Sugar and tooth decay

Most dentists and other health professionals worldwide agree that sugar is a major cause of tooth decay
"Sugar is the principal cause of the most common disease in industrialised countries, dental caries."
The Lancet Medical Journal, February 1983
The Lancet is a weekly peer-reviewed general medical journal. It is among the world's oldest, most prestigious, and best known general medical journals.
There is no doubt: sugar = tooth decay

In 1983, the Lancet Medical Journal made a profound public statement: “Sugar is the principal cause of the most common disease in industrialised countries, dental caries”. On 19 July 2019, The Lancet published a media release again emphasising sugar is the underlying cause of tooth decay. The following quotes were contained in this media release with an excerpt below:

“In Australia, dental caries affects 34% of five-and-six year-old children and 46.2% of nine-and-10-year olds. In older children with permanent dentition the prevalence is 9.2% among six to eight-year-olds and nearly 40% in 12 to 14-year-olds."
Professor Marco Peres
Professor Peres, from Menzies Health Institute Queensland and Griffith University’s School of Dentistry and Oral Health, is the only Australian academic in the international team of authors of the Lancet series.
"Sugar consumption continues to be the key driver in tooth decay, yet there seems to be an unwillingness to tackle this at the policy level. The average Australian teenager is consuming around 20 teaspoons of added sugar per day, more than triple the limit of 6 teaspoons recommended by the World Health Organisation. We need a range of measures to help people reduce their sugar consumption. This includes a tax on sugary drinks, with evidence around the world showing this is an effective way to reduce consumption. Many public health advocates now see sugar as the new tobacco, and we need to implement many of the measures that helped to reduce smoking rates – reducing advertising and marketing of sugary products, especially to children, ending sporting sponsorship of sugary drinks and improving food labelling to help consumers make healthy choices."
Associate Professor Matthew Hopcraft
CEO, Australian Dental Association Victorian Branch
Excerpt from a media release from The Lancet

19 July 2019

Sugar, alcohol and tobacco industries fuel global burden

The burden of oral diseases is on course to rise, as more people are exposed to the main risk factors of oral diseases. Sugar consumption, the underlying cause of tooth decay, is rising rapidly across many LMIC. While sugary drinks consumption is highest in HIC, the growth in sales of sugary drinks in many LMIC is substantial. By 2020, Coca-Cola intend to spend US$12 billion on marketing their products across Africa in contrast to WHO’s total annual budget of $4.4 billion (2017).

Professor Peres said there was debate in Australia regarding the effectiveness and appropriateness of having a ‘sugar tax’: “Many public health, academic and consumer groups support a tax on sugar, but political support is limited and there is a strong lobby against the implementation of a sugar tax led by sugary drinks companies.”

Professor Watt added: “The use of clinical preventive interventions such as topical fluorides to control tooth decay is proven to be highly effective, yet because it is seen as a ‘panacea’, it can lead to many losing sight of the fact that sugar consumption remains the primary cause of disease development. We need tighter regulation and legislation to restrict marketing and influence of the sugar, tobacco and alcohol industries, if we are to tackle the root causes of oral conditions.”

Writing in a linked commentary, Cristin E Kearns of the University of California and Lisa A Bero of the University of Sydney raise additional concerns with the financial links between dental research organisations and the industries responsible for many of these risk factors.

“Emerging evidence of industry influence on research agendas contributes to the plausibility that major food and beverage brands could view financial relationships with dental research organisations as an opportunity to ensure a focus on commercial applications for dental caries interventions—eg, xylitol, oral hygiene instruction, fluoridated toothpaste, and sugar-free chewing gum—while deflecting attention from harm caused by their sugary products.”

Lancet Series authors argue a pressing need exists to develop clearer and more transparent conflict of interest policies and procedures, and to restrict and clarify the influence of the sugar industry on dental research and oral health policy.

Radical reform of dentistry needed

Lancet Series authors have called for wholesale reform of the dental care model in five key areas:

1. Close the divide between dental and general healthcare
2. Educate and train the future dental workforce with an emphasis on prevention
3. Tackle oral health inequalities through a focus on inclusivity and accessibility
4. Take a stronger policy approach to address the underlying causes of oral diseases
5. Redefine the oral health research agenda to address gaps in LMIC knowledge

Sugar fact sheets
Unfortunate facts about sugar consumption in Australia
March 2018 Oral Health Tracker: 70.3% of children aged 9 to 13 and 73.1% of young people aged 14 to 18 are consuming too much sugar.