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Table 3 Studies on the dental caries risk associated with SSB consumption

From: The negative impact of sugar-sweetened beverages on children’s health: an update of the literature

Author, Year Setting Sample Size Sample Age Method of Diet Assessment SSB Unit of Analysis Primary Outcome Direction of Association Findings
Cross-Sectional Studies
Armfield, 2013 Australian children enrolled in school dental services 16,508 5-16 years Questionnaire given to parents asked about SSB consumption ≥3/day, 1-2/day vs. 0/day, (1 serving = “1 medium glass”) Decayed, missing and filled deciduous teeth (for ages 5-10)
Decayed, missing and filled permanent teeth (for ages 11-16)
Positive 5-10 years old
≥3 vs. 0 servings/day
β = 0.46 [95%CI: 0.29, 0.64]*
1-2 vs. 0 servings/day
β = 0.34 [95%CI: 0.23, 0.45]*
11-16 years old
≥3 vs. 0 servings/day
β = 0.27 [95%CI: 0.13, 0.41]*
1-2 vs. 0 servings/day
β = 0.16 [95%CI: 0.06, 0.26]*
Chi, 2015 Convenience sample of Alaska Native Yup’ik children 51 6-17 years Verbally administered survey, including questions on beverage consumption adapted from Beverage and Snack Questionnaire 40 grams/day of added sugar (i.e. amount of sugar in 12-ounce soda) measured using hair biomarker and self-report.
Note: Biomarker would include all sources of added sugar, not just liquid.
Proportion of carious tooth surfaces Mixed Biomarker:
6.4% [95%CI: 1.2, 11.6%]*
Self-Report:
Null. No measure of association reported.
Derlerck, 2008 Preschool children in four distinct geographical areas of Belgium 2533 3 and 5 year olds Questionnaire given to parents with structured open-ended questions about dietary habits Daily or more consumption of SSBs at night vs. none
Daily consumption of SSBs between meals vs. none
Odds of caries experience (using criteria from British Association for the Study of Community Dentistry) Positive SSB consumption at night
3 year-olds
OR= 7.96 [95%CI: 1.57, 40.51] *
5 year-olds
OR = 1.64 [95%CI: 0.18, 14.63]
SSB consumption between meals
3 year-olds
OR=1.47 [95%CI: 0.36, 6.04]
5-year olds
OR= 2.60 [95%CI: 1.16, 5.84] *
Evans, 2013 Low-income children recruited from pediatric dental clinics in D.C. and Ohio 883 2-6 years Parent-completed 24-hour recall and interviewer-administered FFQ Using 24-hour recall
1.7 to 14 servings SSB/day vs. 0 servings/day
Using FFQ
0.63 to 7 servings SSB/day vs. <0.16 servings/day (1 serving = 8 ounces)
Odds of severe early childhood caries Positive Using 24-hour recall
OR = 2.02 [95%CI: 1.33, 3.06]*
Using FFQ
OR = 4.63 [95%CI: 2.86, 7.49]*
Guido, 2011 Children from small rural villages in Mexico 162 2-13 years Questionnaire with questions about beverage consumption specific to ones sold in local stores Drinking soda at least onece/day Decayed, missing and filled deciduous teeth
Decayed, missing and filled permanent teeth
Positive No measures of association reported
p=0.71
p=0.04*
Hoffmeister, 2015 Random sample of children in southern Chile from a daycare center register 2987 2 and 4 years Survey filled out by parents with questions about sugary drink frequency >3 servings of sugary drinks/week at bedtime vs. ≤ 3 servings of sugar drinks/week at bedtime (1 serving = not reported) Prevalence ratio of decayed, missing and filled deciduous teeth Positive 2 year olds
PR = 1.43 [95%CI: 0.97, 2.10] *
4 year olds
PR = 1.30 [95%CI: 1.06, 1.59] *
Jerkovic, 2009 Children recruited from primary schools in northern region of the Netherlands, including low and high SES schools 301 6 and 10 years Questionnaire filled out by parents including information on nutritional care ≥5 glasses of fruit juice/soft drinks vs. ≤4 glasses of fruit juice/soft drinks Prevalence of caries Positive Measures of association not reported.
