Pediatric Dentist Concerns: Does Sugar Cause Cavities in Kids?
When it comes to sweets, one common area of concern I hear from parents has to do with oral hygiene. Namely, cavities. Most of us grew up hearing things like, “Don’t eat too much sugar or you’ll get cavities!”, and as parents, there’s no doubt we worry about this for our own children.
Every time I’ve taken my kids into the pediatric dentist, we definitely get grilled on how often we let our children have candy and fruit snacks. And we aren’t able to leave the office until we’ve heard the lecture about limiting the number of sweets our children eat in the name of preventing cavities.
But when it comes to allowing your children to eat sweets, what’s the best approach?
Research clearly shows the effects of restricting sweets in children. When foods of any kind are limited or highly controlled with children, it only makes these foods more desirable. Kids are more likely to become preoccupied with any foods that feel restricted, and when they do get access to restricted foods, they’re more likely to overeat them. Restricting access to a palatable snack food, like candy or fruit snacks, increases a child’s intake of that food when it becomes available.
So is restricting or limiting foods, like candy and fruit snacks the solution for preventing cavities in our children?
How can you approach sweets with your children in a way that supports overall dental health while not restricting the foods they likely enjoy and want to eat?
We’re going to dive into that my friends.
Because I don’t believe restricting sweets is the answer to preventing tooth decay. And with all due respect to our pediatric dentists (who I love and am grateful for), I don’t believe fear-mongering around sweets and sugar is helpful either.
Ultimately, when we look at the health of our children, we need to see the big picture.
And yes, dental health and good oral hygiene is a BIG part of that. But equally as important is our children having a positive and healthy relationship with food. Creating fear around eating certain foods or rigidly controlling sweets can be a trigger for many complications around food. Which is not what we want either.
And please hear me out when I say that I’m not advocating for making sweets and candy free for all for our children. My stance on sweets is often misconstrued in this manner, where allowing our children to have sweets means that we should not care about what they eat or just let them eat whatever they want whenever they want.
Um, no. I want to be clear that’s not what I’m saying here. That wouldn’t be helpful for our children either.
I firmly believe there’s a way to approach sweets that offers both structure and support but that doesn’t cause our children to feel restricted from foods. This is an essential part of raising a child to have a healthy relationship with food.
(For more on how to take a supportive approach with sweets for your children, be sure to read this blog here: “Feeding Kids Sweets 101: Knowing Your Role When You Feed the Kids”)
I also strongly believe in parent power, where parents and caregivers can be empowered to support their children in developing positive attitudes and behaviors around food and their bodies, so we can raise a generation of kids that are free from diet culture.
This is possible in every area of our children’s lives - from how they eat to how they take care of their teeth and everything in between.
So let’s get back to the topic on hand: how to help our children with good oral hygiene and dental health without restricting them from sweets in the process.
Does Sugar Cause Cavities?
Before we get started with this topic with strategies to help your children, it’s important to look at the facts around cavities. Are cavities caused by sugar?
Let’s take a look at the facts.
Cavities, or tooth decay, are actually not directly caused by exposure to sugar from food.
Cavities can form when the tooth enamel is exposed to acid, which is formed by bacteria in the mouth. Plaque, which is a sticky film of bacteria that can cover the teeth, turns the sugars from food and drinks that are ingested into acid.
This acid can break down tooth enamel and form a cavity. The cavity can continue to spread deeper through the layers of the tooth once it forms.
So again, it’s not sugar ALONE that creates tooth enamel decay. It’s the combination of plaque (bacteria) and sugars from food/beverages ingested that creates the acid in our mouths, which can cause cavities.
This is an important distinction because again, it’s not sugar alone that is a risk factor for tooth decay. If that were the case, we’d all experience some form of tooth decay.
Nearly every food or beverage that we consume will provide some nourishment to the bacteria in the mouth, which can in turn be used to produce acid that attacks our teeth.
ALL carbohydrate foods, including fruits, grains, dairy and vegetables, begin breaking down into the simplest usable forms of energy in the mouth. Digestion begins in the mouth with salivary amylase, an enzyme which begins the breakdown process of the sugars in ANY carbohydrate foods that have been ingested.
This is a key point because we tend to lump sweets into their own separate category and treat them differently.
But in terms of digestion, sweets are being broken down into the simplest units of energy (glucose) in the same way other carbohydrate rich foods are, including grains, breads, pasta, dairy, fruits and vegetables.
If sugar alone was the culprit for causing tooth decay and eliminating sugar was somehow the solution, that would mean we would need to eliminate virtually all carbohydrates from our diets, which of course, would not be conducive to good health and a healthy relationship with food. Carbohydrates are one of the main macronutrients our bodies need and is the body’s preferred source of energy.
But you see where I’m going here?
