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2023-11-22 19:13:01
9 November 2017
Key facts
- Dental caries (also known as tooth decay or dental cavities) is the most
common noncommunicable disease worldwide.
- Severe dental caries affects general health and often causes pain and
infection, which may result in tooth extraction.
- Dental caries is an expensive disease to treat, consuming 5 10% of healthcare
budgets in industrialized countries, and is among the main reasons for
hospitalization of children in some high-income countries.
- Free sugars are the essential dietary factor in the development of dental
caries. Dental caries develops when bacteria in the mouth metabolize sugars to
produce acid that demineralizes the hard tissues of the teeth (enamel and
dentine).
- In many countries, sugars-sweetened beverages, including fruit-based and
milk-based sweetened drinks and 100% fruit juices, are a primary source of free
sugars, as well as confectionery, cakes, biscuits, sweetened cereals, sweet
desserts, sucrose, honey, syrups and preserves.
- Limiting free sugars intake to less than 10% of total energy intake and
ideally even further, to less than 5% minimizes the risk of dental caries
throughout the lifecourse.
- Severe dental caries is a frequent cause of absenteeism at school or work. An
association between dental caries and undernutrition in children has been
reported in some low- and middle-income countries; however, whether this is
cause or effect, or both, remains to be determined.
Dental caries is a major public health problem globally and is the most
widespread noncommunicable disease (NCD). It is also the most prevalent
condition included in the 2015 Global Burden of Disease Study, ranking first
for decay of permanent teeth (2.3 billion people) and 12th for deciduous teeth
(560 million children).
Dental caries can be prevented by avoiding dietary free sugars. Moreover,
dental caries is largely preventable through simple and cost-effective
population-wide and individual interventions, whereas treatment is costly, and
is often unavailable in low- and middle-income countries.
Teeth affected by caries are often extracted (pulled out) when they cause pain
or discomfort.
Severe dental caries can impair quality of life, including difficulties in
eating and sleeping, and in its advanced stages (abscesses), it may result in
pain and chronic systemic infection or adverse growth patterns. Tooth decay is
a frequent cause of absence from school or work.
Risk factors
Everyone is at risk of dental caries, but children and adolescents are most at
risk. Almost half of the world s population is affected by dental caries,
making it the most prevalent of all health conditions. High levels of dental
caries occur in middle-income countries, where sugars consumption is high. The
majority of dental caries occurs in adults because the disease is cumulative.
There is a clear dose-response relationship between sugars consumption and
dental caries. The disease is also associated with socioeconomic status, with
high prevalence rates among the poor and disadvantaged population groups.
Dental caries develops over time; loss of tooth substance (enamel and dentine)
is caused by acid production resulting from bacterial metabolism of sugars.
Early stages are often without symptoms, but advanced stages of dental caries
may lead to pain, infections and abscesses, or even sepsis.
It has been estimated that, globally in 2010, US$ 298 billion was spent on
direct costs associated with dental caries. In addition, indirect costs came to
US$ 144 billion, with the total financial cost reaching US$ 442 billion in
2010.
Prevention and control
Population-wide strategies to reduce free sugars consumption are the key public
health approach that should be a high and urgent priority. Because dental
caries is the result of lifelong exposure to a dietary risk factor (i.e. free
sugars), even a small reduction in the risk of dental caries in childhood is of
significance in later life; therefore, to minimize the lifelong risk of dental
caries, free sugars intake should be as low as possible.
It is important that population-wide prevention interventions are universally
available and accessible. Such interventions include the use of fluoride and
comprehensive patient-centred essential oral health care.
Challenges
Dental caries disproportionally affect poor and disadvantaged populations,
which have lower access to prevention and care. Often, dental caries does not
receive adequate priority in health planning due to an underestimation of the
true burden and impact of the disease. The focus of interventions is generally
characterized by an isolated disease approach and a focus on costly clinical
treatment, rather than on integrated cost-effective public health strategies
that address entire populations and focus on common risk factors for NCDs.
Economic growth is associated with increased access to sugar-sweetened
beverages and other dietary sources of free sugars. Increased availability of
sugars in the absence of adequate oral health preventive measures is associated
with a marked increase in the burden of oral disease.
WHO response
WHO works with Member States and partners on policies and programs to reduce
dental caries as part of work to prevent noncommunicable diseases. Key policies
include:
- taxation of sugar-sweetened beverages and foods with high free sugar content;
- implementing clear nutrition labelling, including the information on sugars
contained in a product;
- regulating all forms of marketing and advertising of food and beverages high
in free sugars to children;
- improving the food environment in public institutions, particularly schools,
through regulating sales of foods and beverages high in free sugars; and
- prioritizing awareness and access to clean water as a drink that is safe for
teeth .
Implementation of public health strategies to promote the use of fluoride
should also be encouraged, although it does not completely prevent dental
caries if implemented as a sole (i.e. an isolated) action. Addressing the cause
(i.e. free sugars) is therefore essential in preventing and reducing dental
caries.
[1] The severity of dental caries may be measured by using indices such as the
DMFT/dmft index (where upper case denotes permanent dentition and lower case
primary dentition), which records the number of decayed (D), missing (M) and
filled (F) teeth.
[2] Free sugars include all monosaccharides and disaccharides added to foods
and drinks by the manufacturer, cook or consumer, and sugars naturally present
in honey, syrups, fruit juices and fruit juice concentrates (WHO Guideline on
sugars intake for adults and children:
https://www.who.int/publications-detail/9789241549028/
).
https://www.who.int/news-room/fact-sheets/detail/sugars-and-dental-caries