The Role of Diet and Oral Hygiene in Dental Caries

  • Carlos Alberto Feldens
  • Paulo F. Kramer
  • Fabiana Vargas-Ferreira


This chapter aims to address the aspects involved in the relationship between dietary practices and dental caries, such as early introduction of sucrose, frequency and quantity of free sugars consumed. These concepts will be illustrated by previous community experiences in promoting healthy eating practices that have been proposed to prevent dental caries. Additionally, this chapter will address the role of oral hygiene in biofilm control with special emphasis to oral hygiene counselling as a strategy with potential to contribute to the prevention and control of carious lesions. Guidelines for promoting healthy eating practices and oral hygiene will be discussed according to each stage of child growth and development, always recognising the role of the family and the environment throughout the process. In this way, we intend to contribute to the understanding of the aetiology of dental caries as well as in the elaboration and implementation of strategies for prevention and control of the disease.


Dental caries Child Diet, cariogenic Oral hygiene 


  1. 1.
    Glick M, Williams DM, Kleinman DV, Vujicic M, Watt RG, Weyant RJ. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. Int Dent J. 2016;66(6):322–4.CrossRefGoogle Scholar
  2. 2.
    Feldens CA, Ardenghi TM, Dos Santos Dullius AI, Vargas-Ferreira F, Hernandez PA, Kramer PF. Clarifying the impact of untreated and treated dental caries on oral health-related quality of life among adolescents. Caries Res. 2016;50(4):414–21.CrossRefGoogle Scholar
  3. 3.
    Chaffee BW, Rodrigues PH, Kramer PF, Vítolo MR, Feldens CA. Oral health-related quality-of-life scores differ by socioeconomic status and caries experience. Community Dent Oral Epidemiol. 2017;45(3):216–24.CrossRefGoogle Scholar
  4. 4.
    Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res. 2017;96(4):380–7.CrossRefGoogle Scholar
  5. 5.
    WHO. Guideline: sugars intake for adults and children. Geneva: World Health Organization; 2015.Google Scholar
  6. 6.
    Carmo CDS, Ribeiro MRC, Teixeira JXP, Alves CMC, Franco MM, França AKTC, Benatti BB, Cunha-Cruz J, Ribeiro CCC. Added sugar consumption and chronic oral disease burden among adolescents in Brazil. J Dent Res. 2018;97(5):508–14.CrossRefGoogle Scholar
  7. 7.
    Fejerskov O. Concepts of dental caries and their consequences for understanding the disease. Community Dent Oral Epidemiol. 1997;25(1):5–12.CrossRefGoogle Scholar
  8. 8.
    Fisher-Owens SA, Gansky SA, Platt LJ, Weintraub JA, Soobader MJ, Bramlett MD, Newacheck PW. Influences on children’s oral health: a conceptual model. Pediatrics. 2007;120(3):e510–20.CrossRefGoogle Scholar
  9. 9.
    Seow KW. Environmental, maternal, and child factors which contribute to early childhood caries: a unifying conceptual model. Int J Paediatr Dent. 2012;22(3):157–68.CrossRefGoogle Scholar
  10. 10.
    Gustafsson BE, Quensel CE, Lanke LS, Lundqvist C, Grahnen H, Bonow BE, Krasse B. The Vipeholm dental caries study: the effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontol Scand. 1954;11(3–4):232–64.PubMedGoogle Scholar
  11. 11.
    Sullivan HR, Goldsworthy NE. Review and correlation of the data presented in papers 1–6 (Hopewood house study). Aust Dent J. 1958;3(6):395–8.CrossRefGoogle Scholar
  12. 12.
    Weiss RL, Trithart AH. Between-meal eating habits and dental caries experience in preschool children. Am J Publ Health. 1960;50:1097–104.CrossRefGoogle Scholar
  13. 13.
    Sheiham A, James WP. Diet and dental caries: the pivotal role of free sugars reemphasized. J Dent Res. 2015;94(10):1341–7.CrossRefGoogle Scholar
  14. 14.
    Peres MA, Sheiham A, Liu P, Demarco FF, Silva AE, Assunção MC, Menezes AM, Barros FC, Peres KG. Sugar consumption and changes in dental caries from childhood to adolescence. J Dent Res. 2016;95(4):388–94.CrossRefGoogle Scholar
  15. 15.
