Sugars and caries prevention

Dental caries remains the single most important oral condition treated by the dental profession on a daily basis. From a public health perspective, the prevention of caries is still therefore a major challenge. As outlined in Chapter 4 , before effective prevention can be delivered the cause of the condition needs to be fully understood. In addition, the disease process should be clear. This chapter will review the evidence on the aetiology of dental caries and present an overview of preventive measures that can be adopted at an individual clinical level, as well as community wide. Dental caries occurs because of demineralization of enamel and dentine structure by organic acids formed by oral bacteria present in dental plaque through the anaerobic metabolism of dietary sugars. The caries process is influenced by the susceptibility of the tooth surface, the bacterial profile, the quantity and quality of saliva, and the presence of fluoride which promotes remineralization and inhibits the demineralization of the tooth structure. Caries is a dynamic process involving alternating periods of demineralization and remineralization. However, the majority of lesions in permanent teeth advance relatively slowly, with an average lesion taking at least 3 years to progress through enamel to dentine (Mejare et al. 1998). In populations with low DMF/dmf levels, the majority of carious lesions are confined to the occlusal surfaces of the molar teeth. At higher DMF/dmf levels, smooth surfaces may also be affected by caries (Sheiham and Sabbah 2010). Many different terms have been used to name and classify sugars. This has caused a degree of confusion amongst both the general public and health professionals. In recognition of this, an expert UK government committee—Committee on Medical Aspects of Food Policy (COMA)—has recommended a revised naming system, which has now become the standard classification of sugars in the UK (Department of Health 1989). The COMA classification is based upon where the sugar molecules are located within the food or drink structure. Intrinsic sugars are found inside the cell structure of certain unprocessed foodstuffs, the most important being whole fruits and vegetables (containing mainly fructose, glucose, and sucrose).