DentalPublicHealth

Colwyn Jones

Neil Craig and Neil Anand

The UK Soft Drinks Industry Levy:

Implications for Dental Health
Abstract: A Soft Drinks Industry Levy on sugar-sweetened beverages (SSBs) was announced in the Westminster budget on 16 March 2016.
The UK Government plans to introduce the SSB levy in 2018, with legislation enacted in 2017. The aim of the levy is ‘…..to give companies
plenty of space to change their product mix’.
The levy is a banded duty on soft drinks with less than 5 g/100 ml being classed as tax exempt, drinks with between 5−8 g/100 ml taxed
at a basic level tax at 18 pence per litre, and drinks with greater than 8 g/100 ml taxed at a higher level of 24 pence per litre. The Office
for Budget Responsibility forecast that the Soft Drinks Industry Levy will attract revenue of £500 million for 2019−2020, the second year
of implementation. Unusually, the expected revenue raised will be hypothecated to fund physical activity and breakfast clubs in English
schools.
CPD/Clinical Relevance: The UK Soft Drinks Industry Levy on SSBs has the potential to reduce both childhood obesity and the prevalence
and severity of tooth decay, although precise estimates of effect are unclear. The levy should be welcomed by the dental profession as a
structural fiscal policy to improve both general and dental health.
Dent Update 2017; 44: 476-484

As a developed European country, a
relatively small group of health conditions
(the non-communicable diseases or NCDs)
are now responsible for a large part of
the overall disease burden in the UK.
The impact of the major NCDs (diabetes,
cardiovascular diseases, cancer, chronic
respiratory diseases and mental disorders)
account for an estimated 86% of the deaths
and 77% of the disease burden in Europe.1
The WHO NCD global action
plan 2013−2020 proposes addressing four
risk factors: physical inactivity, tobacco,
alcohol and unhealthy diet. Producing
Colwyn Jones, Consultant in Dental
Public Health, NHS Health Scotland, Neil
Craig, Principal Public Health Advisor,
NHS Health Scotland and Neil Anand,
Public Health Advisor (Health Economics),
NHS Health Scotland, 1 South Gyle
Crescent, Edinburgh EH12 9EB, UK.
476 DentalUpdate June 2017
and selling processed food and drink
(sometimes described as ultra-processed
food products see Table 1), alcohol and
tobacco is big business, with substantial
profits generated throughout the supply
chain. These business interests have
been classed as unhealthy commodity
industries, producing health-harming
products specifically designed to be
ingested.2 Existing efforts to reduce or stop
alcohol and tobacco use include market
interventions which aim to change the
supply/demand for these products.
In 2014, it was reported
that 58% of English women and 65% of
English men were overweight or obese.3
The Carbohydrates and Health Report by
The Scientific Advisory Committee on
Nutrition (SACN) showed that sugar-
sweetened beverages (SSBs) are associated
with increased risk of type 2 diabetes
and obesity.4 SACN concluded that high-
sugar beverages result in weight gain
and increased body mass index (BMI)
in teenagers and children, and increase
the risk of developing type 2 diabetes
independently of obesity.
There is an epidemic of obesity
in the UK, which is unlikely to improve
in the short term as the proportion of
overweight or obese boys is 15th highest
(26.1%) and for girls is 4th highest (29.2%)
out of the 34 OECD (Organization for
Economic Co-operation and Development)
countries.5
The tenth version of the
International Classification of Disease codes
(ICD10) includes obesity (E66.0 − Obesity
due to excess calories). Obesity is typically
a co-morbidity rather than a principle
diagnosis for hospital admission. The non-
communicable diseases mentioned above
often arise as the sequelae of obesity
including, when sugars are considered,
dental caries.
Sugar is highly palatable and
changes in the supply and manufacture
of food over the last few decades have

 Ultra-processed products are made
from substances extracted or refined from
whole foods, eg, oils, hydrogenated oils
and fats, flours and starches, variants of
sugar, and cheap parts or remnants of
animal foods − with little or no whole
foods. Products include burgers, frozen
pizza and pasta dishes, nuggets and
sticks, crisps, biscuits, confectionery,
cereal bars, carbonated and other sugar
sweetened drinks, and various snack
products. Most are made, advertised
and sold by large or transnational
corporations and are very durable,
palatable and ready to consume, which is
an enormous commercial advantage over
fresh and perishable whole or minimally
processed foods.