    Fejerskov O, Kidd E. Dental caries: the disease and its clinical management. 2nd ed. Hoboken: Wiley; 2009. p. 640.Google Scholar
  16. 16.
    Loesche WJ. Role of Streptococcus mutans in human dental decay. Microbiol Rev. 1986;50(4):353–80.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Bowen WH, Eastoe JE, Cock DJ. The effect of sugar solutions on the pH of plaque in caries-active monkeys (Macaca irus). Arch Oral Biol. 1966;11(8):833–8.CrossRefGoogle Scholar
  18. 18.
    Zero DT, van Houte J, Russo J. The intra-oral effect on enamel demineralization of extracellular matrix material synthesized from sucrose by Streptococcus mutans. J Dent Res. 1986;65(6):918–23.CrossRefGoogle Scholar
  19. 19.
    Rölla G. Why is sucrose so cariogenic? The role of glucosyltransferase and polysaccharides. Scand J Dent Res. 1989;97(2):115–9.PubMedGoogle Scholar
  20. 20.
    Marsh PD. Microbial ecology of dental plaque and its significance in health and disease. Adv Dent Res. 1994;8(2):263–71.CrossRefGoogle Scholar
  21. 21.
    Cury JA, Rebello MA, Del Bel Cury AA. In situ relationship between sucrose exposure and the composition of dental plaque. Caries Res. 1997;31(5):356–60.CrossRefGoogle Scholar
  22. 22.
    Paes Leme AF, Koo H, Bellato CM, Bedi G, Cury JA. The role of sucrose in cariogenic dental biofilm formation—new insights. J Dent Res. 2006;85(10):878–87.CrossRefGoogle Scholar
  23. 23.
    Chaffee BW, Feldens CA, Rodrigues PH, Vítolo MR. Feeding practices in infancy associated with caries incidence in early childhood. Community Dent Oral Epidemiol. 2015;43(4):338–48.CrossRefGoogle Scholar
  24. 24.
    Feldens CA, Rodrigues PH, de Anastácio G, Vítolo MR, Chaffee BW. Feeding frequency in infancy and dental caries in childhood: a prospective cohort study. Int Dent J. 2018;68(2):113–21. Google Scholar
  25. 25.
    Wan AK, Seow WK, Purdie DM, Bird PS, Walsh LJ, Tudehope DI. A longitudinal study of Streptococcus mutans colonization in infants after tooth eruption. J Dent Res. 2003;82(7):504–8.CrossRefGoogle Scholar
  26. 26.
    Newbrun E. Sucrose in the dynamics of the carious process. Int Dent J. 1982;32(1):13–23.PubMedGoogle Scholar
  27. 27.
    Zhao W, Li W, Lin J, Chen Z, Yu D. Effect of sucrose concentration on sucrose-dependent adhesion and glucosyltransferase expression of S. mutans in children with severe early-childhood caries (S-ECC). Nutrients. 2014;6(9):3572–86.CrossRefGoogle Scholar
  28. 28.
    Ventura AK, Worobey J. Early influences on the development of food preferences. Curr Biol. 2013;23(9):R401–8.CrossRefGoogle Scholar
  29. 29.
    Birch LL. Development of food acceptance patterns in the first years of life. Proc Nutr Soc. 1998;57(4):617–24.CrossRefGoogle Scholar
  30. 30.
    Skinner JD, Carruth BR, Wendy B, Ziegler PJ. Children’s food preferences: a longitudinal analysis. J Am Diet Assoc. 2002;102(11):1638–47.CrossRefGoogle Scholar
  31. 31.
    Wendt LK, Hallonsten AL, Koch G, Birkhed D. Analysis of caries-related factors in infants and toddlers living in Sweden. Acta Odontol Scand. 1996;54(2):131–7.CrossRefGoogle Scholar
  32. 32.
    Grytten J, Rossow I, Holst D, Steele L. Longitudinal study of dental health behaviors and other caries predictors in early childhood. Community Dent Oral Epidemiol. 1988;16(6):356–9.CrossRefGoogle Scholar
  33. 33.
    Paunio P, Rautava P, Helenius H, Alanen P, Sillanpää M. The Finnish Family Competence Study: the relationship between caries, dental health habits and general health in 3-year-old Finnish children. Caries Res. 1993;27(2):154–60.CrossRefGoogle Scholar
  34. 34.