p<0.001 *
Jurzak, 2015 Pediatric patients from university dental clinic in Poland 686 1-6 years Questionnaire including questions about SSB consumption Frequent consumption of fruit juices and carbonated drinks vs. Infrequent consumption (1 serving = not reported) Odds of decayed, missing and filled teeth Mixed, depending on age 1-2 years old
2.60 [95%CI: 0.77, 8.74]
3-4 years old
2.23 [95%CI: 1.25, 3.96] *
5 years old
OR=2.134 [95%CI: 0.84, 5.44]
6 years old
OR= 2.25 [95%CI: 1.03, 4.92]*
Kolker, 2007 African American children with household incomes below 250% of the 2000 federal poverty level 436 3-5 years Block Kids FFQ Consumption of soda (1 serving = not reported) Odds of higher score of decayed, missing and filled deciduous teeth Null OR = 1.00 [95%CI: 1.0, 1.1]
Note: this result is for soda. See full paper for powdered drinks, sports drinks, fruit drinks, etc.
Lee, 2010 Convenience sample of healthy primary school children in Australia 266 4-12 years Prat Questionnaire asked about consumption of sweet drinks Sweet drinks consumed in the evening/night vs. no sweet drinks consumed Caries experience in past 12 months Positive 18% vs. 29%
p=0.004*
Measure of association not reported.
Majorana, 2014 Italian toddlers born to mothers attending two obstetric wards 2395 24-30 months Self-administered questionnaire for mothers with questions about SSB consumption ≥2 servings day vs. ≤1 servings of SSBs, (1 serving = 250mL) Odds of higher International Caries Detection and Assessment System score Positive OR = 1.18 [95%CI: 0.99-1.40]*
Mello, 2008 Sample of schoolchildren in Portugal 700 13 years Semi-quantitative FFQ ≥2 servings/week vs. ≤2 servings/week of soft drinks derived from cola, other soft drinks and any soft drinks (1 serving = not reported) Odds of ≥4 decayed, missing and filled teeth Positive Soft drinks from cola
OR = 2.23 [95%CI: 1.50, 3.31]*
Other soft drinks
OR = 1.54 [95%CI: 1.05, 2.26]*
Any soft drinks
OR = 1.88 [95%CI: 1.07, 3.29]*
Nakayama, 2015 Japanese infants 1675 18-23 months Questionnaire for parents or guardian with questions about SSB consumption Drinking soda ≥4 times/week vs. <4 times/week, (1 serving = not reported) Odds of early childhood caries Positive OR = 3.70 [95%CI: 1.07, 12.81] *
Pacey, 2010 Inuit preschool-aged children in Nunavut, Canada 388 3-5 years Past-month qualitative FFQ, 24-hour dietary recall (with repeat 24-hour recalls on 20% of sub-sample) Mean SSB consumption compared between groups of Reported Caries Experience Reported Caries Experience (RCE) Positive Mean SSB consumption /day among those with RCE
0.8 [SE=0.1]
Mean SSB consumption /day among those without RCE
0.5 [SE=0.1]
*Significant difference between groups.
Skinner, 2015 Random sample of adolescents in Australia 1187 14 to 15 years Questionnaire including questions about SSB consumption 0 cup of soft drinks or cordial vs. 1-2 cups per day vs. 3+ cups per day Mean decayed, missing and filled permanent teeth Positive 0 cups per day
Male: 1.14
Female: 0.81
1-2 cups per day
Male: 1.12
Female: 1.47
3+ cups per day
Male: 1.69
Female: 1.39
*Significant difference
between groups.
Measure of variation not reported
Note: this result is for soft drinks or cordial. See full paper for sweetened fruit juice, diet soft drinks and sports drinks.