 In the global north, ie North America
and Europe − ultra-processed products
have largely replaced food systems and
dietary patterns based on fresh and
minimally processed food and culinary
ingredients that have less fat, sugar and
salt.
 Ultra-processed products are typically
energy dense; have a high glycaemic load;
are low in dietary fibre, micronutrients
and phytochemicals; and are high in
unhealthy types of dietary fat, free sugars
and sodium. When consumed in small
amounts and with other healthy sources
of calories, ultra-processed products are
harmless; however, intense palatability
(achieved by high content of fat, sugar,
salt and cosmetic and other additives),
omnipresence, and sophisticated and
aggressive marketing strategies (such as
reduced price for super-size servings),
all make modest consumption of
ultra-processed products unlikely and
displacement of fresh or minimally
processed foods very likely. These factors
also make ultra-processed products liable
to harm endogenous satiety mechanisms
and so promote energy overconsumption
and thus obesity.
Table 1. Ultra-processed products.2
increased the availability and affordability
of high sugar foods and drinks.6 The result
is that the average Scottish diet now
contains three times the recommended
intake of sugar; which should be only 5%
June 2017 DentalUpdate 477
of total energy intake.7 For manufacturers,
sugar-sweetened beverages are immensely
profitable. They are cheap to manufacture
and the high sugar content gives a long
shelf life. Concerned about profits, the
processed food and beverage industries
have opposed any form of regulation or
taxation. These tactics were first used by the
tobacco industry, hence the suggestion that
‘Sugar is the New Tobacco’.8
Despite recent improvements,
there remains an epidemic of tooth decay
in our children. In 2015/16 almost a third
(30.6%) of children entering primary school
in Scotland had experience of tooth decay.9
Although SSBs are now believed to be a
major cause of tooth decay and of obesity,
the soft drinks industry actually started in a
number of places with naturally carbonated
mineral water originally being marketed for
medicinal purposes. In the 19th century, the
food industry started supplying the British
Royal Navy with an antiscorbutic agent. The
problem of transporting and conserving
juice from citrus fruit for sailors, to prevent
vitamin C deficiency causing scurvy, led to
both the development of the soft drinks
industry, and the vernacular description of
UK sailors, later residents or migrants, as
Limeys. Around 1867, Lauchlin Rose of Leith
mixed lime juice with sugar (by 1860 limes
had replaced mainland European lemons
to promote British Economic interests in
the West Indies). However, in addition to
supplying the armed forces to prevent and
treat scurvy, they began selling Lime Juice
Cordial to the general public, a soft drink
which endures to the present day.10
Tooth decay is initiated and
progresses when acid is produced within
dental plaque as commensal bacteria
anaerobically metabolize simple sugars.11
Typically, the pH measured in dental plaque
falls almost immediately sugars are taken
into the mouth, with a slow recovery back
to normal pH taking around 45 minutes.
During this period, demineralization of
the inorganic phase of tooth enamel
and dentine takes place. Remember the
Stephan Curve of undergraduate teaching?
If repeated acid attacks occur because
of a high frequency of sugar ingestion,
demineralization continues, the organic
phase of enamel and dentine is then lost so
that mineral cannot be replaced, with the
subsequent formation of a dental cavity.
The more sugar individuals eat or drink
DentalPublicHealth
and the more frequently they eat or drink
sugar-containing foods, the more likely they
are to suffer from tooth decay. Sugared soft
drinks, drunk regularly, are believed to be a
major cause of tooth decay. It should also
be noted that advice aimed at promoting a
healthy diet has never included consuming
soft drinks.
Dental erosion (tooth
surface loss) is also caused by the citric,
phosphoric or other acids added during the
manufacture of carbonated drinks, even in
sugar-free varieties.12
The Soft Drinks Industry Levy
The announcement of the UK
Soft Drinks Industry Levy on SSBs in the
Westminster budget on 16 March 2016
was, for many in the medical and dental
professions, a welcome surprise. Table 2 lists
common names for sugars that should be
included. The Chancellor of the Exchequer
stated that he was “……not prepared to look
back at my time here in this Parliament……
and say to my children’s generation, I’m
sorry. We knew there was a problem with
sugary drinks. We knew it caused disease,
but we ducked the difficult decisions and we
did nothing. We are introducing the levy on
the industry which means that companies
can ……. promote low-sugar or no-sugar
brands….’.13
The Westminster Government
plans to introduce the SSB levy in 2018,
with legislation passed in a finance bill
during the 2017 Parliamentary year. The
Chancellor of the Exchequer stated that
this was, ‘…to give companies plenty of space
to change their product mix’. Unusually, the
expected revenue raised by the levy will be
hypothecated to fund physical activity and
breakfast clubs in English schools.14
Essentially, the SSB levy
announced by the Chancellor is a banded
duty; similar in structure to some UK alcohol
excise duties (Table 3).
