Dietary factors and dental caries

Articles were sourced using Medline, the Cochrane Library, reference lists of identified articles and selected textbooks.

Studies chosen for inclusion in the review were randomised or controlled clinical trials of at least 2 years' duration that used caries increment in the permanent or primary dentition as the end point. Publications in Danish, English, French, German, Italian, Norwegian, Spanish or Swedish were included. For multiply reported trials the one with the longest follow-up period was included.

Inclusion decisions and grading of the studies was carried out independently by two of the authors. The main outcome was caries increment and the measure of treatment effect was either relative risk reduction or prevented faction. A qualitative synthesis of the included studies was conducted.

Eighteen studies met the inclusion criteria. They included the total or partial substitution of sucrose with sugar substitutes or the addition of protective foods to chewing gum. No study could be found that had evaluated the effect of information designed to reduce sugar intake/frequency as a single preventive measure. It is suggested that the evidence for the use of sorbitol or xylitol in chewing gum, or for the use of invert sugar, is inconclusive. No caries-preventive effect was found from adding calcium phosphate or dicalcium phosphate dihydrate to chewing gums.

The review dearly demonstrates the need for well-designed randomised clinical studies, with adequate control groups and high compliance, looking at the effect of dietary measures on dental caries.