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Research and clinical experience have shown that abundant and frequent exposures to dietary fermentable substances enhance the ability of cariogenic bacteria to implant, colonize and increase acid production, which facilitates the carious process. Initial implantation and colonization of mutans streptococci is made possible even if the amounts of sucrose, a sugar commonly used in food manufacture, are very low. Thus, colonization is mainly influenced by the interaction of specific biochemical properties of the cariogenic bacterial strains with dietary substrates and the oral ecological environment.

Once cariogenic bacteria are established in dental plaque, their metabolic activity is stimulated by increases in the intake of fermentable carbohydrates but modulated by: 

  • the type of food containing sugars or starches consumed; 
  • the frequency of intake of such foods;
  • oral hygiene status;
  • availability of fluoride; 
  • salivary gland function;
  • saliva composition; and 
  • other host factors.
Considering the ubiquity of cariogenic bacteria in most population groups, frequent consumption of sugar-containing foods, medications and chewing substances are recognized as having a strong potential to increase the risk of dental caries, although the severity and magnitude of the caries challenge produced by these foods varies between individuals and population groups.

In light of current laboratory and epidemiological research findings, the Association recognizes that it is neither advisable nor appropriate to eliminate from the American diet sugar-containing foods that provide necessary energy value for optimal nutrition. However, it strongly recommends that major efforts be made to eliminate sugars from oral suspensions, chewable tablets, pastilles and troches and to promote the use of sugar-free foods or chewing substances in place of sugar containing foods that involve a frequent intake or repeated oral use. In these circumstances, use of these sugar-free foods will contribute to improved oral health without any deleterious nutritional consequences.

November 01, 1999 

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Page Updated: June 05, 2002