The Office for Budget
Responsibility forecast that the Soft
Drinks Industry Levy will operate with a
specific revenue target of £500 million
for 2019−2020, the second year of
implementation.15
One criticism of this approach
is that there is no incentive for producers
to reduce sugar content further below
the thresholds of the bands. The use of
 DentalPublicHealth
monosaccharides (galactose, glucose and
fructose)
disaccharides (sucrose, lactose and maltose)
cane sugar, raw sugar
beet sugar
honey
brown sugar, muscovado and demerara sugar
molasses and treacle
corn syrup and high fructose corn syrup
fruit juice concentrate (apple juice)
fruit puree (apple puree)
hydrolysed corn syrup
hydrolysed corn starch
crystalline sucrose
nectars
short chain oligosaccharides
barley malt, malt and malt syrup
cane juice and dehydrated cane juice
golden syrup
dextran
Table 2. Sugars that should be subject to the UK Soft Drinks Industry Levy.
Sugar level
Less than 5 g/100 ml
Between 5−8 g/100 ml
Greater than 8 g/100 ml
Table 3. Thresholds in the proposed UK Soft Drinks Industry Levy. A weight per volume of 5 g/100 ml is
a 4.7% solution of sugar (5/105 as a percentage) 8 g/100 ml = 7.4% (8/108 as a percentage).
a volumetric levy or tax would avoid this
issue. An alternative would be a scaled
volumetric levy or tax where the rate is
scaled down on low sugar drinks and scaled
up on high sugar drinks. One unfortunate
effect of setting these legislative thresholds
might be to encourage the general public
to assume tacit government approval of
soft drinks with lower sugar levels that
nevertheless could still be health harming.16
The choice of the content
thresholds of 5 g and 8 g for the SSB levy
may have been derived from the UK front
of pack (FoP) nutrition labelling for pre-
478 DentalUpdate June 2017
grape sugar contain around 10 g/100 ml across the UK.
Scotland’s second national drink contains
panocha 10.3 g/100 ml of sugar. These products
would fall into the higher tax band.
dextrose
Interestingly, more recent
buttered syrup innovations, such as Coca Cola Life (other
brands are available) is now marketed in
diastatic malt
the UK with a green label and is sold as
diatase reduced sugar compared to the original
formulation (6.7 g/100 ml, or 63% of the
refiner’s syrup
original). Sweetness is maintained with
ethyl maltol a plant-based extract called Stevia. That
means it would exceed the exemption
invert sugar
threshold or 5 g/100 ml and be subject to
rice syrup the basic level of SSB levy. However, the
same product sold in Germany only has
caramel
5 g/100 ml and, if sold in the UK, would
sorbitol be entirely exempt from the SSB levy: an
sorghum syrup example of how soft drinks manufacturers
already reformulate their products to suit
corn syrup solids taste and regulations in different countries.
maltodextrin However, from the dental health viewpoint,
a 2.5% sucrose solution will drop dental
carob syrup plaque pH to below the critical level,
mannitol causing demineralization of enamel, ie
tooth decay.11 So sugar concentrations
turbinado sugar at the 5 g/100 ml, or 50 g/litre (50 g is
date sugar 12 teaspoons of sugar) threshold for tax
exemption will cause tooth decay. They may
maple syrup also encourage continued habituation to a
diet with an intensely sweet taste.
An additional problem with
Tax status Tax per litre health harming industries adopting a harm
reduction approach is that they may then
Tax exempt Nil
claim they have ‘done their bit’ to improve
Basic level tax 18 pence per litre the health of the nation and may attempt
to exploit this through their marketing and
Higher level tax 24 pence per litre
advertising strategies.
