Sugar-sweetened beverages and dental caries in adults: A 4-year prospective study
Bernabe,E., Vehkalahti,M.M., Sheiham,A., Aromaa,A. and Suominen,A.L., (2014)
J.Dent. 42:952-958 10.1016/j.jdent.2014.04.011
OBJECTIVE: To explore the association between frequency of sugar-sweetened beverages (SSB) consumption and caries increment over 4 years in adults, and to explore whether the association between frequency of SSB consumption and caries increment varied by socio-demographic characteristics and use of fluoride toothpaste.
DESIGN: Prospective study. Habitual consumption of six selected sugary items was recorded at baseline, including SSB (namely sugary coffee or tea and other sugary drinks such as sugared juices, fizzy drinks or cocoa). Consumption frequency options were 3+ times a day, 1-2 per day, 2-5 times a week, more rarely, or never. SSB consumption was grouped into 0, 1-2 and 3+ times per day.
SETTING: Finland
PARTICIPANTS: The Finnish Health 2000 Survey was a national survey conducted in 2000-2001 - the stratified two-stage cluster sample was representative of the Finnish population aged 30+ years. From this survey (n=~8000), 6335 had oral examinations. 2000 of these subjects were randomly selected for a population study to evaluate the effects of the dental care reform implemented in 2001-2002. This 'Follow-Up Study on Finnish Adults Oral Health' was conducted in 2004-5 to assess the short-term effects of the reforms on clinically determined oral health. Follow-up examination was undertaken by 1049 subjects.
The Bernabe study is based on n=939 dentate adults (54% women; mean age 48.2 years) who participated in both surveys and had complete data (75% of original sampling frame). Length of follow-up was approximately 4 years.
MAIN OUTCOME MEASURES: 4-year net DMFT (decayed, missing and filled teeth) increment calculated from baseline and follow-up clinical oral examinations.
RESULTS: Mean DMFT at baseline was 21.88 (range 0-32), and the 4-year net DMFT increment was 0.76 (range 0-12). 57% of participants had zero increments. Significantly higher frequency of SSB consumption was associated with being male, younger age groups, adults with basic and secondary education and tooth brushing once a day or less. Higher frequency of SSB consumption was not related to dental attendance or use of fluoride toothpaste.
SSB consumption was positively associated with net DMFT increment, with more teeth affected by dental caries as frequency of SSB consumption increased. Gender, education, dental attendance pattern and tooth brushing frequency were also related to DMFT increment, but not age or use of fluoride toothpaste.
A linear trend was found between frequency of SSB consumption and net DMFT increment in regression models. Adults drinking 1-2 and 3+ SSBs per day had, respectively, 1.31 (95%CI 1.02-1.67) and 1.33 (1.03-1.72) times greater 4-year net DMFT increment vs 0 SSB at baseline. The two-way interactions of frequency of SSB consumption and sex, age, education and use of fluoride toothpaste were not significant (P<0.190).
CONCLUSIONS: The authors conclude that there is a dose-response relationship between frequency of SSB consumption and caries increment in this sample of Finnish adults, which did not vary according to use of fluoride toothpaste. Also, that SSB consumption as a risk factor for dental caries is not a problem limited to children.
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