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Updated: Sep 1, 2025

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Free sugars and early childhood caries development: a prospective cohort study
K Boustedt1, J Roswall2,3, S Twetman4
1Maxillofacial Unit, Halland Hospital Halmstad, Halmstad, Sweden.
Summary
Giving children under two years old free sugars in foods and drinks significantly increases their risk of early childhood caries by age five. Limiting sugar intake early is crucial for preventing dental problems.
Area of Science:
- Pediatric Dentistry
- Public Health Nutrition
- Epidemiology
Background:
- Early childhood caries (ECC) is a prevalent issue affecting young children's oral health.
- Dietary habits established in early life significantly influence long-term health outcomes, including dental health.
Purpose of the Study:
- To examine the association between early-life exposure to free sugars in foods and beverages and the incidence of early childhood caries (ECC) by age five.
- To provide evidence-based recommendations for caregivers and healthcare professionals regarding sugar consumption in children under two years old.
Main Methods:
- A cohort study involving 208 children, tracking feeding habits and dietary intake from birth to 24 months via questionnaires.
- Dental caries assessment (decayed, missed, filled teeth) using WHO criteria at five years of age.
- Statistical analysis using chi-square tests and relative risk (RR) with 95% confidence intervals to determine associations.
Main Results:
- Twenty-two percent of children developed caries by age five.
- Consumption of fruit juice with meals (RR 2.3), cookies/biscuits at 24 months (RR 2.4), and weekly fast food intake (RR 2.9) significantly increased ECC risk.
- These dietary factors more than doubled the risk for early childhood caries.
Conclusions:
- A clear link exists between early-life free sugar consumption and the prevalence of dental caries at age five.
- Emphasizing current sugar recommendations in primary and dental care is vital.
- Educating caregivers to avoid offering free sugars to children before the age of two is recommended to prevent ECC.
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