, SY, Noren, JG. Sugar Consumption and Caries Experience in 12- and 13- Year-Old Icelandic Children. Acta Odontologika Scandinavika 1989; 47: 315–21.CrossRefGoogle ScholarPubMed
88Sundin, 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 Dent. Oral Epidemiol. 1992; 20: 7680.CrossRefGoogle ScholarPubMed
89Sundin, B, Granath, L.Sweets and Other Sugary Products Tend to Be the Primary Etiologic Factors in Dental Caries. Scandinavian J. Dent. Res. 1992; 100: 137–9.Google ScholarPubMed
90Kalsbeek, H, Verrips, GH. Consumption of Sweet Snacks and Caries Experience of Primary School Children. Caries Res. 1994; 28: 477–83.CrossRefGoogle ScholarPubMed
91Jamel, HA, Sheiham, A, Watt, RG, Cowell, CR. Sweet preference, Consumption of Sweet Tea and Dental Caries: Studies in Urban and Rural Iraqi Populations. Int. Dent. J. 1996; 47: 213–7.CrossRefGoogle Scholar
92Jones, C, Woods, K, Whittle, G, Worthington, H, Taylor, G.Sugar, Drinks, Deprivation and Dental Caries in 14-Year-Old Children in the North West of England in 1995. Community Dent. Health 1999; 16: 6871.Google ScholarPubMed
93Kleemola-Kujala, E, Rasanen, L.Relationship of Oral hygiene and Sugar Consumption to Risk of Caries in Children. Community Dent. Oral Epidemiol. 1982; 10(5): 224–33.CrossRefGoogle ScholarPubMed
94Larsson, B, Johansson, I, Ericson, T.Prevalence of Caries in Adolescents in Relation to Diet. Community Dent. Oral Epidemiol. 1992; 20: 133–7.CrossRefGoogle ScholarPubMed
95Bergendal, 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 Dent. J. 1985; 9: 17.Google ScholarPubMed
96Scheinin, A, Mäkinen, KK. Turku Sugar Studies 1-XX! Acta Odontologika Scandinavika 1975; 33(Supp 70): 1351.Google Scholar
97Scheie, AA, Fejerskov, OB. Xylitol in Caries Prevention – What is the Evidence for Clin. efficacy? Oral Diseases 1998; 4: 268–78.CrossRefGoogle Scholar
98Frostell, G, Birkhed, D, Edwardsson, S, Goldberg, P, Petersson, L-G, Priwe, C, Winholt, A-S. Effect of Partial Substitution of Invert Sugar for Sucrose in Combination with Duraphat Treatment on Caries Development in Preschool Children: The Malmo Study. Caries Res. 1991; 25: 304–10.CrossRefGoogle ScholarPubMed
99Birkhed, D, Bär, A.Sorbitol and Dental Caries. World Review of Nutrition & Diet 1991; 65: 137.CrossRefGoogle ScholarPubMed
100Frostell, G, Blomlof, L, Blomqvist, T, Dahl, GM, Edward, S, Fjellstrom, A, Henrikson, CO, Larje, O, Nord, CE, Nordenvall, KJ. Substitution of Sucrose by Lycasin in Candy the Roslagen Study. Acta Odontologika Scandinavika 1974; 32: 235–54.CrossRefGoogle ScholarPubMed
101Rugg-Gunn, AJ. Starchy Foods and Fresh Fruits: Their Relative Importance as a Source of Caries in Britain. Occasional Paper No. 3. London: Health Education Council, 12 1975.Google Scholar
102Rugg-Gunn, AJ, Nunn, JH. Nutrition, Diet and Oral Health. Oxford University Press, 1999: 43–5.Google Scholar
103Edgar, WM. Prediction of the Cariogenicity of Various Foods. Int. Dent. J. 1985; 35(3): 190–4.Google ScholarPubMed
104Edgar, WM. Extrinsic and Intrinsic Sugars: A Review of Recent UK Recommendations on Diet and Caries. Caries Res. 1993; 27(Suppl 1): 64–7.CrossRefGoogle ScholarPubMed
105Koulourides, T, Bodden, R, Keller, S, Manson-Hing, L, Lastra, J, Housch, T.Cariogenicity of Nine Sugars Tested with an Intraoral Device in Man. Caries Res. 1976; 10: 427–41.CrossRefGoogle ScholarPubMed