    Rajab LD, Hamdan MA. Early childhood caries and risk factors in Jordan. Community Dent Health. 2002;19(4):224–9.PubMedGoogle Scholar
  35. 35.
    Baric L, Blinkhorn AS, MacArthur G. A health education approach to nutrition and dental health education. Health Educ J. 1974;33(3):79–90.CrossRefGoogle Scholar
  36. 36.
    Grindefjord M, Dahllöf G, Nilsson B, Modéer T. Stepwise prediction of dental caries in children up to 3.5 years of age. Caries Res. 1996;30(4):256–66.CrossRefGoogle Scholar
  37. 37.
    Milgrom P, Riedy CA, Weinstein P, Tanner AC, Manibusan L, Bruss J. Dental caries and its relationship to bacterial infection, hypoplasia, diet, and oral hygiene in 6- to 36-month-old children. Community Dent Oral Epidemiol. 2000;28(4):295–306.CrossRefGoogle Scholar
  38. 38.
    Tsai AI, Chen CY, Li LA, Hsiang CL, Hsu KH. Risk indicators for early childhood caries in Taiwan. Community Dent Oral Epidemiol. 2006;34(6):437–45.CrossRefGoogle Scholar
  39. 39.
    Thylstrup A, Fejerskov O. Carologia clínica. 2nd ed. São Paulo: Santos; 1995.Google Scholar
  40. 40.
    Feldens CA, Giugliani ERJ, Vigo A, Vítolo MR. Early feeding practices and severe early childhood caries in four-year-old children from Southern Brazil: a birth cohort study. Caries Res. 2010;44(5):445–52.CrossRefGoogle Scholar
  41. 41.
    Tham R, Bowatte G, Dharmage SC, Tan DJ, Lau MX, Dai X, Allen KJ, Lodge CJ. Breastfeeding and the risk of dental caries: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):62–84.CrossRefGoogle Scholar
  42. 42.
    Peres KG, Chaffee BW, Feldens CA, Flores-Mir C, Moynihan P, Rugg-Gunn A. Breastfeeding and oral health: evidence and methodological challenges. J Dent Res. 2018;97(3):251–8. Google Scholar
  43. 43.
    Tanaka K, Miyake Y, Sasaki S, Hirota Y. Infant feeding practices and risk of dental caries in Japan: the Osaka maternal and child health study. Pediatr Dent. 2013;35(3):267–71.PubMedGoogle Scholar
  44. 44.
    Chaffee BW, Feldens CA, Vítolo MR. Association of long-duration breastfeeding and dental caries estimated with marginal structural models. Ann Epidemiol. 2014;24(6):448–54.CrossRefGoogle Scholar
  45. 45.
    Nirunsittirat A, Pitiphat W, McKinney CM, DeRouen TA, Chansamak N, Angwaravong O, et al. Breastfeeding duration and childhood caries: a cohort study. Caries Res. 2016;50(5):498–507.CrossRefGoogle Scholar
  46. 46.
    Peres KG, Nascimento GG, Peres MA, Mittinty MN, Demarco FF, Santos IS, Matijasevich A, Barros AJD. Impact of prolonged breastfeeding on dental caries: a population-based birth cohort study. Pediatrics. 2017;140(1):e20162943.CrossRefGoogle Scholar
  47. 47.
    Hallett KB, O'Rourke PK. Pattern and severity of early childhood caries. Community Dent Oral Epidemiol. 2006;34(1):25–35.CrossRefGoogle Scholar
  48. 48.
    Bernabé E, Vehkalahti MM, Sheiham A, Lundqvist A, Suominen AL. The shape of the dose-response relationship between sugars and caries in adults. J Dent Res. 2016;95(2):167–72.CrossRefGoogle Scholar
  49. 49.
    Food and Agriculture Organization of the United Nations. Guidelines on the collection of information on food processing through food consumption surveys. Rome: FAO; 2015.Google Scholar
  50. 50.
    Kiwanuka SN, Astrom AN, Trovik TA. Dental caries experience and its relationship to social and behavioural factors among 3-5-year-old children in Uganda. Int J Paediatr Dent. 2004;14(5):336–46.CrossRefGoogle Scholar
  51. 51.
    Karjalainen S, Söderling E, Sewón L, Lapinleimu H, Simmel O. A prospective study of sucrose consumption, visible plaque and caries in children from 2 to 6 years of age. Community Dent Oral Epidemiol. 2001;29(2):136–42.CrossRefGoogle Scholar
  52. 52.
