Frequent consumption of simple carbohydrates, primarily in the form of dietary sugars is significantly
associated with increased dental caries risk. Malnutrition (under or over nutrition) in children is often
a consequence of inappropriate infant and childhood feeding practices and dietary behaviors
associated with limited access to fresh, nutrient dense foods substituting instead,high-energy low
cost and nutrient poor sugary and fatty foods. Lack of availability of quality food stores in rural and
poor neighborhoods, food insecurity, and changing dietary beliefs resulting from acculturation
including changes in traditional ethnic eating behaviors, can further deter healthful eating and
increase risk for Early Childhood Caries and obesity.
America is witnessingsubstantial increases in children and ethnic minorities living in poverty,
widening the gap in oral health disparities noted in the Surgeon General's Report, Oral Health in
America. Dental and other care providers can educate and counsel pregnant women, parents and
families to promote healthy eating behaviors and should advocate for governmental policies and
programs that decrease parental financialand educational barriers to achieving healthy diets. For
families living in poverty, however, greater efforts are needed to facilitate access to affordable healthy
foods, particularly in urban and rural neighborhoods in order to effect positive changes in children's
diets and advance the oral components of general health.
Diet and pediatric caries
The prevalence of dental caries inprimary teeth, early childhood caries (ECC), increased from
approximately 40 percent in children aged 2–11 years in the 1988–1994 National Health and
Corresponding author: Connie Mobley, Ph.D., R.D. Professor of Nutrition & Associate Dean of Research University of Nevada Las
Vegas School of Dental Medicine 1001 Shadow Lane, MS 7410 Las Vegas, NV 89106-4124 firstname.lastname@example.org Phone:702-774-2643 FAX: 702-774-2647.
NIH Public Access
Acad Pediatr. Author manuscript; available in PMC 2010 May 3.
Published in final edited form as:
Acad Pediatr. 2009 ; 9(6): 410–414. doi:10.1016/j.acap.2009.09.008.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Nutrition Examination Survey (NHANES) to 42 percent in the 1999–2004 survey.1 For
children2–5 years of age the rate increase was greater, rising from 24 percent to 28 percent.
Increases were identified specifically among non-Hispanic white males and children living in
households with incomes at or below the Federal Poverty Level (FPL).2 Changing and
increasing numbers of ethnic minorities, cultural and dietary practices, and children living in
poverty have widened the chasm ofdisparity.3 Understanding the role of diet, eating behaviors,
demographics and environmental factors in contributing to increased caries rates in children
is essential in order to improve the oral component of general health.4 In particular, an
established relationship has been reported linking malnutrition in children, inappropriate infant
feeding practices and excessive intakes of sugar to ECC.4,5The association of dental caries to excessive sugar intake has been affirmed by an Expert Panel
of the World Health Organization (WHO), whose members reviewed the strength of evidence
linking dietary factors to caries in 2003. The Panel reported an increased risk of caries
associated with frequent and total intake of free, simple sugars.6 Reports in the US noted total
and individual intakesof free, simple sugars were not associated with caries experience in
young Iowa children suggesting that current simple sugar intakes exceeds the caries threshold
or that caries is influenced more by frequency and other factors.7 The WHO Expert Panel also
reported a decreased risk of caries related to consumption of specifically hard cheeses and use
of sugar-free chewing gum. Evidence was...