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Sugar Restriction For Caries Prevention: Amount and Frequency. Which Is More Important?
Sugar Restriction For Caries Prevention: Amount and Frequency. Which Is More Important?
Fig. 1. pH curves in dental plaque after consecutive rinses with solutions of increasing sucrose concentrations [Imfeld, 1977].
(5–17 g per 100 g) and low in sugars (0–5 g per 100 g) indicate that consuming fruits maybe as cariogenic as
[Heijn, 2016]. It would be interesting to compare the car- consuming fruit juices [Issa et al., 2011; Zaura et al., 2005].
iogenicity of products from these various categories. PH There are multiple arguments that it is better to replace
telemetric measurements showed the pH curve in dental foods high in free sugars with fresh fruit and the dental
plaque upon sucrose challenges with increasing concen- health professionals should encourage people to do so,
trations (Fig. 1) [Imfeld, 1977]. These data suggest that but they should still be alert not to increase the frequency
maximum acid production is reached with concentra- of intake.
tions at or just above 10% sucrose. This would imply that
differences of cariogenicity of the products in the upper
3 categories of the manufactures/retailers “health” list Dietary Advice
cannot be discerned, while products in the lowest cate-
gory may not be or may be cariogenic. Furthermore, it Dietary advice by dental health professionals should be
has been claimed that the relative cariogenicity of a food consistent and not conflict with advices from other health
is not correlated with the amount of carbohydrates it professionals, based on the evidence in the various pro-
contains and it is not possible to estimate the minimal fessional fields and based on the national dietary guide-
cariogenic concentration of sugars in foods, since this lines. In this respect, it has to be remarked that not all
threshold varies with too many factors [Kandelman, national boards of health or nutrition have (yet) adapted
1997]. the WHO-guidelines and that national guidelines may be
less strict on the sugar intake. Furthermore, when people
receive dietary advices from the dental health profession-
Intrinsic Sugars al, the advices may be more readily accepted when the
professional can make unequivocally clear that the advice
The dietary advice for the reduction of caries is com- benefits caries prevention. If not, the person may not un-
plicated by the claim that so-called intrinsic sugars are not derstand why the dental professional interferes with his
cariogenic. Intrinsic sugars are sugars within the struc- diet and not accept the advices. This does not dismiss the
ture of fruits and vegetables. Indeed, when not released in dental professional from also explaining the benefits for
the oral cavity, these sugars may not contribute to caries. general health on limiting or reducing the intake of sug-
But it is probably unrealistic to consume fruits without ars. There is a risk that an overzealous dental profession-
releasing the intrinsic sugars, and experimental studies al may suggest alternatives for sugar take that increase the
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