Australian Dental Journal

The official journal of the Australian Dental Association

Australian Dental Journal 2015; 60: 169–175

doi: 10.1111/adj.12310

Sugary drink consumption and dental caries in New South

Wales teenagers
J Skinner,* R Byun,† A Blinkhorn,* G Johnson*
*Population Oral Health Unit, Faculty of Dentistry, The University of Sydney, New South Wales.
†Centre for Research, Evidence Management and Surveillance, Sydney and South Western Sydney Local Health Districts, New South Wales.

ABSTRACT
Background: The consumption of water, milk and various sugary drinks and their relationship with the caries experience
of a random sample of teenagers aged 14 to 15 years living in New South Wales, Australia was investigated.
Methods: Data were obtained from both clinical and questionnaire components of the NSW Teen Dental Survey, 2010.
The analyses allowed for various demographic and behavioural risk factors using caries experience (DMFT >0) and
mean DMFT as the key outcome variables.
Results: Males were more likely than females to consume large volumes of sugary drinks. Consuming two or more
glasses of sugary drinks per day led to significantly increased caries experience amongst this sample of 14 and 15 year
olds. Factors found to be associated with elevated sugary drink consumption included family income, gender, and
mother’s education level.
Conclusions: There is a strong correlation between increased caries experience of NSW teenagers and high levels of
consumption of sugary drinks.
Keywords: Adolescent health, dental caries, soft drink, sugary drinks.
Abbreviations and acronyms: DMFT = decayed, missing or filled permanent teeth; SES = socio-economic status; SSB = sugar-sweetened
beverages.
(Accepted for publication 20 June 2014.)

are frequent consumption of refined carbohydrates,

INTRODUCTION
According to the Australian Cancer Council, sugar-
sweetened beverages (SSBs) include all non-alcoholic
water based beverages with added sugar; such as
sugar-sweetened soft drinks, energy drinks, fruit
drinks, sports drinks and cordial.1 In the United
States, soft drink consumption has increased dramati-
cally over the last two decades and this increase has
also occurred in Australia.2 In 2007, the Australian
National Children’s Nutrition and Physical Activity
Survey reported that 47% of children aged 2 to 16
years of age consumed SSBs and 25% consumed soft
drinks on a daily basis.3 With the increasing levels of
consumption, research has provided evidence of an
association between soft drink consumption and
weight gain, being overweight and obesity in both
children and adults.4–6
There is also considerable evidence, both interna-
tionally and within Australia, that SSB consumption
increases the risk of dental caries.7–11 Shared dietary
risk factors for dental caries and childhood obesity
soft drinks and other sweetened beverages.11 With the
intake of SSBs within Australia remaining high, com-
bined with the increased trend in the prevalence of
dental caries in Australian children, SSB consumption
is a major public health issue.12–14
SSB consumption causes dental caries through the
high levels of sugar, which are metabolized by plaque
microorganisms that generate acid, which in turn can
demineralize tooth enamel and cause dental caries.9
While the acids produced by this process can be lar-
gely neutralized by saliva flow, frequent consumption
of SSBs with high sugar content reduces the ability of
saliva to protect against the resulting acid.9 An
Australian study by Armfield et al. found that older
children drinking 3 or more glasses of SSBs a day had
a mean DMFT 25.7% higher than children not
consuming SSBs.10
The study applied a cross-sectional and clustered
sampling design to obtain information on 16 508 chil-
dren aged 5 to 16 years from school based dental ser-
vices in the Australian states of South Australia,

© 2015 Australian Dental Association 169

J Skinner et al.