The new SSB levy is aimed at
the producers and importers of sugar-
sweetened beverages, who will need to
register with Her Majesty’s Revenue and
packed products sold through retail outlets: Customs (HMRC) to allow enforcement of
the voluntary UK food traffic light system the new regulations. The aim is to use the
rejected by the European Union following market to influence the SSB producers and
importers.
intense lobbying by the food industry. The
In reality, the response of the
traffic light system has an upper threshold
soft drink industry is likely to be a mix of
of 5 g/100 g for low sugar foods to be given
approaches as, in 2014, the proportion
a ‘green’ rating.17
of sugar-free and levy-exempt soft drinks
A separate FoP green traffic light already sold in the UK was estimated at 49%
upper threshold was proposed for healthy of total sales, and is expected to continue
drinks at 2.5 g/100 ml, exactly half of the to rise.18
sugar content proposed by the Chancellor The Republic of Ireland will
for the lower threshold of the SSB levy. also introduce a levy on sugary drinks
To put these figures in context, from 2018. The Irish Finance Minister made
most original sugar-sweetened beverages an announcement in their Budget on 11

October 2016 and confirmed the approach
would likely be aligned with the UK’s Soft
Drinks Industry Levy.
No simple solutions exist to the
problems caused by the ultra-processed or
‘neoliberal diet’.19 Aside from highlighting
the health problems of sugared drinks
and obesity to the UK population, what
evidence exists that a levy on home
produced or imported sugar-sweetened
beverages will produce a health gain?
Impact of SSB levy: economic
theory
The economic argument for
taxes reflects basic economic theory. If a tax
or levy raises prices for a product, demand
for that product will fall. If, as shown with
sugar, this product is harmful, the effect of
the tax should be to reduce harms through
reducing consumption. The impact of the
levy will depend in part on the response of
consumers: how do they react to any price
changes arising from the levy, what do they
consume instead and is this less harmful
than sugar? It will also depend on the
reaction from the soft drinks industry. They
may choose to absorb the cost, pass on
some of the cost to the customer through
higher prices, reformulate the product so
that the tax or levy is not payable, or some
combination of all three. In short, a tax is
likely to have a range of impacts, and the
precise effect is uncertain.
The Government stressed
the re-formulation objective in its
recent consultation on the SSB levy but
acknowledged the potential for all three
outcomes to occur to a lesser or greater
extent. This will be influenced by how
much producers expect demand to fall
as a result of any increase in price. This is
referred to as ‘price elasticity of demand’
(PEOD). If demand is relatively elastic, ie
the more consumers are influenced by
price, the greater the potential impact
on consumption of a tax or levy and the
more likely it is that producers will absorb
a higher proportion of a tax or levy, rather
than raise prices. Price elasticity of demand
also depends, in part, on the availability and
price of alternative products.
Figure 1 shows two different
demand functions setting out how the
quantity of a product demanded relates
to the price charged. At a price of P1, for
June 2017 DentalUpdate 479
example, demand is Q1. The functions slope
downward from left to right showing the
traditional relationship between the price
of a commodity and demand for it: as price
goes up, quantity demanded for most
products goes down.
The amount by which demand
goes down depends on the PEOD. This is
the percentage change in demand divided
by the percentage change in price. This
is typically negative because, as noted
earlier, for most products, as price goes up,
demand falls. Where the percentage fall
in demand is greater than the percentage
increase in price, PEOD would be less than
-1, and demand would be considered to
be elastic. Where the percentage fall in
demand is smaller than the percentage
increase in price, PEOD would be between
-1 and 0, and demand would be considered
to be inelastic.
This is indicated in Figure 1. The
more elastic is demand, the more demand
changes in response to a given change in
price and the flatter is the demand curve.
In the hypothetical example in Figure
1, as price rises from P1 to P2, quantity
demanded according to the elastic demand
function falls substantially from Q1 to Q2e.
Conversely, where demand is inelastic, the
Inelastic
Price Demand
Elastic
Demand
P2
P1
Q2e Q2i Q1
Figure 1. Two different demand functions setting out how the quantity of a product demanded relates
to the price charged
DentalPublicHealth
same price increase leads to a much smaller
fall in demand from Q1 to Q2i.
PEOD is influenced by things
like the availability of alternative products,
the amount of money spent on the product
in the first place, and the economic
circumstances of the consumers, which
determines how well placed they are to
afford the potential increase in spending
arising from the price increase.
