Dental Tribune United Kingdom Edition

A scientific study¹, con- ducted at the Leeds Den- tal Institute, has shown there to be no significant differ- ence in the enamel demineral- ising effects of intrinsic sugars (those contained within foods) and ‘free’ or extrinsic sugars (those added in food manufac- turing and found in fruit juice and honey). The study, by A I Issa, K J Toumba, A J Preston, M S Dug- gal, was performed using an Intra-oral Cariogenicity Test – a device placed in the mouth to test how conducive substances are to promoting dental caries - to compare the effect on enamel demineralisation of fruits and vegetables, consumed either whole or in a juiced form. The findings contradict a long-held belief in the UK that intrinsic sugars contained in whole fruits, for example, are ‘safer for teeth’ than extrinsic sugars found in fruit juices. Earlier reports from both the Committee on Medical As- pects of Foods Policy (COMA) 1991², and the World Health Or- ganisation (WHO) 2004³, have recommended limiting the con- sumption of extrinsic sugars in favour of intrinsic sugars, which were seen to present less of a risk to dental health. However, in 2007 a joint report from the Food and Agriculture Organisation (FAO) and WHO4 , provided a scientific update on carbohydrates in human nutri- tion and referred to ‘total sug- ars’ as the most useful term when describing dietary sug- ars, suggesting a change in di- rection from previous thinking. The study was conducted among ten healthy adults, who had normal salivary function. Each subject wore a remov- able appliance attached to the teeth of their lower jaw, which carried pre-demineralised hu- man enamel slabs. They each consumed one of the test foods, seven times each day, for ten days. They were instructed to brush their teeth twice a day, using fluoride-free toothpaste, while the appliances were out of the mouth. Test foods were whole or juiced apples, oranges, grapes, carrots, and tomatoes – juices were extracted from the same batch of fresh produce con- sumed as whole fruits. Raisins were also included in the study. The study showed significant net demineralisation when the subjects consumed each of the test foods, containing either ex- trinsic or intrinsic sugars: to- mato, tomato juice, apple, apple juice, orange, orange juice, car- rot, carrot juice, grape, grape juice, and raisins. Professor Monty Duggal, co-author of the study, said: “The results of the research show that eating fruits and veg- etables as ‘whole’ foodstuffs may cause similar deminer- alisation in enamel to when they are consumed as a juice, when frequently consumed by people who are not using fluoride toothpaste”. “The results will be ex- tremely useful in helping to provide evidence for accurate health advice for patients. The findings are particularly sig- nificant for ‘at risk’ patients, usually those not brushing regularly with fluoride tooth- paste, and especially children who can be less than diligent in this regard.” DT Sweet study for sugar lovers References 1 Issa AI, Toumba KJ, Preston AJ, and Duggal MS (2011) Comparison of the Effects of Whole and Juiced Fruits and Vegetables on enamel Demineralisation in situ. Caries Research 2011;45:448-452 (DOI: 10.1159/000330597) 2COMA (1991). Depart- ment of Health, Committee on Medical Aspects of Foods Policy. Report on health and social subjects. No 41. Dietary refer- ence values for food energy and nutrients for the United Kingdom. London, Her Majesty’s Stationary Office.3 World Health Organisation Global Strategy on Diet, Physical Activity and Health (2004) 4 Cummings, JH and Stephen AM (2007) Carbohydrate terminology and classi- fication. In FAO/WHO scientific update on carbohydrates in human nutrition: conclusions. European Journal of Clinical Nutrition, 61 Suppl 1, S5-18. 7News & OpinionSeptember 12-18, 2011United Kingdom EditionUnited Kingdom Edition