This is why it doesn’t make sense to say that we need to eliminate or restrict sweets to decrease the risk of cavities. Even if you did that, your child’s teeth would still be exposed to the mouth acid that could contribute to tooth decay. Other foods your child is likely eating would still provide nourishment to the bacteria in their mouth to generate the acid which attacks tooth enamel.
In summary, there are 3 major factors that contribute to cavities in kids: Oral bacteria, sugar, and the time these are combined in the presence of the tooth.
So you might limit sweets as an approach to preventing tooth decay in your child’s mouth, but that doesn’t mean your child won’t get cavities. (You might also end up with more of a struggle around food with your child if you’re battling with sweets)
In reality, there are a variety of factors at play that influence tooth decay, and some individuals may be more susceptible to cavities than others.
Risk of dental cavities can be contributed by a variety of factors, including:
Oral hygiene: Not taking proper care of teeth (including regular brushing and flossing) can be a risk factor for tooth decay, as this can increase the levels of plaque, or bacteria, in the mouth. Also, inadequate dental care can also be a risk factor, and this can certainly be a barrier for individuals and families who are unable to access dental care.
Having a dry mouth or lower saliva levels: Did you know that saliva is important for neutralizing the acids in our mouth created by bacteria and sugar? Individuals that have drier mouths may be more prone to cavities. Certain illnesses, including some auto-immune conditions, are associated with decreased saliva excretion in the mouth. Impaired or injured salivary glands can also contribute to lower salivary levels in the mouth. Stress or dehydration can also contribute to dryer mouth.
Weak tooth enamel: Some children may have weaker tooth enamel, which can make their teeth more susceptible to tooth decay. The condition of the tooth enamel can be influenced by a variety of factors, including childhood illnesses, genetics or family history. There is some research that supports that vitamin D deficiency can also contribute to weak or brittle teeth in children and has been linked to a higher risk of tooth caries.
Oral Microbiome: The oral microbiome refers to all the bacteria that live in our mouths. Some research suggests we have up to 700 different species of bacteria in our mouths, which work synergistically to help keep our mouths healthy. Our oral microbiomes are highly individual and influenced by a variety of factors. Research suggests that an imbalance of microbial flora contributes to oral disease, including risk of tooth decay.
Teeth anatomy: Adults and children who have more crowded teeth, or teeth that are very close together, may be more susceptible to cavities. Crowded teeth can create more potential pockets where plaque and cavity-causing bacteria accumulate. It can also be harder to thoroughly clean these areas with traditional toothbrushes and floss.
Frequent grazing: Kids who graze frequently throughout the day are increasing the time their teeth are being exposed to acid, which can in turn, heighten risk of tooth decay. When there are breaks between meals and snacks, the acid levels in the mouth can lower and return to baseline, which can help decrease a child’s risk to higher levels of acid exposure in the mouth.
As you can see, there are a variety of factors at play influencing the risk of cavities in kids.
Cavity Prevention For Kids
I do believe there is a middle ground in approaching dental health with our kids, one that doesn’t involve restricting sugar and that allows for healthy teeth.
And as a disclaimer here, I am not a pediatric dentist.
I am a registered dietitian nutritionist that specializes in maternal child health, and I’m also a mother of 5 children. I’ve seen firsthand the damaging effects of any type of food restriction in the families I work with in my practice. And I know a healthy relationship with food or the ability to enjoy freedom with food as a family is not possible when certain foods are restricted, limited, or tightly regulated. When we approach food from a place of fear, this can hinder our ability to enjoy food together as a family.
Undoubtedly, we encounter a LOT of fear in how we feed our kids.
While the health professionals we engage with certainly mean well and have the best interest at hand for our families, it’s important to trust your intuition and do what feels right for your children and your family.
So with that in mind, here are some strategies you can adopt in your own family to promote healthy teeth without restricting sugar and sweets.
Healthy Teeth Without Restricting Sugar
Build a Meal and Snack Routine:
As mentioned earlier, continually grazing throughout the day can increase the time teeth are potentially exposed to acid. Stick to a meal and snack routine as much as possible to prevent grazing.
This doesn’t have to be anything rigid. Think of it like having designated meal and snack times for your children and family, and maintaining healthy boundaries around food and eating between those times.
When kids learn the kitchen is “closed” between meals and snacks, this can help them learn to eat when food is offered. This can also help support your children in building a positive relationship with food. For more on this, check out this post here: “Build Healthy Habits For Kids With a Feeding Schedule”
2. Offer sweets alongside meals and snacks:
Consider offering sweets your child is eating or wanting to eat alongside meals and/or snacks.
There are several benefits for this, outside of serving as a protective factor for teeth, including helping them build a positive relationship with all foods and not elevating sweets on a pedestal.