    Martens L, Vanobbergen J, Willems S, Aps J, De Maeseneer J. Determinants of early childhood caries in a group of inner-city children. Quintessence Int. 2006;37(7):527–36.PubMedGoogle Scholar
  53. 53.
    King JM. Patterns of sugar consumption in early infancy. Community Dent Oral Epidemiol. 1978;6(2):47–52.CrossRefGoogle Scholar
  54. 54.
    WHO. Global nutrition targets 2025: childhood overweight policy brief (WHO/NMH/NHD/14.6). Geneva: World Health Organization; 2014.Google Scholar
  55. 55.
    Vitolo MR, Bortolini GA, Feldens CA, Drachler ML. Impacts of the 10 steps to healthy feeding in infants: a randomized trial. Cad Saude Publica. 2005;21(5):1448–57.CrossRefGoogle Scholar
  56. 56.
    Feldens CA, Vitolo MR, Drachler ML. A randomized trial of the effectiveness of home visits in preventing early childhood caries. Community Dent Oral Epidemiol. 2007;35(3):215–23.CrossRefGoogle Scholar
  57. 57.
    Feldens CA, Giugliani ERJ, Duncan BB, Drachler ML, Vítolo MR. Long-term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial. Community Dent Oral Epidemiol. 2010;38(4):324–32.CrossRefGoogle Scholar
  58. 58.
    Chaffee BW, Feldens CA, Vítolo MR. Cluster-randomized trial of infant nutrition training for caries prevention. J Dent Res. 2013;92(7 Suppl):S29–36.CrossRefGoogle Scholar
  59. 59.
    McGill R, Anwar E, Orton L, Bromley H, Lloyd-Williams F, O'Flaherty M, Taylor-Robinson D, Guzman-Castillo M, Gillespie D, Moreira P, Allen K, Hyseni L, Calder N, Petticrew M, White M, Whitehead M, Capewell S. Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health. 2015;15:457.CrossRefGoogle Scholar
  60. 60.
    Andreyeva T, Long MW, Brownell KD. The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. Am J Public Health. 2010;100(2):216–22.CrossRefGoogle Scholar
  61. 61.
    Schwendicke F, Thomson WM, Broadbent JM, Stolpe M. Effects of taxing sugar-sweetened beverages on caries and treatment costs. J Dent Res. 2016;95(12):1327–32.CrossRefGoogle Scholar
  62. 62.
    Watt RG. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiol. 2007;35(1):1–11.CrossRefGoogle Scholar
  63. 63.
    Von der Fehr FR, Löe H, Theilade E. Experimental caries in man. Caries Res. 1970;4(2):131–48.CrossRefGoogle Scholar
  64. 64.
    Holmen L, Thylstrup A, Ogaard B, Kragh F. A scanning electron microscopic study of progressive stages of enamel caries in vivo. Caries Res. 1985;19(4):355–67.CrossRefGoogle Scholar
  65. 65.
    Peres MA, Latorre MRDO, Sheiham A, Peres KGA, Barros FC, Hernandez PG, Maas AMN, Romano AR, Victora CG. Social and biological early life influences on severity of dental caries in children aged 6 years. Community Dent Oral Epidemiol. 2005;33(1):53–63.CrossRefGoogle Scholar
  66. 66.
    Reisine ST, Psoter W. Socioeconomic status and selected behavioral determinants as risk factors for dental caries. J Dent Educ. 2001;65(10):1009–16.PubMedGoogle Scholar
  67. 67.
    Blinkhorn AS, Gratrix D, Holloway PJ, Wainwright-Stringer YM, Ward SJ, Worthington HV. A cluster randomized, controlled trial of the value of dental health educators in general dental practice. Br Dent J. 2003;195(7):395–400.CrossRefGoogle Scholar
  68. 68.
    Hilgert LA, Leal SC, Mulder J, Creugers NH, Frencken JE. Caries-preventive effect of supervised toothbrushing and sealants. J Dent Res. 2015;94(9):1218–24.CrossRefGoogle Scholar
  69. 69.
    Sheiham A, Nicolau B. Evaluation of social and psychological factors in periodontal disease. Periodontology. 2005;39:118–31.CrossRefGoogle Scholar
  70. 70.