PEOD also affects the impact of
a price increase on the value of sales. Elastic
demand leads to a fall in revenues when
prices rise because the proportionate fall in
demand exceeds the proportionate price
increase. In contrast, inelastic demand leads
to an increase in revenues even if demand
falls, because the size of the price increase,
in proportionate terms, is greater than
the fall in demand. For example, demand
for most alcohol products is estimated to
lie between 0 and -1 so the anticipated
effect of the increase in prices of cheap
alcohol caused by the implementation of
minimum unit pricing in Scotland is both a
fall in demand for such alcohol but also an
increase in revenues to retailers.20,21
It is important to note that
whether the levy itself leads to a price
change in the first place depends on
Demand/
Quantity
 DentalPublicHealth
whether producers choose to pay the levy,
reformulate products to avoid it, or pass
it on to consumers in higher prices. This
decision will partly be influenced by what
they believe PEOD to be: the more elastic
is demand, the less likely they will be to try
and pass it on to consumers.
On the basis of the available
evidence, the WHO report suggests that
demand for SSBs is generally elastic, with
price elasticities around -0.9 to -1.3, ie a rise
in price of 1% will lead to a fall in demand
of between 0.9% and 1.3%. SSBs are also a
targeted measure because individuals who
are high consumers of SSBs are also likely to
be more price responsive.22
The health effects of these
expected falls in consumption depend
on what consumers substitute for sugar-
sweetened beverages and whether
these products have harmful effects.
The alternative products consumed will
depend in part on relative prices, which will
themselves reflect differences in the taxes
or levies imposed on potential substitutes.
Taxing equally sugary alternatives to a
lesser degree may simply shift consumption
to equally harmful products.
Evidence around the effect
of SSB tax on consumption comes from
modelling studies of some country
case studies where such a tax has been
implemented and has shown some effect.
In Mexico, and other countries, there is
evidence that an excise tax on sugar-
sweetened beverages reduces demand.22
A SSB tax increasing prices by 10% to 20%
and above can reduce SSB consumption.23,24
More recent evidence
from modelling studies predicts that a
considerable reduction in SSB consumption
is more likely if the levy is set at 20%, a level
emphasized in the recent WHO report and
an Institute of Economic affairs (IEA) report
that illustrates how any lower level tax
(<20%) hasn’t been successful enough to
reduce consumption.22,25,26,27
Effect of SSB levy on general
and/or dental health outcomes
Almost all evidence to support
the health benefits of the SSB tax comes
from modelling studies which need to be
interpreted with caution. One of the key
reasons for this is either lack of robust
evaluations assessing health impacts of
480 DentalUpdate June 2017
such policies or, in most cases, a general
failure to achieve significant SSB reduction
successfully, mainly due to setting an
inadequate tax level (<20%) and/or not
supplementing it with other relevant
food policies (tax, subsidies, marketing
regulations, etc).22,28
Existing evidence suggests
that to reduce obesity and diet-related
diseases caused by high sugar intake, a
more comprehensive, structured and multi-
action approach (subsidies, ring-fencing
revenue, nutrient profiling, etc) is needed,
of which SSB tax could be the starting
point. So, although the evidence is limited
with respect to the effect of the SSB tax on
health outcomes, it is robust in pointing out
the health harming effects of existing levels
of sugar intake in the UK via SSBs in the
form of obesity and dental caries, especially
in children and adolescents.
Overall, theory and evidence
suggest that a sugary drinks levy will help
reduce consumption of a major source of
sugar and calories in children’s diets. In
addition, the move will hopefully have a
positive ripple effect here in the UK and
across the world, helping to strengthen
resolve to enact other measures which
further protect children’s health and
improve the environment in which they
grow up.
Effect of SSB levy/tax on health
inequalities in UK
Price increases on food items
usually have a greater impact on purchasing
decisions of low-income or vulnerable parts
of the population since they have to spend
a larger proportion of their income on food.
However, given the higher consumption
levels among low-income populations, it
may be that an SSB levy will be regressive,
ie lower income groups pay more in tax as
a proportion of their income than higher
income groups. But this depends on relative
price elasticities. A price elasticity of -1
suggests an increase in price of, say, 5%
will be matched by a fall in demand of 5%
such that the amount spent on the taxed
product would hardly change, especially
if, as the WHO report suggests, demand
would fall more in lower income groups,
because their price elasticity of demand is
larger. Overall, elasticities of this magnitude
suggest that the real effect in cash terms of
any regressivity would be modest.
