Impact of National Income and Inequality on Sugar and Caries Relationship

Abstract

Objective: The aim of this study was to examine the impact that national income and income inequality in high and low income countries have on the relationship between dental caries and sugar consumption. Methods: An ecological study design was used in this study of 73 countries. The mean decayed, missing, or filled permanent teeth (DMFT) for 12-year-old children were obtained from the WHO Oral Health Country/Area Profile Programme. United Nations Food and Agricultural Organization data were used for per capita sugar consumption. Gross national incomes per capita based on purchasing power parity and the Gini coefficient were obtained from World Bank data. Bivariate and multivariate linear regression analysis was performed to estimate the associations between mean DMFT and per capita sugar consumption in different income and income inequality countries. Results: Bivariate and multivariate regression analysis showed that countries with a high national income and low income inequality have a strong negative association between sugar consumption and caries (B = –2.80, R² = 0.17), whereas countries with a low income and high income inequality have a strong positive relationship between DMFT and per capita sugar consumption (B = –0.89, R² = 0.20). Conclusion: The relationship between per capita consumption of sugar and dental caries is modified by the absolute level of income of the country, but not by the level of income inequality within a country.

A new understanding of the relationship between sugars, dental caries and fluoride use: implications for limits on sugars consumption

“…Effects of wartime sugar rationing and sanctions Meta-analyses confirm the statistical relationship between the average sugar intakes and the prevalence of caries (4,28,29) , reinforcing the ecological studies with in effect national interventions induced by wartime sugar rationing and sanctions on sugar imports. Iraq (21) showed the marked responsiveness of caries to prevailing sugar intakes: levels of dental caries in Iraqi children halved after UN sanctions that reduced sugars from 50 kg/capita per year (27·4 %E) before sanctions to 12 kg/capita per year (6·6 %E) five years later (Table 1) (21) .…”

Sugar Restriction for Caries Prevention: Amount and Frequency. Which Is More Important?

“…The authors suggested as possible explanation for the anomalous association of low mean DMFT with high sugar disappearance in Western Europe that the extensive use of, mainly fluoride-containing, toothpastes neutralise the potential damage from high sugar consumption [Downer et al, 2008]. A recent global evaluation [Masood et al, 2012] confirmed that among high-income countries, there is a negative correlation between sugar disappearance (kg/capita/year) and dental caries level, while in low-income countries, this correlation is a positive one. In the ensuing discussion, Masood et al (2012) explain their findings by the accessibility to fluoride.…”

Dental Anxiety Levels and Affecting Factors in 7-14 Years Old Children

“…This is attributed to increasing sugar consumption and lack of fluoride [8,9,21]. In our study, the major cause of admission to hospital of the children was tooth decay with 25%.…”