Food Composition

We do not typically eat macronutrients in isolation; rather, we eat foods composed of macronutrients. Translation of caries science to clinical practice requires a thorough understanding of caries risk associated with macronutrients and macronutrient composition of foods (Figure 10). Proteins and fats are not subject to fermentation by oral bacteria, and therefore, are not cariogenic. Proteins and fats accompanied by calcium might have beneficial effects as the calcium could remineralize enamel or dentin. The likelihood of oral bacteria fermentation determines the individual carbohydrate risk. Complex carbohydrates are of limited caries risk, processed starches are of significant caries risk, and sugars and baked starches with sugars are of high caries risk. It is worth noting that the carbohydrate’s origin is not relevant to caries risk; oral bacteria do not distinguish natural or organic sugars. Thus, organic honey and/or raw sugar are highly cariogenic.

Figure 10. Caries Risk Based on Food Composition

Figure 10. Caries Risk Based on Food Composition

Most foods are composed of mixed macronutrients. The presence of fat and/or protein within a food or consuming foods high in fats/proteins as part of mixed meals can reduce the caries risk associated with carbohydrates. When evaluating the caries risk of food groups, it is important to consider the presence of carbohydrate as well as the degree of carbohydrate processing (Figure 11). In doing so, one can quickly identify the overall caries risk of a food. For example, fresh fruit contains several sugars; given the presence of fiber and water within the fruit, the caries risk associated with fresh fruits is minimal. Removal of either the water (dried fruit) which concentrates the sugars or fibrous material (juice) which produces a sugared beverage increases the caries risk compared to the original fruit.

Figure 11. Caries Risk by Food Group

Figure 11. Caries Risk by Food Group