ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In The Era of Increased Fluoride Usage, Between-Meal Snacking May Not Be a Significant Risk Factor for Dental Caries
Clinical Question In this era of fluoride usage, does between-meal snacking adversely influence the development of dental caries?
Clinical Bottom Line For patients who have adequate exposure to fluoride, especially if they brush at least once a day, between-meal snacking does not significantly increase their caries risk. This is supported by a cross-sectional study that concluded the daily consumption of sugar-containing drinks between meals and more than two between-meals snacks were neutralized by the use of systemic fluorides and brushing more than once a day with a fluoridated toothpaste. This is also supported by a systemic review that similarly concluded that sugar consumption is a moderate-to-mild risk factor for caries in most people with good exposure to fluoride.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 11784285Vanobbergen/20014468 ChildrenOther
Key resultsThis study found that while daily use of sugar-containing drinks between meals (OR½1.38, CI½1.18–1.69) and consumption of more than two between-meals snacks per day (OR½1.22, CI½1.05–1.43) continued to be important caries risk factors, regular use of fluoride supplements (OR½ 1.54, CI½1.33–1.78 for no use) and brushing more than once a day (OR½1.24, CI½1.01–1.53 for brushing less than once a day) remained protective factors. In overall, multiple logistic regression model (at 0.05 level) showed that the combined effect of daily consumption of sugar-containing drinks between meals and more than two between-meals snacks was neutralized by the use of systemic fluorides and brushing more than once a day with a fluoridated toothpaste.
#2) 11699972Burt/200136 StudiesSystematic review of non-randomized trials
Key resultsThis systematic review examined several studies but used only 36 qualified studies to address the question "In the modern age of extensive fluoride exposure, do individuals with a high level of sugar intake, measured either as total amount or a high frequency of consumption, experience greater caries severity relative to those with a lower level of intake?." The review concluded that sugar consumption is likely to be a more powerful indicator for risk of caries infection in persons who do not have regular exposure to fluoride. Where there is good exposure to fluoride, sugar consumption is a moderate-to-mild risk factor for caries in most people.
Evidence Search ("Dietary Sucrose"[Mesh]) AND "Dental Caries/etiology"[Mesh] and ("between-meal" OR snack OR snacking)
Comments on
The Evidence
Validity In Vanobbergen’s cross-sectional study, children were selected from the same area and within the same age group using stratified cluster sampling. Calibrated dentists performed the clinical findings, and the parents and schools completed questionnaires. Univariate analyses using chi-square tests and t-test, and multiple logistic regression analyses was used to quantify the results. Burt’s comprehensive and detailed search for relevant studies, and the assessment of their validity resulted in a review of 36 cohort, case-control, and cross-sectional studies; no randomized control studies were included. A meta-analysis was not performed because of the heterogeneity in the design, measurement, and social conditions of the studies. Perspective Because caries is a multifactorial disease, further studies may be helpful in order to better quantify the opposing effects of fluoride and between-meal snacking.
Applicability In today’s modern time, patients are being exposed to fluoride in their water, toothpastes, and other related vehicles. When counseling patients regarding the risk of dental caries, more emphasis should be placed on the use of fluoride. As supported from the above articles, if a patient has adequate fluoride exposure, especially if they brush at least once a day, they are likely to be protected from caries, including those caused by frequent snacking.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry) (Basic Science)
Keywords Fluoride, Snacking, Between-meal Snacking, Dental Caries
ID# 2665
Date of submission: 03/24/2014spacer
E-mail vujt@ivemail.uthscsa.edu
Author Jaclyn T. Vu
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Bennett T. Amaechi, BDS, MSc, PhD
Faculty mentor/Co-author e-mail amaechi@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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