Victoria, Tasmania and Queensland from 2002 to MATERIALS AND METHODS

2005. The study did not include Australia’s most pop-
Data for this study were sourced from the NSW Teen
ulous state New South Wales (NSW) as it commenced
Dental Survey undertaken in 2010 amongst a random
moving away from traditional school based dental ser-
sample of Year 9 secondary students aged 14 to 15
vices to integrated community dental care in 2001.10
years.19 Oral examinations were undertaken by 19
A second study in Queensland showed an associa-
calibrated examiners on 1256 14 and 15 year olds.
tion between soft drink consumption and increased
These teenagers who had a clinical examination also
primary tooth extractions of children.15 They also
completed a questionnaire with their parents and
found that the consumption of soft drinks between
guardians as part of the consent process. The student
meals also increased the risk of extraction in this
component included a 17-item questionnaire related
group of children. However, the authors noted their
to oral hygiene behaviours and perceived oral health
relatively small sample size was a potential weakness
status, as well as consumption of water and soft
in the study design.15
drinks. The parental component of the questionnaire
Despite substantial evidence confirming the direct
included questions on parental income and education
relationship between an intake of dietary sugars and
levels. Questions about food consumption and weight
dental caries across the lifespan, caries prevalence has
were omitted from this current study because there is
decreased worldwide, even though sugar consumption
already a regular School Health Behaviours Survey in
has risen. An explanation for this has been the intro-
NSW which covers these issues.21
duction of fluoride in water systems and the wide-
To allow modelling of the data, and comparison
spread use of topical fluorides.10 National dietary
with other surveys, a new variable was created for
guidelines recently released in Australia included
mothers’ highest education level. Data on drink con-
advice to limit the intake of added sugar. These guide-
sumption for soft drinks, fruit juice, energy drinks
lines raised debate about the role of sugar in poor oral
and sports drinks were combined into a sugary drink.
health and general health, and particularly the role of
The three water consumption responses were also
SSBs as the source of sugar consumption.4,16 There
combined into a single variable in order to allow com-
has also been a growing interest in further under-
parison with the findings of the NSW School Health
standing and identifying the common risk factors for
Behaviours Survey 2010.21
obesity and dental caries.17,18 Current research on
Data were analysed in SAS 9.222 and the question-
SSBs has demonstrated an association between SSB
naire data were compared with the clinical data using
consumption and caries; however, there is still a lack
caries experience (DMFT >0) and mean DMFT as the
of large scale epidemiological evidence that accounts
key dependent variables. Due to missing questionnaire
for risk factors including fluoridation exposure, socio-
data for 34 teenagers, the combined clinical examina-
economic status, diet and access to oral health
tion and questionnaire data set included 1187 records.
care.9,11
The TABULATE and SURVEYFREQ procedures in
The NSW 2010 Teen Dental Survey was under-
SAS were used to produce cross-tabulations and deter-
taken due to a report of a lack of national dental car-
mine 95% confidence intervals.
ies data for teenage children aged 14–15 years in
Ethics approval for the survey was granted by the
Australia, and recorded the dental caries experience of
New South Wales Population and Health Services
a random sample of adolescent school students.19 This
Research Committee and through the State Education
scientifically designed survey is comparable with
Research Process (SERAP) of the New South Wales
surveys undertaken in the UK and the US, and pro-
Department of Education and Training. The Catholic
vides important information to inform planning,
Education Commission and Association of Indepen-
policy decisions and to assist with health service deliv-
dent Schools also gave their permission to involve
ery.20
their schools in the survey.
This article will examine the relationship between
sugary drink consumption levels and dental caries
experience amongst a sample of the 14–15 year olds
RESULTS
reported in the New South Wales 2010 Teen Dental
Survey.19 Our study will explore the hypothesis that The majority of teenagers consumed one or more cups
those adolescents with high sugary drink consumption of tap water per day. The proportions were similar
will have higher levels of dental caries experience for males and females and at 2 or more cups per day
when compared with individuals who have a lower tap water showed a protective effect in terms of caries
intake of sugary drinks. Other risk factors such as experience (Table 1). Approximately 46% of teenag-
mother’s education level, family income, oral health ers consumed 1 or more cups of bottled water with
access, water fluoridation and toothbrushing fre- females consuming more than males (Table 1). There
quency are considered and investigated. was limited consumption of rain or tank water
170 © 2015 Australian Dental Association
 Sugary drink consumption and dental caries in NSW teenagers

