Sugar-sweetened Beverages (SSB)

OHCP have long used the terms ‘nursing bottle caries’ and ‘Mt Dew mouth’ to refer to dental caries specifically associated with extensive bottle use by infants and SSB intakes in older children and adults. In both disease processes, the anterior maxillary teeth experience significant decay often requiring extraction. In 2003 Marshall et al investigated associations among age 1-5 year beverage intakes, dairy food intakes, nutrient intakes, and overall diet quality and 5 year caries experience in participants of the Iowa Fluoride Study.¹⁶ They reported that high intakes sugar-sweetened soda-pop intake and beverages made from powders were associated with increased caries.¹⁶ They subsequently explored the meal or snack timing of individual beverages and reported that daily intakes of sugar-sweetened soda pop, but not 100% juice or milk/formula were associated with dental caries at 5 years of age.¹⁷ More recently, they explored the effect of age 1-17 year beverage intakes on caries at age 17 while controlling for fluoride intake, toothbrushing, sex, and socioeconomic status. They reported that each additional 8 oz of daily SSB increased the expected decayed, filled, surface attack rate (i.e., caries experience adjusted for tooth surfaces; DFSAR) by 42%, while each additional 8 oz of daily juice or water/sugar free beverage decreased expected DFSAR by 53% and 29%, respectively (Figure 8).¹⁸ It is unclear why juice which contains sugars is not associated with increased caries in this study; however, multiple other investigators have reported similar findings.^19,20

Figure 8. Marshall’s Age 17 Study¹⁸

Figure 8. Marshall’s Age 17 Study¹⁸