106Bowen, WH. Dental caries in primates. In: Tanzer, JM, ed. Animal Models in Cariology. London: IRL, 1980: 131–5.Google Scholar
107Firestone, AR, Schmid, R, Muhlemann, HR. Cariogenic Effects of Cooked Wheat Alone or with Sucrose and Frequency-controlled Feedings in Rats. Arch. Oral Biol. 1982; 27: 759–63.CrossRefGoogle ScholarPubMed
108Mundorff, SA, Featherstone, JDB, Eisenberg, AD, Cowles, E, Curzon, MEJ, Espeland, MA, Shields, CP. Cariogenic Potential of Foods. II. Relationship of Food Composition, Plaque Microbial Counts, and Salivary Parameters to Caries in the Rat Model. Caries Res. 1994; 28: 106–15.Google Scholar
109Cohen, B, Bowen, WH. A Bacteriological Study of Dental Caries in Experimental Monkeys. Br. Dent. J. 1966; 121: 269–76.Google Scholar
110Cohen, B.Letter to editor. Br. Dent. J. 1983; 155: 329.Google Scholar
111Lehner, T, Challacombe, SJ, Caldwell, J.An Experimental Model for Immunological Studies of Dental Caries in the Rhesus Monkey. Arch. Oral Biol. 1975; 20: 299304.CrossRefGoogle ScholarPubMed
112Pollard, MA. Potential Cariogenicity of Starches and Fruits as Assessed by Plaque Sampling Method and Intraoral Cariogenicity. Caries Res. 1996; 29: 6874.CrossRefGoogle Scholar
113Harris, R.The Biology of the Children of Hopewood House, Bowral, 4. Observations on Dental Caries Experience Extending Over Five Years (1957–61). J. Dent. Res. 1963; 42: 1387–99.CrossRefGoogle ScholarPubMed
114Newbrun, E, Hoover, C, Mettraux, G, Graf, H.Comparison of Dietary Habits and Dental Health of Subjects with Hereditary Fructose Intolerance and Control Subjects. J. the Am. Dent. Association 1980; 101: 619–26.CrossRefGoogle ScholarPubMed
115Rugg-Gunn, AJ, Hackett, AF, Appleton, DR. Relative Cariogenicity of Starch and Sugars in a 2-Year Longitudinal Study of 405 English Schoolchildren. Caries Res. 1987; 21: 464–73.CrossRefGoogle Scholar
116Toverud, G.The Influence of War and Post-war Conditions on the Teeth of Norwegian Schoolchildren. Millbank Memorial Fund Quarterly 1957; 35: 127–96, 373459.CrossRefGoogle Scholar
117Takeuchi, M.Epidemiological Study on Dental Caries in Japanese Children Before, During and After World War II. Int. Dent. J. 1961; 11: 443–57.Google Scholar
118Künzel, W, Fischer, T.Rise and Fall of Caries Prevalence in German Towns with Different F Concentrations in Drinking Water. Caries Res. 1997; 31: 166–73.CrossRefGoogle ScholarPubMed
119Zeisenitz, SC, Edmondson, EMS. Dental Health. Relationship Between Dental caries, Diet, Eating Patterns and Fluoride. Paper submitted to the EU Working Group 1 on Nutrition and Diet or Healthy Lifestyles in Europe. Rome, 10 1999.Google Scholar
120Afronsky, D.Some Observations on Dental Caries in Central China. J. Dent. Res. 1951; 30: 5361.CrossRefGoogle Scholar
121Russell, AL, Littleton, NW, Leatherwood, EC, Sydow, GE, Green, JC. Dental Surveys in Relation to Nutrition. Public Health Reports 1960; 75: 717–23.Google ScholarPubMed
122Fisher, FJ. A Field Survey of Dental Caries, Periodontal Disease and Enamel Defects in Tristan da Cunha. Part 2, Methods and Results. Br. Dent. J. 1968; 125: 447–53.Google Scholar
123Anaise, JZ. Prevalence of Dental Caries among Workers in the Sweet industry in Israel. Community Dent. Oral Epidemiol. 1980; 8: 142–5.CrossRefGoogle ScholarPubMed
124Katayama, T, Nagagawa, E, Honda, O, Tani, H, Okado, S, Suzuki, S.Incidence and Distribution of Strep. Mutans in Plaque From Confectionery Workers. J. Dent. Res. 1979; 58(Sp. issue. D): 2251 (Abstr. 11).Google Scholar
