by Marion Nestle
Jul 24 2019

At last: attention to sugar’s role in dental health

I included a chapter on sugar and dental disease in my 2015 book, Soda Politics: Taking on Big Soda (and Winning), because billions of people have decayed teeth and other dental problems that could have been kept intact by dental hygiene, fluoride treatment, or—consuming less sugar or sugary drinks.


  • Dental disease has a long history of being overlooked as a public health problem.
  • Sugar has a long history of being ignored as a cause of dental disease.

This may now be changing.

The Lancet has a new series on oral health:

Radical action on oral health will benefit from harnessing a clear global health mandate. Because oral diseases share the main risk factors of other non-communicable diseases (NCDs)—sugar consumption, tobacco use, and harmful alcohol use—oral health should have a stronger place on the global NCDs agenda.

  • Oral diseases: a global public health challenge: Marco A Peres, Lorna M D Macpherson, Robert J Weyant, Blánaid Daly, Renato Venturelli, Manu R Mathur, Stefan Listl, Roger Keller Celeste, Carol C Guarnizo-Herreño, Cristin Kearns, Habib Benzian, Paul Allison, Richard G Watt.  The Lancet, Vol. 394No. 10194.  

Among this article’s key messages:

  • Oral conditions share common risk factors with other non-communicable diseases, which include free sugar consumption, tobacco use, and harmful alcohol consumption, as well as the wider social and commercial determinants of health
  • Of particular concern is the effect of free sugar consumption on the prevalence of caries and overweight or obesity, and associated conditions such as diabetes
  • Recognition is increasing of the influence, power, and effect of the global sugar industry as a threat to public health, which requires tighter regulation and legislation by governments
  • Ending the neglect of global oral health: time for radical action: Richard G Watt, Blánaid Daly, Paul Allison, Lorna M D Macpherson, Renato Venturelli, Stefan Listl, Robert J Weyant, Manu R Mathur, Carol C Guarnizo-Herreño, Roger Keller Celeste, Marco A Peres, Cristin Kearns, Habib Benzian.  The LancetVol. 394No. 10194

In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.

A check of dental research organisation websites shows that corporate members of ORCA include Cloetta, a Nordic confectionery company; Unilever, a global consumer goods company that sells ice cream and sugary beverages; and Mars Wrigley Confectionery, a leading manufacturer of chewing gum, chocolate, mints, and fruity confections (through its Wrigley Oral Healthcare Program). Corporate members of the International Association for Dental Research (IADR) include Unilever and Mondelēz International, one of the world’s largest snack companies, whose products include cookies, chocolate, and confectionery. These financial ties are slightly less shocking given the oral health-care products these companies sell: xylitol chewing gum and pastilles (Cloetta), sugar-free gum with xylitol (Mondelēz, Mars Wrigley), and toothbrushes and fluoridated toothpaste (Unilever). Nonetheless, as the dental research community comes to terms with its neglect of sugars intake, these relationships with industry are ripe for scrutiny.  [I’ve written previously about Kearns’ discovery of links between sugar trade associations and dental professional organizations].

Two key strategic aims for a global oral health movement will be to ensure that oral health treatment and prevention services are central to UHC [universal health coverage] and to support global efforts to limit the damage caused by the sugar industry…There is fragmented global action for reducing the damage of the sugar industry and some progress has been made in a number of cities and countries, especially with the introduction of taxes on sugary drinks.  However, there is no united global movement against sugar, as there is against the tobacco industry.

  • Perspective:  Richard Watt: time to tackle oral diseases: Rachael Davies.  The Lancet, Vol. 394No. 10194.  “The mouth really is a marker of people’s social position and future disease risk…and oral diseases are a canary in the coal mine for inequality.”
  • Perspective: Polished smiles and porcelain teeth.  Richard Barnett.  The Lancet, Vol. 394No. 10194. 
This is a history of George Washington’s teeth and the later development of the dental profession, ending with this thought: “in the early 21st century, the great global divide in dentistry remains—as it was in Washington’s day—between the rich and the poor.”

It’s great that The Lancet has finally taken this on.

Here’s The Guardian’s Account.  There should be a lot more press coverage.  Dental conditions affect billions of people throughout the world.