My Advice On Processed Carb Consumption

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Sugars are undoubtedly the most important dietary factors in the etiology of dental caries. Today's diet contains an increasing range of fermentable carbohydrates, including highly processed starch-containing foods. (1) Studies indicate that table sugar is the most cavity causing (cariogenic) sugar and that lactose (found in milk) is the least. (2) Table sugar or sucrose causes the synthesis of extracellular glucans which enhance accumulation of cavity causing bacteria on teeth and appear to enhance their ability to cause tooth decay. (3) My personal observation over the last thirty years of practice is that when sugar is repeatedly introduced into the mouth, even in small amounts, rampant decay can result. Additionally, many soft drinks are highly acidic and can lead to tooth erosion, another dental issue I will address in a future post.

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Many studies point to the frequency of eating sugars to be of greater etiological importance for caries than the total consumption of sugars [ (4,5) One study that showed that the frequent intake of lozenges can cause rampant decay resonated with me as I have seen this many times over the last thirty years. (6 )It is well known that nursing bottle caries results when children are left to sleep with a bottle of milk or even dilute juice overnight. (7,8) Simply put, given enough time, weak sugars and starches can cause devastating amounts of tooth decay.

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Another factor in determining how strong the potential for a particular food to cause decay is the retention of the food. This simply means how long the food stays on the teeth. Most dentists advise against sticky sweets, but this advice is unfounded. Study findings show that consumers cannot accurately assess the retentiveness of foods. For instance, cookies, crackers, and potato chips were most retentive, but because they contain less sugar, they don’t contribute to decay as much. Whereas caramels, jellybeans, raisins, and milk chocolate bars were among those poorly retained, but due to the high sugar content, they promote decay more than cookies, crackers and potato chips. (9)

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As you can see, the evidence is quite confusing. Therefore I strongly recommend that in order to minimize the risk for tooth decay, don’t eat dense acellular carbohydrates (processed carbs). This is impractical for most of my patients and I completely understand. We all like to eat treats. Hopefully only on special occasions. More realistic advice is to eat/drink the substances that contain processed sugars and carbs quickly. Once you are done, brush and floss. If you cannot brush and floss right away, rinse with water and wipe your teeth with a napkin or your finger.

Keep in mind that the formula for tooth decay is:

 processed carbs + your plaque + your teeth + time x frequency = decay.

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Anything that you do to disrupt the formula will lower your risk for decay. Let's break it down:

  • Removing processed carbs will lower your decay. the more you remove, the lower the risk.

  • Remove the plaque from your teeth by brushing and flossing especially after carb consumption.

  • No teeth = no cavities, but you need all of your teeth to properly chew your food.

  • Decrease the amount of time substances are on your teeth by brushing and flossing, especially after meals.

  • MOST IMPORTANTLY Decrease the frequency of processed carbohydrate ingestion by eating more in one sitting rather than slowly consuming them.


    My advice is to drink your sugary soda in a few minutes. If you continually take small sips over many hours, you are increasing the frequency to a level that could quickly lead to decay. Acidity can be a factor, but as I mentioned earlier, I will address that in a future post.