Table 1. Daily drink consumption by 14 and 15 year Table 2. Drink consumption by 14 and 15 year old
old children by water type and decay experience children by type and decay experience
Tap/mains water Gender N % Mean DMFT Natural/unsweetened Gender N % Mean DMFT
fruit juice
0 cups per day Male 89 7.4 1.95
Female 125 10.4 1.49 0 cups per day Male 312 26 1.32
1 to 2 cups per day Male 186 15.5 1.21 Female 331 27.6 0.98
Female 209 17.4 0.89 1 to 2 cups per day Male 222 18.5 1.04
3 or more cups per day Male 291 24.3 1.01 Female 261 21.8 1.09
Female 299 24.9 1.05 3 or more cups per day Male 32 2.7 1.4
Female 41 3.4 1.63
Bottled water Gender N % Mean DMFT
0 cups per day Male 400 33.4 1.32 Sweetened fruit juice Gender N % Mean DMFT
Female 362 30.2 1.03 0 cups per day Male 406 33.9 1.21
1 to 2 cups per day Male 120 10 0.85 Female 444 37 1.06
Female 191 15.9 1.11 1 to 2 cups per day Male 134 11.2 1.19
3 or more cups per day Male 46 3.8 1.19 Female 155 12.9 1.02
Female 80 6.7 1.13 3 or more cups per day Male 26 2.2 1.38
Female 34 2.8 1.36
Rain/tank water Gender N % Mean DMFT
0 cups per day Male 436 36.4 1.27 Soft drinks or cordial Gender N % Mean DMFT
Female 494 41.2 1.04 0 cups per day Male 232 19.3 1.14
1 to 2 cups per day Male 74 6.2 0.75 Female 363 30.3 0.81
Female 67 5.6 1.37 1 to 2 cups per day Male 243 20.3 1.12
3 or more cups per day Male 56 4.7 1.33 Female 205 17.1 1.47
Female 72 6 1.02 3 or more cups per day Male 91 7.6 1.69
Female 65 5.4 1.39
All water consumption Gender N % Mean DMFT
0 cups per day Male 27 2.3 3.51 Diet soft drinks or Gender N % Mean DMFT
Female 15 1.3 3.24 diet cordial
1 to 2 cups per day Male 131 10.9 1.14 0 cups per day Male 471 39.3 1.18
Female 142 11.8 1.26 Female 534 44.5 1.08
3 or more cups per day Male 408 34 1.05 1 to 2 cups per day Male 73 6.1 1.02
Female 476 39.7 0.96 Female 85 7.1 1.03
3 or more cups per day Male 22 1.8 2.62
Female 14 1.2 0.99
Sports drinks Gender N % Mean DMFT
0 cups per day Male 485 40.5 1.15
reported. When all water types were combined only Female 565 47.1 1.06
5.3% of teenagers did not report consuming any type 1 to 2 cups per day Male 73 6.1 1.59
Female 63 5.3 1.07
of water daily. 3 or more cups per day Male 8 0.7 1.57
After water the most common drinks consumed by Female 5 0.4 2.24
14 and 15 year olds were plain milk (59%), soft drink Plain milk Gender N % Mean DMFT
and cordial (49%), and natural or unsweetened fruit 0 cups per day Male 185 15.4 1.45
juice (46%) (Table 2). Females were less likely to con- Female 288 24 1.1
1 to 2 cups per day Male 277 23.1 1.07
sume milk regularly than males and also consumed it Female 285 23.8 0.94
in smaller quantities (Table 2). Milk was also found 3 or more cups per day Male 104 8.7 1.18
to be protective in terms of caries experience with Female 60 5 1.61
respondents consuming 1 or more cups per day having Flavoured milk Gender N % Mean DMFT
a lower mean DMFT. 0 cups per day Male 300 25 1.19
Female 366 30.5 1.07
Mean DMFT by drink type consumption level is 1 to 2 cups per day Male 227 18.9 1.18
given in Table 2. Just under 50% of 14 and 15 year Female 248 20.7 0.99
olds reported drinking 1 or more cups of soft drink 3 or more cups per day Male 39 3.3 1.6
Female 19 1.6 2.2
per day. These teenagers had a significantly higher
mean DMFT score than those who did not consume
soft drinks regularly.
Females were less likely to consume soft drink and For Table 3 all sugary drinks were combined into a
cordial than males and on average a smaller percent- single sugary drink consumption variable and DMFT,
age of females consumed these drinks at 2 more decay rates and caries experience prevalence pre-
glasses per day than males. A higher percentage of sented. Those teenagers consuming no sugary drinks
females consumed 2 or more cups per day of sweet- daily had a lower mean DMFT than those teenagers
ened and unsweetened fruit juice than males consuming one or more glasses a day of sugary
(Table 2). Of note is that the consumption of sports drinks. There was an upward trend from no sugary
drinks (12.3%) was at a similar level to that of diet drinks to 1 glass per day to 2 or more glasses per day,
soft drinks and cordials. but this trend was not statistically significant
© 2015 Australian Dental Association 171
J Skinner et al.

