Diet and Dental Caries: The Pivotal Role of Free Sugars Reemphasized

J Dent Res. 2015 Oct;94(10):1341-7. doi: 10.1177/0022034515590377. Epub 2015 Aug 10.


The importance of sugars as a cause of caries is underemphasized and not prominent in preventive strategies. This is despite overwhelming evidence of its unique role in causing a worldwide caries epidemic. Why this neglect? One reason is that researchers mistakenly consider caries to be a multifactorial disease; they also concentrate mainly on mitigating factors, particularly fluoride. However, this is to misunderstand that the only cause of caries is dietary sugars. These provide a substrate for cariogenic oral bacteria to flourish and to generate enamel-demineralizing acids. Modifying factors such as fluoride and dental hygiene would not be needed if we tackled the single cause--sugars. In this article, we demonstrate the sensitivity of cariogenesis to even very low sugars intakes. Quantitative analyses show a log-linear dose-response relationship between the sucrose or its monosaccharide intakes and the progressive lifelong development of caries. This results in a substantial dental health burden throughout life. Processed starches have cariogenic potential when accompanying sucrose, but human studies do not provide unequivocal data of their cariogenicity. The long-standing failure to identify the need for drastic national reductions in sugars intakes reflects scientific confusion partly induced by pressure from major industrial sugar interests.

Keywords: cariogenic; dose-response; epidemiology; guidelines; multifactorial; review.

MeSH terms

  • Dental Caries / etiology*
  • Dental Caries / prevention & control
  • Dietary Carbohydrates / administration & dosage
  • Dietary Carbohydrates / adverse effects*
  • Dietary Carbohydrates / standards
  • Forecasting
  • Health Policy* / trends
  • Humans
  • Nutrition Policy


  • Dietary Carbohydrates