by Marion Nestle
Jun 26 2012

How junk foods and sodas ruin kids’ teeth: PBS NewsHour on dental health in El Salvador

Dr. Karen Sokal-Gutierrez, a pediatrician I know who teaches in the UCSF-Berkeley Joint Medical Program, is involved in a health program in El Salvador that among other things focuses on the dental health of urban and rural kids.

As she explains, when she was a Peace Corps volunteer thirty years ago, the kids had perfect teeth and beautiful smiles.  She has a collection of photographs to prove it (she sent me this one).

Today, kids’ teeth are rotted to the roots as a result of the introduction of sugary drinks and snacks.  She and her students are working to educate parents to take care of their kids’ teeth but also to feed their kids healthier foods.

PBS NewsHour has just done a segment on her program (it’s a bit over 7 minutes).

This is well worth watching as a case study of:

  • The efforts of junk food and soda companies to sell products in developing countries.
  • The effects of junk foods and sodas on kids’ health.
  • The hard work that Dr. Sokal-Gutierrez and her colleagues must do to counteract these effects.
  • The investigative and production skills of recent journalism school graduates.

The segment is also worth watching for the priceless comments of Coke and Pepsi (these come at  about 4.3 minutes).

Coke: “With basic dental hygiene practices, people have enjoyed our products for decades without risk to their dental health.”

Pepsi: “We believe that parents should decide what their children eat and drink…Any food and beverage with sugars and starches, including some of our beverages can contribute to the development of cavities.”

Those of us who have access to fluoridated water, toothbrushes, and dental care don’t usually think of severe dental disease as a consequence of drinking sodas.

We should.

Addition:  Dr. Sokal-Gutierrez asked that I also post a photograph of what the kids’ teeth look like.  Happy to oblige.

  • Foodie

    Dentist, Dr. Weston Price saw the very same thing 80 years before and wrote about it in his book, Nutrition and Physical Degeneration. It is a very interesting and frightening read– So was this clip.

  • I do volunteer work in Cambodian villages and rural schools. It is shoking to see the state of the children’s teeth there. When you ask children if they have painful teeth half of the class’s hands go up. Walking between the rows of wooden desks, looking into the mouth of small children and discovering big black craters in their mouth is really disconcerting. With the help of a wonderful organization GLOBAL GRINS we distributed 2000 toothbrushes and conducted lessons on oral hygiene. Early education of children and their mothers is the key, but of course it is hard to counteract the marketing machine of big soft drink and candy manufacturers.

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  • FarmerJane

    Looks like the teeth of some of the children in rural New York. Areas of abandoned farms, little or no employment, and pediatric dentists who do not take Medicaid. Some of the families load up on cheap soda and juice at Walmart. Breaks my heart to see young mothers with carts full of discount 2 liter bottles of soda and no milk in the cart. Growing up, we never saw children’s teeth like this. Even though people were poor or middle class, families seemed to provide children with the basics of a nutritious diet. Most was cooked from scratch. With hundreds of local dairy farms, it was common for people to go and dip fresh milk out of their neighbor’s farm bulk tank.
    What has changed between my youth of decades ago and now?

  • Julia Mazer

    heartbreaking and infuriating. thanks for this awareness.

  • Michael

    Too bad their teeth are rotting, but that probably wouldn’t be the case if they brushed their teeth regularly.

    Wouldn’t the same happen if they drank orange juice or ate a ton of strawberries and neglected to brush their teeth properly?

  • Monica

    Michael, drinking and eating large amounts of fruit sugar is not healthy either.
    You take for granted how easy it is to brush your teeth when you have access to the materials and clean water. Moreover, I see young kids in SF with a mouth full of fillings. Many parents are fine with their kids having sugary drinks and foods. This doesn’t seem that wrong to them because it is everywhere. The food industry has managed to insinuate sugar and junk into our everyday lives so much that we often don’t see anything wrong with it and when sensible people raise the issue, they get accused of killing all the fun.