Table 3. Decay experience of 14 and 15 year old children by SSB consumption

Oral Health Indicator Age (years)

14 15 All ages

Number of teenagers
No sugary drinks N 139 99 238
One sugary drink a day N 140 101 241
Two or more sugary drinks a day N 348 360 708
Percent of survey who drink one or more % 77.8 82.3 79.9
sugary drinks a day
NSW N 627 560 1187
Decayed, missing and filled teeth (DMFT)
No sugary drinks Mean 0.70 0.96 0.80
95% CI 0.38–0.98 0.36–1.55 0.47–1.12
One sugary drink a day Mean 0.83 1.33 1.04
95% CI 0.56–1.10 0.78–1.88 0.78–1.31
Two or more sugary drinks a day Mean 1.36 1.18 1.27
95% CI 1.10–1.61 0.95–1.41 1.10–1.43
NSW Mean 1.15 1.19 1.17
95% CI 0.96–1.34 1.01–1.37 1.04–1.29
Decayed teeth (D)
No sugary drinks Mean 0.30 0.31 0.30
95% CI 0.12–0.47 0.14–0.48 0.18–0.42
One sugary drink a day Mean 0.37 0.38 0.38
95% CI 0.17–0.58 0.17–0.59 0.23–0.52
Two or more sugary drinks a day Mean 0.56 0.48 0.52
95% CI 0.40–0.72 0.29–0.68 0.39–0.65
NSW Mean 0.48 0.43 0.46
95% CI 0.36–0.60 0.29–0.58 0.36–0.56
Percent DMFT = 0
No sugary drinks Prevalence (%) 68.9 62.5 66.2
95% CI 59.0–78.8 49.4–75.6 57.3–75.1
One sugary drink a day Mean 61.9 53.4 58.2
95% CI 51.5–72.3 42.0–64.8 50.5–65.9
Two or more sugary drinks a day Prevalence (%) 48.2 53.8 51.0
95% CI 40.6–55.7 47.7–59.9 46.0–56.0
NSW Prevalence (%) 54.7 54.3 54.6
95% CI 49.4–60.0 49.9–59.0 50.8–58.3

(Table 3). The number of decayed teeth showed a
similar trend, but again was not statistically signifi-
cant.
The percentage of teenagers with no dental caries
experience (DMFT = 0) was 66.2% for those 14 and
15 year olds consuming no sugary drinks. Fifty-one
per cent of 14 and 15 year olds consuming 2 or more
sugary drinks per day had no dental caries experience
(Table 3).
Gender differences were found in sugary drink con-
sumption, with boys being more likely than girls to
have high sugary drink consumption levels (Table 4).
There was a general association between high sugary
drink consumption and low water consumption.
Those from low income families were more likely to
have higher consumption levels of sugary drinks than
those with a higher income level. Also, teenagers with
a mother with at least some university or college edu-
cation were less likely to consume 3 or more sugary
drinks per day compared to teenagers whose mothers
had a lower education level (Table 4).
172
Soft drink consumption by extraction/filling rates
are shown in Table 4. There is a strong correlation
between high levels of soft drink consumption and
having a tooth filled or extracted at the last dental
visit. The toothbrushing behaviour of teenagers was
found to be inversely related to level of consumption
of sugary drinks, with the general trend being the
higher the frequency of toothbrushing per day, the
lower the consumption of sugary drinks.
DISCUSSION
The Teen Dental Survey was conducted in the same
year as the New South Wales Schools Physical Activ-
ity and Nutrition Survey (SPANS) 2010.21 SPANS
found that 13.8% of secondary school students
reported a daily consumption of 1 or more cups of
soft drink with students from low SES backgrounds
more likely to report a weekly consumption of 2 or
more cups per week.21 In this present study, 52% of
14 and 15 year olds reported drinking 1 or more cups
© 2015 Australian Dental Association
 Sugary drink consumption and dental caries in NSW teenagers