Wilder, 2016 School-based sample of third grade students in Georgia, U.S. 2944 8 and 9 years Supplemental survey including questions about SSB consumption Increment of a serving/day of SSB, (1 serving = not reported) Prevalence ratio of caries experience Positive PR: 1.22 [95%CI: 1.13, 1.32]*
Longitudinal Studies
Lim, 2008 Low-income African American children in Detroit 369 3-5 years, followed-up 2 years later Block Kids FFQ Change from low SSB consumption cluster to high SSB consumption cluster vs. low consumers at both time periods Incident decayed, missing and filled deciduous teeth and incident filled surfaces at follow-up Positive New d 2 mfs:
IRR=1.75 [95%CI: 1.16, 2.64]*
New filled surface:
IRR=2.67 [95%CI: 1.36, 5.23]*
Park, 2015 U.S. children in Infant Feeding Practices Study II and Follow-up Study 1274 10-12 months, followed-up at 6 years of age 10 postpartum surveys through infancy, which asked about intake of SSBs during past 7 days Any SSBs vs. no SSBs during infancy
SSB introduction at or after 6 months, SSB introduction before 6 months vs. Never consumed SSBs during infancy
SSB consumption < 1 time/week, 1-3 times/week, ≥3 times/week vs. No SSBs
Dental caries in child’s lifetime at follow-up Mixed Any vs. No intake during infancy
OR = 1.14 [95%CI: 0.82, 1.57]
SSB intro at or after 6 months vs. no SSB
OR = 1.07 [95%CI: 0.76, 1.52]
SSB intro before 6 months vs. no SSB
OR = 1.29 [95%CI: 0.77, 2.17]
Consumed <1 time/week vs. No SSBs during infancy
OR = 1.15 [95%CI: 0.61, 2.18]
Consumed 1-3 times/week vs. No SSBs during infancy
OR = 0.85 [95%CI: 0.48, 1.49]
Consumed ≥3 times/week vs. No SSBs during infancy
OR = 1.83 [95%CI: 1.14, 2.92]*
Warren, 2009 Children in rural community in Iowa enrolled in WIC program 212 6-24 months, followed-up 9 and 18 months later Questionnaire asking about SSB consumption at each follow-up SSB consumption vs. no SSB consumption at baseline Odds of caries at 18-month follow-up Positive OR = 3.0 [95%CI: 1.1, 8.6]*
Warren, 2016 American Indian infants from Northern Plains Tribal community 232 Infants followed-up at 4, 8, 12, 16, 22, 28 and 36 months Validated beverage frequency questionnaire for parents adapted from Iowa Fluoride study, a 24-h dietary recall tool and food habit questionnaire Added-sugar beverage intake as proportion of total Odds of caries experience at follow-up Positive OR = 1.02 [95%CI: 1.00, 1.04]*
Watanabe, 2014 Japanese infants recruited from Kobe City Public Health Center 31,202 1.5 years, followed-up 21 months later (at ~3 years old) Questionnaire for parents asking about SSB consumption and frequency Daily SSB consumption vs. no SSB consumption, at baseline Odds of dental caries at 3-years Positive OR = 1.56 [95%CI: 1.46, 1.65]*
Wigen, 2015 Children in the Norwegian Mother and Child Cohort Study 1095 1.5 years, followed-up at 5 years old Questionnaire for parents asking about SSB consumption SSBs offered at least once a week vs. less than once a week, at 1.5 years Odds of decayed, missing and filled deciduous teeth Positive OR = 1.8 [95%CI: 1.1, 2.9]*
Intervention Studies
Author, Year Setting Sample Size Sample Age Intervention Control Primary Outcome Direction of Association Findings
Maupomé, 2010 American Indian toddlers in U.S. Four geographically separate tribal groups (3 intervention groups, 1 control group); Group A = 63 enrolled, 53 completed. Group B = 62 enrolled, 56 completed; Group C = 80 enrolled, 69 completed. Group D = NR. 18-30 months, 3-pronged approach: 1) increase breastfeeding, 2) limit SSB consumption, 3) promote consumption of water for thirst
Each intervention group measured at pre and post; also compared to control group to account for secular trends
No intervention received. Post-pre difference in fraction of affected mouths by incident caries (d1t and d2t) Positive d1t
Group A:
-0.574 [SDE: 0.159]*
Group B:
-0.300 [SDE: 0.140]*
Group C:
-0.631 [0.157]*
d2t
Group A:
-0.449 [SDE: 0.180]*
Group B:
-0.430 [SDE: 0.153]*
Group C:
-0.342 [SDE: 0.181]
  1. Note: * indicates statistical significance (p<0.05) as reported by each study