  • Ellen

    Free dental health clinics and education in poor areas should definitely receive lots of applause and donations– I’m glad you’ve pointed people toward a worthy cause to give to.

    As far as blaming soda for an epidemic of tooth decay in El Salvador, though, the statistics I see don’t indicate that there IS an epidemic of tooth decay there. WHO figures gave the average number of decayed, missing, or filled teeth a 12-year-old child there would have in 1989 (about the time Dr. Sokal-Gutierrez would have been a Peace Corps volunteer) as 5.1 and the latest figures, for 2008, as 1.45. (

    I’m sure Dr. Sokal-Gutierrez has warm memories of beautiful smiles during her early time there, but those statistics seem to show that (no doubt thanks in part to the efforts of people like her!) tooth decay has declined steeply in El Salvador over the past 20 years.

  • Because childhood malnutrition plays such an important role in brain development, and in every adult achieving , or not achieving his/her human potential, the issue has enormous and far-reaching ramifications. Dr. Sokol-Gutierrez’s observations are most important for everyone involved in international development, and have some – not unimportant – messages for parents here at home. I am not sure where the soft drink and fast food purveyors will take this odyssey, but I hope that they can see a win-win future in which they take a leading role in dental hygiene promotion.

  • We know the importance of Oral Health and we understand the problem of cavities and the impact that junk food those to children teeth, it was a lot of work for Dr. karen sokal and ASAPROSAR to teach and aware the families in rural areas on how important is to have a healthy diet, many people may think is easy all you have to do is to brush your teeth frecuently, but!!! in the areas where we went is more expensive to get a tooth brush then to get a soft drink, we work on educating those families and traying to get donations to provide them with tooth brushes and paste and flouride, and we keep working as Dr. Sokal thought us, and always searching for donations to keep doing this work.

  • Karen Sokal-Gutierrez

    I appreciate everyone’s comments. I wanted to address Ellen’s statement, “the statistics I see don’t indicate that there IS an epidemic of tooth decay there.” Please see the excellent review by Edelstein (2006) “The Dental Caries Pandemic and Disparities Problem”
    A challenge in interpreting the data is that the World Health Organization (WHO) tracks DMFT (decayed, missing, filled teeth) in 12-year-old children who have their newly-erupted permanent teeth– This misses the epidemic of “early childhood caries” or tooth decay in primary (baby) teeth in children from birth to age 6. The baby teeth are smaller, with thinner protective enamel and a larger surface area relative to their volume, making them particularly susceptible to decay in the presence of frequent carbohydrate/sugary snacks and poor oral hygiene. Although the baby teeth eventually fall out from 6-12 years of age, decayed baby teeth can cause young children years of chronic inflammation, mouth pain, difficulty eating and sleeping, malnutrition, difficulty concentrating in school, and overall poor health and wellbeing–this is during the earliest years that are critical to children’s growth and development. When we started our project in El Salvador in 2004, we found that 85% of the children age 6 and under had tooth decay, with an average of 6.5 decayed teeth (i.e., 1/3 of their total 20 baby teeth). Currently, I’m also working in Ecuador (where I served from 1978-80 in the Peace Corps)–in 2011 we found that 88% of the children age 6 and under had tooth decay, with an average of 9 decayed teeth (i.e., nearly 1/2 of their baby teeth). In both countries, we found that nearly 1/2 of the children suffered from mouth pain. I’m also working in Nepal and Vietnam, where we’ve found similar problems, and hear the same from colleagues throughout Latin America and Asia. This is a tragic global pandemic. There are multiple causes, including dramatic changes in the diets of young children, which need to be addressed on a global level.

