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Intake of sweet drinks and sweet treats

versus
reported and observed caries experience
Abstract

AIM: This was to study the intakes of sweet drinks and sweet
treats of children and their caries risk using the Paediatric
Risk Assessment Tool (PRAT, 2003) and Caries-risk Assessment
Tool (CAT, 2007-8). STUDY DESIGN: Parents of 266
healthy primary school children completed the PRAT questionnaire
during their childs dental appointment at the Royal
Dental Hospital of Melbourne, Australia, describing their fluid
and sweet treat intakes in the past 24 hours, oral hygiene
practices and past caries. A subgroup (n=100) was examined
clinically (CAT) for caries requiring restoration, visible
plaque, gingivitis, orthodontic appliances, enamel defects,
and use of dental care. RESULTS: The estimated mean
daily fluid intake was 1.50.5L; fluids were consumed 3-5/
day by 57% of children and 78% usually had evening/night
drinks. Fluids consumed were: tap water by 90%, milk by
74%, juice by 50%, regular soft drink by 30%; sweet treats
were consumed by 62% and confectionery by 25%. Most
children (69%) brushed their teeth 2/day; 5% flossed daily.
Parentally-reported caries was associated significantly with
increasing treats frequency (p=0.006). In the subgroup, 81%
were at high caries risk; 47% had irregular dental care; 21%
had sweet drinks/foods frequently between meals; 49% had
visible plaque/gingivitis, and 34% had enamel demineralisation.
Caries observed in the past 12 months was associated
significantly with evening sweet drinks (p=0.004), and suboptimal
fluoride exposure (p=0.009). Caries observed in
the past 24 months was associated significantly with treats
frequency (p=0.006), intake of sweet drinks plus treats
(p=0.000), enamel demineralisation (p=0.000) and irregular
dental care (p=0.000). CONCLUSIONS: The PRAT and CAT
are valuable tools in assessing childrens caries risk. The risk
of caries from frequent intake of sweet drinks, either alone or
in addition to sweet treats, must be emphasised to parents.
All parents, and particularly those of children assessed at
high risk from intakes of sweet drinks and sweet treats, suboptimal
fluoride exposure, or enamel demineralisation, must
be encouraged to obtain regular dental care for their children.

Introduction

An increase in dental caries in young children in Australia


was reported recently by the School Dental Service (SDS).
Since SDS data collection commenced in 1977, decreasing
dmft/DMFT scores and improved dental health of Australian
children had been attributed to the introduction of community
water fluoridation [AIHW, 1998]. However, increasing
caries experience of 6 yr-old and 12 yr-old children has been
reported from the mid to late 1990s by the SDS [Armfield
and Spencer, 2008]. In the most recent Australian child dental
health survey conducted in 2002 and reported in 2007,
47.4% of 6 yr-olds had experienced caries in the primary
dentition; the mean dmft was 1.96 (SD: 3.01), and the 10% of
children with the greatest caries experience had more than
nine cariously-affected teeth [Armfield et al., 2007]. For 12
yr-olds, over 40% had experienced caries in their permanent
teeth; the mean DMFT was 1.02 (SD: 1.73) and the 10% of
children with the greatest caries experience had nearly five
cariously-affected teeth, exceeding the national average by
almost five and a half-fold [Armfield et al., 2007]. Children living
in low-fluoride areas had poorer dental health than those
living in optimally-fluoridated areas, regardless of socioeconomic

disadvantage [Armfield et al., 2007].


Speculation on the caries increase has focussed on fluid
intakes, noting that societal changes such as expanding
urbanisation and ready access to sweet drinks and fast and
processed foods, have altered childrens diets in Australia
and elsewhere [Sivaneswaran and Barnard, 1993; Ismail et
al., 1997; Shenkin et al., 2003]. International reports indicate
a common trend of increasing consumption of soft drinks
by children. In 2000, the most frequently-reported form
of added sugars in the USA diet was regular soft drink,
accounting for one third of dietary sugar intake [TougerDecker and van Louveren, 2003]. In the UK, soft drink intake
in 11-12 yr-old children increased in the last 20 years [Tahmassebi
et al., 2006; Rugg-Gunn et al., 2007]. A similar shift
in fluid consumption towards sweet drinks may be occurring
in Australia [NHMRC, 2008], and concerns over increasing
childhood obesity in Australian children has led to the restriction
of sales of sweet drinks in public schools [Sanigorski et
al., 2006; Tam et al., 2006].
The intake of dairy products by Australian children appears
to be decreasing. In 1998, the National Nutrition Survey
(conducted in 1995) reported a low intake of dairy products
in children, with about 30% of 2-18 yr-olds consuming less
than one serving of dairy product daily, and a mean milk
intake for 4-7 yr-olds of 0.38L and 0.39L for 8-11 yr-olds
[ABS, 1999]. The Australian dietary guidelines recommend