This touches on another concern
sometimes expressed about taxes: so-called
‘income effects’ where taxes increase
expenditure on the taxed product and
reduce disposable income to spend on
other items. For lower income groups, these
may be necessities such as food, heating,
etc. But the extent of this effect depends on
whether and how much behaviour changes
to offset increases in prices. As noted above,
evidence suggests that demand for SSBs
responds to price, with elasticities of around
-1, and demand may become lower in lower
income groups, such that income effects are
minimal.
In addition, the levy could
benefit more vulnerable groups in health
terms as their increased responsiveness
to price could lead to a larger reduction in
SSB consumption. As such an SSB has the
potential to help reduce health inequalities.
The WHO concluded that ‘vulnerable
populations, including low-income
consumers, are most price-responsive
and, in terms of health, benefit most from
changes in the relative prices of foods and
beverages.’
Elasticities of this magnitude
also have implications for the argument
that taxes will reduce employment in the
soft drinks industry. The WHO suggests
that any net effects on employment will
be modest. Their impact can be reinforced
with subsidies on beneficial products. Some
evidence suggests that additional subsidies
or more choices of low priced substitutes
can help minimize the regressive impact
of such taxes.22,28,29 In addition, if they are
hypothecated, the revenues they produce
can be used to fund other complementary
measures to tackle sugar-related ill-health,
although the revenues collected will
depend on how much demand falls in
response to the tax- or levy-induced price
change.
Overall, therefore, levies, taxes
and other instruments that affect price
are potentially very effective. The devil,
however, in terms of their overall impacts
on consumption patterns and health, is in
the detail: detail regarding consumer and
producer behaviour, the scope and level of
the levy or tax and the price and availability
of close substitutes. The WHO conclude
that ‘there is reasonable and increasing
evidence that appropriately designed taxes

on sugar-sweetened beverages would result
in proportional reductions in consumption,
especially if aimed at raising the retail price
by 20% or more’. 22
Perhaps the most challenging
argument that is sometimes put forward
is about the ‘nanny-state’, ie the widely
reported antipathy to state interference in
consumers’ freedom of choice. This is both
a political argument and an economic issue.
The politics is for readers to decide where
they stand, although it is worth posing the
question about how ‘free’ choices really are,
given the extent of marketing compared to
the availability of clearly understandable
information on the sugar-content and
related harms of sugary drinks. This leads
into the economic argument. Economic
theory suggests freedom of choice is
efficient because it is the mechanism by
which productive resources are aligned
with what we, as consumers, value most,
as expressed through our purchasing
decisions. But this is predicated on the
idea of fully informed consumers having
complete knowledge of both the benefits
and the costs their decisions impose on
themselves and others. Where there is
reason to doubt this, taxes and subsidies
have been advocated in theory and used
in many contexts, to ensure that consumer
choices achieve an efficient allocation of
resources from a societal perspective.30,31
One other factor within Europe
is that the price of sugar is predicted
to drop in 2017 as regulation of sugar
markets changes and production quotas
within the EU are abolished. The EU
Common Agricultural Policy (CAP) has
been influencing the diets of consumers
by determining to a large extent the price
and availability of most foods. This includes
European produced sugar, almost entirely
from sugar beet. The 2013 CAP reforms
liberalize the EU sugar market, quotas will
be abolished and this will lower EU sugar
prices. The liberalization could also mean
that high-fructose corn syrup (HFCS), the
industrial liquid sweetener manufactured
from maize or corn, commonly used outside
Europe to sweeten beverages, will replace
sucrose from sugar beet. The result may be
that the sugar levy will have little financial
impact on the soft drinks industry as falling
sugar prices allow it to absorb the price rise
of the levy.16
June 2017 DentalUpdate 483
Conclusions
The sugar levy is a welcome
structural intervention. It is not a silver bullet
but, as part of a comprehensive approach,
it is a potentially effective government
measure to reduce the consumption of
sugar-sweetened carbonated soft drinks, and
to improve the health of the population.32
Food and water are essential
for life, whereas carbonated drinks, alcohol
and tobacco are not. There is no place for
carbonated drinks, either sugared or sugar-
free, in a healthy diet.
Disclaimer
The views presented in this article
are solely those of the authors.
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Restorative Dentistry
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www.birmingham.ac.uk/restorativedentistry
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sweetened beverages on caries and
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