  • Tragic Global pandemic sure is, everywhere I go..No longer distinctions between rich and poor…everyone is exposed to junk food. Even many foods have questionable ingredients..Farmers in Mexico ask for Coke in addition to salary!!! Have counseled many mothers who could not breastfeed due to complications, one of them high blood pressure. Some are now the generation who were given Coke in the baby bottle. There are also “clubs¨of mothers with autistic children now living in Mexico seeking healthier foods and treatment…
    Recently I attended an International Forum on Obesity and Nutrition at the Peruvian Medical School in Lima. One of the conferencist showed a photo of a Nestle boat sailing the Amazon River…there are efforts for a junk food law, but sometimes I wonder if is already too late!!! or just too few of us…Even worst weeks later there was another similar event sponsored by Gatorade, Gloria (can milk and other milk products) and some foreign vitamin companies. In between there was a Peruvian farmers event, they exhibit many high nutritious ancestral foods, the same people who stated are fighting for good nutrition did not showed up, even when they were in the program as speakers.
    I could go on…but I just feel like crying…

  • Jessica Bixby

    Dr. Sokal-Gutierrez alerted me to the oral health epidemic in children in developing countries before I arrived in Nicaragua for my Peace Corps service this year. Unfortunately, my observations in Nicaragua have only mirrored her experience in El Salvador in regards to poor oral health in young children as well as the population in general. I work in a small Nicaraguan town of 800 and work at the local health center and community schools. Last week, a dentist visited the health center for the first time this year and worked from 8am-5pm pulling teeth without breaking for lunch. Although children under 10 were prioritized for extractions, the dentist left a waiting list of more than twenty people for the next visit. Within my community, tooth decay is obvious with just a quick glance at many youngsters’ teeth. As Dr. Sokal-Gutierrez has already discerned, the problem of oral health is two-fold. Primarily, people are simply not brushing their teeth (nor their children’s) even if they can afford to do so. Possibly more alarming are the widespread consumption of junk-food, candy and soda. It is common to see babies drinking soda that also breastfeed, ice cream is eaten before 10am, and a woman sells candies, cookies, and popsicles everyday during school recess. Junk food and beverages are cheap (a Coca-Cola is less expensive than a bottle of water), these foods are packaged well so it is easy to travel with and take on the run, do not spoil despite the tropical climate, and they taste good! Promoting oral health is a multifaceted challenge and I plan to begin by educating parents to make more informed parenting choices, in terms of nutrition and oral hygiene, and by teaching these good habits to children in my local schools. Luckily, behavior change is easy, especially when telling kids not to eat sweets…

  • I live in a poor rural town in Texas and unfortunately you see many preschool age children with caps on their front teeth. I work at a convenience store (which sells many healthy foods BTW), but I am shocked by how many sodas and candy bars are purchased with the Lone Star card (food stamps). Texas not only allows this but in an indirect way contributes to it. Texas reatailer rules for Lone Star card states that if the person is purchasing sodas, candy bars and food (food is not taxable, soda/candy is) and they only have enough balance on the card to pay for part of the purchase, than you are to put the soda and candy on the Lone Star card, and then do the food purchase with cash so that they don’t have to pay the taxes. I have to wonder if Texas allows this because of some sort of palm greasing from soda companies?

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  • Elaina

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  • Re: Ksenija Olmer, I spent a summer volunteering in Thailand and I agree, it was a shock to see the state of children’s’ teeth there. Adults, too.

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  • Nadellienn Arandia

    Hi! Thank you for sharing
    this post, I’m a mom and I’m having a hard time explaining my kids that junk
    foods and soda could be bad to their teeth and I also Find dentist for them to make them understand what was
    wrong but still they don’t listen. Good thing I have read your post I will show
    this to them, for them to realize that I’m not the one who wants to remind them
    that what they it is just bad for their health thanks a lot!

  • Tiffany Bailey-Lee

    I showed this picture to my son last night when he asked could he have some milk after he brushed his teeth. Needless to say he didn’t want milk he wanted water. I always tell him if you don’t brush your teeth they will get cavities and become painful he doesnt understand. Showing him the picture of a child’s rotted teeth he understands greatly and he felt horrible for the child.

  • I agree on what you’ve said. But at what age basically a child should see a dentist? I’ve read good thoughts from but I wanted to know more deeper about it.

  • It is vital that your daily sugar intake should be limited, thus, resorting to natural food resources such as fruits and vegetables.