Effect of sugar-sweetened beverages on oral health: a systematic review and meta-analysis

• Published in: European journal of public health Vol. 31; no. 1; pp. 122 - 129
• Main Authors: Valenzuela, Maria Josefina, Waterhouse, Beverley, Aggarwal, Vishal R, Bloor, Karen, Doran, Tim
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-02-2021; Oxford Publishing Limited (England)
• Subjects: Beverages; Consumption; Cross-sectional studies; Dental caries; Dental research; Health; Health aspects; Impact analysis; Meta-analysis; Obesity; Observational studies; Oral health; Oral hygiene; Public health; Quality assessment; Quality control; Risk; Sugar; Systematic review; Taxation; Teeth; Weapons of mass destruction; United Kingdom
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckaa147

Abstract
Background
The impact of consumption of sugar-sweetened beverages (SSB) on health outcomes such as obesity have been studied extensively, but oral health has been relatively neglected. This study aims to assess the association between SSB consumption and dental caries and erosion.
Methods
Systematic review of observational studies. Search strategy applied to Medline, Embase, Cochrane Library, SciELO, LILACS, OpenGrey and HMIC. The risk of bias was assessed using the NIH Quality Assessment Tool for Observational Cross-Sectional Studies and evidence certainty using Grading of Recommendation Assessment Development and Evaluation. Relationships between SSB consumption and caries and erosion were estimated using random-effects model meta- and dose–response analyses.
Results
A total of 38 cross-sectional studies were included, of which 26 were rated as high quality. Comparing moderate-to-low consumption, there was significantly increased risk of both caries [OR = 1.57, 95% CI: 1.28–1.92; decayed, missing and filled teeth weighted mean differences (DMFT WMD) = 0.82, 95% CI: 0.38–1.26] and erosion (OR = 1.43, 95% CI: 1.01–2.03). Comparing high-to-moderate consumption, there was further increased risk of caries (OR = 1.53, 95% CI: 1.17–1.99; DMFT WMD = 1.16, 95% CI: −0.59–2.91) and erosion (OR = 3.09, 95% CI: 1.37–6.97). A dose–response gradient and high certainty of evidence was observed for caries.
Conclusions
Increasing SSB consumption is associated with increased risk of dental caries and erosion. Studies were cross-sectional, hence temporality could not be established, but the positive dose–response suggests this relationship is likely to be causal. These findings illustrate the potential benefits to oral health of policies that reduce SSB consumption, including sugar taxation.