Frequent sugar intake--then and now: interpretation of the main results

The Vipeholm Study is a unique diet-caries interventional study that has earned its place as a citation classic. One of the findings, that quantity of sugar consumed at meals in a non-sticky form had little influence on caries rate, has often been misinterpreted, as it is based on an institutional population under supervised dietary control. The other main finding, that sugary foods consumed in a sticky form at high frequency between meals are highly cariogenic, is generally accepted. Although the Vipeholm Study has been criticized on ethical grounds, relatively fewer teeth were extracted for caries than are currently extracted in an adult population. The results of two modern studies in Northumberland, UK, and Michigan, USA, on the relationship between dietary habits and caries increments in children have been compared with the Vipeholm findings. Currently the correlations between dietary habits and caries increments are low because of the low caries increments and relatively small differences in dietary patterns in non-interventional conditions. High frequency of snacking is uncommon and use of topical fluoride agents (dentifrices, rinses) is widespread. However, for the caries-susceptible person, between-meal consumption of sugary foods is still a risk factor.