125Petersen, PE. Dental Health Among Workers at a Danish Chocolate Factory. Community Dent. Oral Epidemiol. 1983; 11: 337–41.CrossRefGoogle Scholar
126Sreebny, LM. Cereal Availability and Dental Caries. Community Dent. Oral Epidemiol. 1983; 10: 17.CrossRefGoogle Scholar
127Moynihan, PJ. Update on the Nomenclature of Carbohydrates and Their Dental Effects. J. Dentistry 1998; 26: 209–18.CrossRefGoogle ScholarPubMed
128Clancy, KL, Bibby, BG, Goldberg, HJV, Ripa, LW, Barenie, J.Snack Food Intake of Adolescents and Caries Development. J. Dent. Res. 1977; 56: 568–73.CrossRefGoogle ScholarPubMed
129Grobler, SR, Blignaut, JB. The Effect of a High Consumption of Apples or Grapes on Dental Caries and Periodontal Disease in Humans. Clin. Preventive Dentistry 1989; 11: 812.Google ScholarPubMed
130Petersson, HG, Bratthall, D.The Caries Decline: A Review of Reviews. European J. Oral Science 1996; 104: 436–43.CrossRefGoogle ScholarPubMed
131Sutcliffe, P. Oral Cleanliness and Dental Caries. In: Murray, JJ, ed. The Prevention of Oral Disease. Oxford: Oxford University Press, 1996: 6877.Google Scholar
132Bellini, H, Arneberg, P, von der Fehr, F.Oral Hygiene and Caries. A Review. Acta Odontologica Scandinavica 1981; 39: 257–65.CrossRefGoogle ScholarPubMed
133Health Education Authority. The Scientific Basis of Dental Health Education. A Policy Document. Fourth Edition. 1996; London: Health Education Authority,.Google Scholar
134Sullivan, HR, Harris, R.The biology of Children of Hopewood House, Bowral, NSW. 2. Observations on Oral conditions. Australian Dent. J. 1958; 23: 311–7.CrossRefGoogle Scholar
135Sheiham, A. What explains the caries decline? In: Guggenheim, B, Shapiro, S, eds. Oral Biology at the Turn of the Century. Basel: Karger, 1998: 3242.Google Scholar
136Nadanovsky, P, Sheiham, A.The Relative Contribution of Dental Services to the Changes and Geographical Variations in Caries Status of 5 and 12 Year-Old Children in England and Wales in the 1980s. Community Dent. Health 1994; 11: 215–23.Google Scholar
137Nadanovsky, P, Sheiham, A.The Relative Contribution of Dental Services to the Changes in Caries Levels of 12 Year-Old Children in 18 Industrialized Countries in the 1970s and early 1980s. Community Dent. Oral Epidemiol. 1995; 23: 231–9.CrossRefGoogle Scholar
138König, KG. Changes in Prevalence of Dental Caries, How Much Can Be Attributed to Changes in Diet? Caries Res. 1990; 24(Suppl): S16–8.CrossRefGoogle Scholar
139Poulsen, S.Dental Caries in Danish Children and Adolescents 1988–94. Community Dent. Oral Epidemiol. 1996; 24: 282–5.CrossRefGoogle ScholarPubMed
140Frencken, JE, Kalsbeck, H, Verrips, GH. Has the Decline in Dental Caries Been Halted? Int. Dent. J. 1990; 40: 225–30.Google ScholarPubMed
141Bowen, WH. Biological Mechanisms of Early Childhood Caries. Community Dent. Oral Epidemiol. 1998; 26(1 Suppl): 2831.CrossRefGoogle ScholarPubMed
142Persson, LA, Holm, AK, Arvidsson, S, Samuelson, G.Infant Feeding and Dental Caries: a Longitudinal Study of Swedish Children. Swedish Dent. J. 1985; 9: 201–6.Google ScholarPubMed
143Rugg-Gunn, AJ, Edgar, WM. Sugar and Dental Caries: A Review of Evidence. Community Dent. Health 1984; 1: 8592.Google Scholar