Table 4. SSB consumption by 14 and 15 year old there is a statistically significant relationship between
children by key indicators, 2010 elevated soft drink consumption and dental caries
experience.
Subgroups 0 1–2 3 or more Total
SSBs SSBs SSBs This study also shows the gender difference in sug-
ary drink consumption, with females having lower
Gender
Male 104 201 252 557 (44.9%)
average consumption levels than males. Teenage girls
Female 134 288 208 630 (53.1%) were also more likely to be concerned about their
Water
level of sugar intake2 and had better oral hygiene hab-
0 cups per day 4 13 13 30 (2.5%) its than teenage boys.
1–2 cups per day 37 104 132 273 (23%) Substitution of water for soft drink between pri-
3 or more cups 197 372 315 884 (74.5%)
per day
mary and secondary school age has been reported in
some studies.17 This is supported by the 2010 NSW
Filling or extraction at last dental visit
Yes 37 112 122 271 (22.8%)
Schools Physical Activity and Nutrition Survey where
No 201 377 338 916 (77.2%) water consumption was 68.9% in the primary years
Toothbrushing per day
and then fell to 63.5% in the secondary years.21 Our
Less than once a day 10 16 56 82 (6.9%) study found that those consuming high volumes of
Once a day 73 164 185 422 (35.7%) sugary drinks consumed lower amounts of water per
Twice or more a day 154 308 216 678 (57.4%)
day.
Family income A potential weakness of this present study is that
Up to $80 000 122 255 259 636 (57.3%)
Over $80 000 97 203 173 473 (42.7%)
dental caries experience and sugary drink consump-
tion levels could not be compared with the Body Mass
Mother’s education
High school and at 112 242 276 630 (57.1%)
Index (BMI). As previously noted BMI was not
least some vocational recorded as it is already routinely collected in the
training SPANS Survey. A recent meta-analysis examined the
At least some 106 220 148 474 (42.9%)
university or college
potential links between soft drink consumption, dental
caries and BMI. It found an association when stan-
dardized measures of BMI were used.9 This potential
relationship will be explored further by the Australian
of soft drink or cordial per day with those teenagers National Child Dental Survey 2012–2014 currently
from low SES groups (based on family income) having underway which is collecting data on both soft drink
a substantially higher level of consumption (46% ver- consumption and self-reported BMI. Given the impor-
sus 23.9%). tance of oral health, plus its links to the common risk
Previous studies have found that fluid consumption factors associated with obesity, there is a strong case
patterns have changed over the past decade with a ris- for inclusion of dental examinations as part of the
ing consumption of sugary drinks and less consump- NSW Schools Physical Activity and Nutrition Survey
tion of water and milk.14,23 A Brazilian fluid intake which is conducted periodically by the NSW Ministry
pattern study found that soft drinks were the second of Health. This will also address the issue of different
most consumed drink after water and made up 10% sugary drink consumption measures used in the Teen
of the daily energy intake of adolescents.23 While this Survey and SPANS.
present study did not measure total daily consump- The survey found food behaviours related to soft
tion, several types of sugary drink were grouped drink consumption were influenced both inside and
together to estimate the number of cups per day of outside the home and negatively affected the intake of
sugary drinks that were consumed daily by teenagers. sugars, thereby putting the students at greater risk of
The relationship between the frequency and amount dental caries and obesity. The food behaviours
of soft drink consumed and elevated DMFT scores included secondary students buying soft drinks from
has been found in both Australia and overseas.10,14 the school canteen (22.4%), buying soft drinks from
Jones et al. found a significant correlation between an vending machines at school (36.1%) and 29.3% hav-
individual’s soft drink consumption and the DMFT ing ready access to soft drink in their homes.21
index.8 Most of the studies of this relationship have Clearly there are actions that could be implemented in
been of children and adults with only limited informa- schools to remove sugary drinks from canteens and
tion on adolescents. Previous studies of adolescent vending machines.
and soft drink consumption and dental caries have A new campaign called Rethink Sugary Drinks was
also been based on small sample sizes. This present launched in January 2013 and aims to reduce soft
study is the largest and most contemporary to date of drink consumption in Australia.24 This campaign is
adolescents in Australia and the impact of their sugary led by Diabetes Australia, the Heart Foundation and
drink consumption on their oral health, and confirms Cancer Council Australia and is based on a similar
© 2015 Australian Dental Association 173
J Skinner et al.
campaign in the US. The campaign targets the grow-
ing concern related to the health impacts of the
increased availability and consumption of sugary
drinks, particularly on diabetes and heart disease
rates. It is notable that in both campaigns little or no
mention is made of the strong links between high con-
sumption of soft drinks and increased risk of dental
caries and dental erosion. Some dental information
has been developed for use in schools as part of the
implementation of the Rethink Your Drink campaign.
This literature has been complemented by the Austra-
lian Dental Association 2013 Dental Health Week
campaign, which focused on young people and their
consumption of sports drinks.25 Nevertheless, to be
successful all schools will have to ensure that sugary
