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Sugar Not the Only Culprit in Early Childhood Caries

Research points to numerous factors involved in tooth decay.

Childhood caries affects kids in every corner of the United States. In fact, it is regarded as the most common chronic disease in children, with more than 40% shown to have tooth decay by the time they enter kindergarten.1,2

It’s no secret that consumption of sugary foods and drinks coupled with poor oral hygiene is a recipe for dental disaster. But, as detailed in a recent report from the directors of the Center for Oral Health Research in Appalachia, the problem is much more complex.2


In their report, co-authors Daniel W. McNeil, PhD, clinical professor emeritus of Dental Public Health & Professional Practice at West Virginia University, and Mary L. Marazita, PhD, director of the Center for Craniofacial and Dental Genetics, and professor of Oral Biology and of Human Genetics at the University of Pittsburgh Health Sciences, explore contributing factors to oral health disparities in Appalachia.

Among the most economically stressed regions in the nation, Appalachia, comprising 13 states, including Northern Mississippi, Alabama, Pennsylvania, South Carolina, North Carolina, Tennessee, Virginia, Kentucky, Ohio, Maryland, Georgia, Southern New York State, and all of West Virginia, is said to have the largest burden of oral health problems per capita in the nation.2


Connecting the dots between economic distress and poor oral health, McNeil and Marazita detail the myriad factors that contribute to dental problems in kids, particularly in this region. They note that variable—such as low levels of education, issues of transportation to and from dental visits, the costs of those visits, and the availability of school-based oral hygiene programs—can play a major role in oral health disparities in these communities. In addition, lack of access to clean water and air, healthy foods, and fluoride exposure can all weigh heavily in the fight against tooth decay.

The consequences of childhood caries be severe. This condition not only impacts eating, speaking, and learning in kids, but can have long-lasting effects into and throughout adulthood, compromising quality of life.


Given the scope of the problem, the authors advise looking beyond sugar as the only cause of dental decay. Personal dental hygiene, properly exercised, with age-appropriate toothbrushes and medicaments, is certainly a step in the right direction. McNeil and Marazita also advocate for improved diet that includes fresh fruits and vegetables, avoidance of tobacco, mouth guard use during some sports, and regular dental visits for preventive care.

Likewise, the authors note the importance of parents developing strong social networks and engaging oral hygiene role modeling for their kids. Solving environmental problems can have a significant impact. For instance, whether or not community water is fluoridated is key. If the only water available is toxic or unappealing, people are more likely to reach for sodas or other sugar-laden beverages.

Overall, McNeil and Marazita stress the value of prevention and the early establishment of a dental home for children before age 1. Further, they conclude that system-level changes are necessary to address cost concerns and improve access to dental insurance. Finally, they favor the integration of oral health programs into school settings that could benefit all children, no matter what kind of socioeconomic status they come from.


  1. Marazita ML, Weyant R, Feingold E, et al. Dental caries: whole genome association and gene x environment studies.
  2. McNeil DW, Marazita ML. No, it’s not just sugary food that’s responsible for poor oral health in America’s children, especially in Appalachia. The Conversation.
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