    Peres MA, Peres KG, Barros AJD, Victora CG. The relation between family socioeconomic trajectories from childhood to adolescence and dental caries and associated oral behaviours. J Epidemiol Community Health. 2007;61(2):141–14.CrossRefGoogle Scholar
  71. 71.
    Peres MA, Peres KG, Thomson WM, Broadbent JM, Gigante DP, Horta BL. The influence of family income trajectories from birth to adulthood on adult oral health: findings from the 1982 Pelotas birth cohort. Am J Public Health. 2011;101(4):730–6.CrossRefGoogle Scholar
  72. 72.
    Horowitz HS. The prevention of oral disease. Established methods of prevention. Br Dent J. 1980;149(11):311–8.CrossRefGoogle Scholar
  73. 73.
    Petersen PE, Peng B, Tai B, Bian Z, Fan M. Effect of a school-based oral health education programme in Wuhan City, Peoples Republic of China. Int Dent J. 2004;54(1):33–41.CrossRefGoogle Scholar
  74. 74.
    Stein C, Santos NML, Hilgert JB, Hugo FN. Effectiveness of oral health education on oral hygiene and dental caries in schoolchildren: systematic review and meta-analysis. Community Dent Oral Epidemiol. 2018;46(1):30–7.CrossRefGoogle Scholar
  75. 75.
    Axelsson P, Lindhe J. The effect of a preventive programme on dental plaque, gingivitis an caries in schoolchildren. Results after one and two years. J Clin Periodontol. 1974;1(2):126–38.CrossRefGoogle Scholar
  76. 76.
    Axelsson P, Lindhe J, Nyström B. On the prevention of caries and periodontal disease. Results of a 15-year longitudinal study in adults. J Clin Periodontol. 1991;18(3):182–9.CrossRefGoogle Scholar
  77. 77.
    Poulsen S, Agerbaek N, Melsen B, Korts DC, Glavind L, Rölla G. The effect of professional toothcleaning on gingivitis and dental caries in children after 1 year. Community Dent Oral Epidemiol. 1976;4(5):195–9.CrossRefGoogle Scholar
  78. 78.
    Kjaerheim V, von der Fehr FR, Poulsen S. Two-year study on the effect of professional tooth cleaning on schoolchildren in Oppegaard, Norway. Community Dent Oral Epidemiol. 1980;8(8):401–6.CrossRefGoogle Scholar
  79. 79.
    Cury JA, Tenuta LMA, Ribeiro CCC, Paes Leme AF. The importance of fluoride dentifrices to the current dental caries prevalence in Brazil. Braz Dent J. 2004;15(3):167–74.CrossRefGoogle Scholar
  80. 80.
    Sjögren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 2008;56(11):2124–30.CrossRefGoogle Scholar
  81. 81.
    Broadbent JM, Thomson WM, Boyens JV, Poulton R. Dental plaque and oral health during the first 32 years of life. J Am Dent Assoc. 2011;142(4):415–26.CrossRefGoogle Scholar
  82. 82.
    Carvalho JC, Ekstrand KR, Thylstrup A. Dental plaque and caries on occlusal surfaces of first permanent molars in relation to stage of eruption. J Dent Res. 1989;68(5):773–9.CrossRefGoogle Scholar
  83. 83.
    Marquezan M, Marquezan M, Faraco-Junior IM, Feldens CA, Kramer PF, Ferreira SH. Association between occlusal anomalies and dental caries in 3- to 5 year-old Brazilian children. J Orthod. 2011;38(1):8–14.CrossRefGoogle Scholar
  84. 84.
    Hujoel PP, Cunha-Cruz J, Banting DW, Loesche WJ. Dental flossing and interproximal caries: a systematic review. J Dent Res. 2006;85(4):298–305.CrossRefGoogle Scholar
  85. 85.
    Oliveira KMH, Nemezio MA, Romualdo PC, da Silva RAB, de Paula E, FWG S, Küchler EC. Dental flossing and proximal caries in the primary dentition: a systematic review. Oral Health Prev Dent. 2017;15(5):427–34.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Carlos Alberto Feldens
    • 1
  • Paulo F. Kramer
    • 1
  • Fabiana Vargas-Ferreira
    • 2
  1. 1.Department of Pediatric DentistryUniversidade Luterana do BrasilCanoasBrazil
  2. 2.Department of Community and Preventive DentistryUniversidade Federal de Minas GeraisBelo HorizonteBrazil

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