drinks are not readily available on school premises.
The Australian Nutrition Guidelines have been
developed for health professionals about the relation-
ship between dental caries and dental erosion in
young people and their soft drink consumption.6
Mainstream media are also recognizing the impor-
tance of sugar on health. For example, the ABC Cata-
lyst television programme ran an episode in 2013
looking at the adverse general health impacts of a
high sugar diet.26 There have also been mainstream
articles regarding the high sugar content of fruit juices
and with a number of brands of apple juice being as
sugary as soft drinks such as Coca-Cola.27 The find-
ings of our study confirm that dental disease levels in
teenagers are similar for both high consumption of
soft drinks and sweetened fruit juices. This is a result
which has often been ignored and fruit juices have
been promoted as a healthy alternative to soft drinks.
There is evidence that some consumers believe the
consumption of fruit juice is as beneficial as the con-
sumption of whole fruit,18,25 which is clearly not the
case. The implications of the common risk factor
approach for dental caries and overweight and obese
children means that nutrition interventions should be
targeting common messages about improved general
health and dental health.9,23 It is important these
interventions and strategies are not only implemented
in the school and health setting, but also include
advice to parents through general health promotion
via media campaigns and from primary health care
professionals. The magnitude of the problem will
require other strategies such as a sugar tax and clearer
labelling on food and drinks that indicate high levels
of sugar.
Traditionally, health promotion messages have
sought to discourage people from consuming foods
and drinks with high sugar content and low overall
nutritional value. As many of these foods and drinks
are appealing and often well-advertised, negative cam-
paigns to stop their consumption have been largely
unsuccessful. Therefore, positive messages about con-
174
suming more water have been used widely, both in
oral health and general health promotion, as well as
in strategies to increase the availability of drinking
water in schools.
More positive recommendations have been devel-
oped to help educate consumers about the conse-
quences of frequent consumption of sugary drinks and
to reduce their chances of suffering dental caries and
erosion of the teeth. These messages include limiting
the intake of sugary drinks to meal times, brushing
teeth twice a day with a fluoride toothpaste, using a
straw whenever possible when consuming sugary
drinks, cooled sugary drinks have less erosive poten-
tial, don’t use sugary drinks in sipper cups or baby
bottles, and limit consumption time and contact with
teeth.9
Our finding that elevated sugary drink consumption
is linked to poor oral health amongst a subgroup of
teenagers has important implications given that sugary
drinks are also associated with childhood weight gain
and obesity.28 There are a number of programmes in
NSW that target healthy eating and increased physical
activity in early childhood and amongst primary
school-aged children.29 It has been recognized recently
that teenagers are a key group needing new pro-
grammes targeting healthy eating and increased physi-
cal activity. The NSW Ministry of Health is working
with key partners to develop new programmes in
three key areas: social marketing for teenagers;
healthy eating programme for disadvantaged youth;
and school canteen menus.29 There is recognition
amongst public health and oral health professionals
that programmes will need to utilize new technologies
so that key messages can be delivered via greater use
of the internet, social media and tablet-based applica-
tions. A recent initiative has seen iPads used to access
an application (app) called MySmileBuddy that is
used by community health workers to administer a
dietary screening assessment with parents to deter-
mine their child’s risk of developing early childhood
caries.30 Given the market penetration of tablet
devices amongst teenagers, the development of strate-
gies delivered via apps such as MySmileBuddy could
easily be modified for self-administration by teenag-
ers.
CONCLUSIONS
The increased consumption of sugary drinks amongst
adolescents is a major challenge to the oral health of
future generations of Australians. While the highest
levels of dental caries is concentrated amongst certain
subpopulations, the common risk factor of this over
consumption of refined sugar as a cause of diabetes
and heart disease is a major concern. While access to
fluorides in drinking water and toothpastes may be
© 2015 Australian Dental Association
 Sugary drink consumption and dental caries in NSW teenagers
moderating the risk of dental disease, it is not effec-
tive in controlling the current obesity epidemic. Thus,
there needs to be renewed efforts at educating parents,
adolescents, health professionals and politicians to
more fully understand the situation. Actions such as a
soft drink tax, greater control over the marketing of
soft drinks and their availability at school canteens
and vending machines may well have to be imple-
mented through legislation or official government pol-
icy initiatives to improve the general health of
Australian adolescents. This will require a unified
public health effort involving a range of health and
education professionals.
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Address for correspondence:
Mr John Skinner
Population Oral Health Unit
Faculty of Dentistry
The University of Sydney
1 Mons Road
Westmead NSW 2145
Email: john.skinner@health.nsw.gov.au
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