My grandma went to her grave with no teeth. I made a full denture for my dad as a dental student. But you can take your natural teeth to your grave. Just before last Halloween, there was a sign near the elevator on my floor in my building in Greenwich Village asking the tenants to check a box if they welcome trick-or-treaters. That means our willingness to give children cavity-causing candy. In front of the box next to my apartment number I wrote, “Sorry, I am a dentist.”
Now Thanksgiving is over, and very soon, it will be the December holidays, all marked with unregulated consumption of sugary things. Cavities in teeth (also known as caries or tooth decay) are one of the most common chronic diseases of childhood in the United States and are directly linked to sugar intake. I am a public health professor and an epidemiologist who has done research on tooth decay around the world for over 42 years. Candy or added sugars and cavities have always been on top of my mind. Children lose teeth mostly due to cavities, and adults, due to gum disease and cavities. Both are preventable. Let me just focus on cavities here.
The average American adult, teenager, and child consume about 17 teaspoons of added sugar a day, or about 270 calories. That is about 132 pounds of added sugars per capita. The Dietary Guidelines for Americans for 2020-2025 advise that all Americans 2 years and older limit added sugars in the diet to less than 10 percent of total calories. The American Heart Association (AHA) also recommends that Americans drastically cut back on added sugar to help slow the obesity and heart disease epidemics. In February 2022, the European Food Safety Authority concluded that intakes of added and free sugars should be as low as possible. In addition to diabetes, obesity, and heart disease, these added sugars are also detrimental to your teeth.
I have seen rotten teeth of children from Sri Lanka to India, China, Thailand, the Caribbean, and both urban and rural America. Kids are not born with cavities. My 8-months old granddaughter has no teeth, so no cavities yet. I like to keep her cavity-free. Babies acquire cavities, a result of the bacterial action on sugar that produces acid, and lose their rotten teeth after much pain and suffering, with or without a visit to the emergency room or the OR and live with the consequences. Over 2 million dental-related emergency visits were there in 2018. Some may even die from untreated tooth decay, as happened to Deamonte Driver in Maryland in 2007.
Where are our American children in terms of cavities today? Nearly one-third of poor and minority American children still have untreated cavities in their baby teeth. Frequent consumption of free sugar is a major immediate or downstream cause of tooth decay. Upstream causes such as poverty, lack of education, and limited access to care also play a major role in the etiology of tooth decay.
Among the ways of reducing cavities include adding fluoride to drinking water. That was thought to be one of the major public health successes in the 20th century. Grand Rapids, Michigan, became the first U.S. city to fluoridate its public water supply in 1945. By 2018, 73.0 percent of the U.S. population was on community water systems, or 207,426,535 people had access to fluoridated water. But the use of bottled water with unknown amounts of fluoride may deprive children and adults of the benefit of added fluoride. It is not surprising that children go to school with untreated tooth decay or cavities.
Going to the dentist regularly also can help at least to increase awareness of good oral health, but children living at lower income levels are less likely to have had a dental visit in the previous year. Though most children brush their teeth at least once a day, frequent snacking on free sugar-containing food and drinking sugary beverages can put them at risk for cavities.
If you do not have private or public dental insurance, do not drink fluoridated water at home, can’t afford to pay out of pocket for dental care, or can’t get time off from work to take your child to the dentist, keep an eye on the amount of added sugar you give your child during and even after the holidays. Because unplanned urgent dental visits result in over 34 million lost school hours in the United States, complications from cavities such as pain and suffering, preventable OR visits, and other consequences may include rare death.
Ananda P. Dasanayake is a professor of epidemiology.