144Moore, LM, Nielsen, CR, Mistretta, CM. Sucrose Taste Thresholds: Age Related Differences. J. Gerontology 1982; 37: 64–9.CrossRefGoogle ScholarPubMed
145Steele, 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. London: The Stationery Office, 1998.Google Scholar
146Newbrun, E.Sucrose in the Dynamics of the Carious Process. Int. Dent. J. 1982; 32: 1323.Google ScholarPubMed
147Sheiham, A.Sugars and Dental Decay. The Lancet 1983; I: 282–4.CrossRefGoogle Scholar
148Sheiham, A.Sucrose and Dental Caries. Nutrition and Health 1987; 5: 25–9.CrossRefGoogle ScholarPubMed
149Sreebny, LM. The Sugar-Caries Axis. Int. Dent. J. 1982; 32: 112.Google ScholarPubMed
150Wilska, A.Sokerikaries-Vuosistamme Levinnen tauti (Sugar Caries – The Most Prevalent Disease of our Century). Duodecim 1947; 63: 449510.Google Scholar
151Takeuchi, M.Epidemiological Study on Relation Between Dental Caries Incidence and Sugar Consumption. Bulletin of the Tokyo Dental College 1960; 1: 5870.Google Scholar
152Takeuchi, M.On the Rpidemiological Principles in Dental Caries Attack. Bulletin of the Tokyo Dental College 1962; 3: 96111.Google Scholar
153Takahashi, 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: 4457.Google Scholar
154Shimamura, S.A Cohort Survey on Caries Attacks in Permanent Teeth During a Period of Approximately 20 kg of Annual Sugar Consumption Per Person in Japan. J. Dent. Health 1974; 24: 4652.CrossRefGoogle Scholar
155Schulerud, A. Dental Caries and Nutrition During Wartime in Norway. Oslo: Fabritius and Sonners Trykkeri, 1950.Google Scholar
156Knowles, EM. The Effects of Enemy Occupation on the Dental Condition of Children in the Channel Islands. Monthly Bull. Min. of Health 1946: 161–72.Google ScholarPubMed
157Buttner, W. Zuckeraufnahme und karies. In: Cremer, HD, ed. Grundfragen der Ernährungswissenschaft. Freiburg im Breisgau, Rombach, 1971: 175191. Cited by Marthaler, TM. In: Guggenheim B, ed. Health and Sugar Substitutes. Proceedings of ERGOB Conference on Sugar Substitutes. Basel: Karger, 1979; 27–34.Google Scholar
158Künzel, W.Beziehungen der Kariesverbreiting zum Fluoridgehalt des Trinkwassrs sowie dem jährlichen Zuckerkonsum. Zahn-Mund-und Kieferheilkunde Bild 1982; 70: 584–90.Google Scholar
159U.S. Department of Health and Human Services, Public Health Service. The Surgeon General's Report on Nutrition and Health Washington, D.C: Government Printing Office, 1988: 368.Google Scholar
160Cannon, G. Food and Health: The Experts Agree. London: Consumers Association, 1992.Google Scholar
161Freire, MDCM, Cannon, G, Sheiham, A. Sugar and Health – An analysis of the recommendations on Sugars and Health in One Hundred and Fifteen Authoritative Scientific Reports on Food, Nutrition and Public Health Published Throughout the World in Thirty Years Between 1961–1991. Department Monograph Series, No. 1. Department of Epidemiology and Public Health, University College London, 1992.Google Scholar
162Marinho, V. A Systematic Review of Topical Fluorides in Caries Prevention. A Meta-analysis Being Conducted Under the Supervision of the Cochrane Collaboration. (unpublished), 2000.Google Scholar
163Bär, A.Caries Prevention with Xylitol. World Review of Nutrition & Diet 1988; 55: 183209.CrossRefGoogle ScholarPubMed
164Silverstein, SJ, Knapp, JF, Kirkos, L, Edwards, H.Dental Caries Prevalence in Children With a Diet Free of Refined Sugar. Am. J. Public Health 1983; 73: 1196–9.CrossRefGoogle ScholarPubMed