Combining other macronutrients, including fats and proteins, alongside carbohydrates, can help protect teeth enamel from acid in the mouth. Fats and proteins in the diet help to protect the teeth from sugars that become adherent to the teeth.
Foods higher in fiber, fat and protein can also help neutralize acid in the mouth, which can protect the teeth from decay.
One important thing here is to offer a variety of foods at meals and snacks that include the major macronutrients (carbohydrates, proteins and fats) but to not pressure your child into eating certain foods, as this can potentially backfire and make it challenging for your child to eat at mealtimes.
Offer a variety of foods and include sweets with meals, while allowing your child to decide what to eat from the foods you’ve made available. For more on this approach, read this blog here: “7 Practical Reasons Why To Offer Your Kids Dessert With Dinner”
3. Promote proper oral hygiene:
Sometimes, getting kids into an effective oral hygiene routine can be challenging. This can be especially hard if you have a child who may have oral sensitivities, a sensitive gag reflex or any type of oral trauma.
Regular brushing and flossing, of course, is going to help keep teeth clean and decrease risk of tooth decay. One thing that’s helped with my kids is getting fun toothbrushes or floss they’re excited about using and making teeth hygiene part of their morning and evening routines.
Using an automatic toothbrush can also be more effective with teeth brushing. Talk with your pediatric dentist about ways to build an effective oral hygiene routine if you’re needing more help in this area.
Don’t forget about the power of modeling!
Our kids are constantly watching us and modeling what we’re doing.
If they see you regularly brushing and flossing, they’re more likely to want to do it too! Make teeth brushing time a fun part of your daily routine with your children to make caring for your teeth a positive behavior.
Lastly, part of healthy oral care is maintaining regular check ups with your pediatric dentist as well. If you’re facing financial difficulties or don’t have health care, these can be challenging barriers to get your children into the pediatric dentist regularly.
If you need help with this and are in the United States, be sure to check out Mouth Healthy to find free or reduced cost dental care for your child. Remember that modeling regular teeth brushing can also be supportive in helping your child develop healthy teeth habits.
4. Adequate hydration to prevent dry mouth:
As mentioned earlier, dry mouth or low saliva flow can contribute to teeth decay.
Adequate saliva production can help wash away harmful acids and food particles away from teeth, as well as help to neutralize acid that can make teeth susceptible to decay.
Dehydration can cause dry mouth and lower saliva flow in the mouth.
Ensuring your child is adequately hydrated can help maintain appropriate saliva levels in the mouth to support overall teeth health.
If it’s a struggle for your child to drink water, consider offering ice cubes (or cold water in general), add in a fun reusable straw your child can drink water from, or naturally flavor water with fresh fruit or veggies, like berries, lemon, and cucumbers.
5. Vitamin D supplementation:
Studies have found that lack of vitamin D can lead to dental caries, as well as weak and brittle teeth, which can be more susceptible to decay.
Vitamin D is found predominantly in fortified foods, like milk (cow’s, soy, etc), orange juice, and some cereals/oatmeals. Other foods naturally rich in Vitamin D include cheese, egg yolks and fatty fish, like tuna and salmon.
Sun exposure can also support the body’s vitamin D levels. If your child doesn’t regularly eat any foods higher in Vitamin D or gets little sun exposure, consider talking to your pediatrician about testing their Vitamin D levels and looking at supplementation as necessary.
One controlled study of almost 3,000 children found a reduction of 47% in cavities of the children who received vitamin D supplements.
Again, this is just one area to consider. As always, please advise your pediatrician, pediatric dentist, and registered dietitian to determine if this is right for your child and before beginning any supplementation. Not all supplements are created equal, and it’s important to look at an individualized supplement protocol that might be right for your child.
Getting Help From Your Pediatric Dentist for Healthy Teeth
It’s also important to know that if your child has gotten cavities, it’s not your fault or a reflection of you as a parent.
Sometimes, all the factors align like the perfect storm and our kids may get cavities, despite our best efforts to help prevent them. That’s okay, and you’ll both be okay. This is why regular and routine dental check ups are important to help identify any problem areas as soon as possible.
Lastly, you might be wondering how you can talk with your pediatric dentist about language around food in effort to avoid fear-mongering tactics with eating sweets.
This is a valid concern, and again, I know you’re wanting to look at a middle ground approach to caring for your child’s teeth so that sweets aren’t restricted, feel off limits or unnecessary shame/guilt/fear is created around eating and enjoying sweets. Ultimately, this can dampen your child’s relationship with food and create unwanted consequences around eating sweets.
If you’re worried about how your pediatric dentist might interact with your child at a visit when it comes to having a “talk” about eating sweets, consider reaching out to your dentist ahead of time about your concerns.
In some situations, I’ve seen parents write out a short note about their concerns and pass it on to their dentist before they go in for their pediatric dental check-up or sending an email ahead of the appointment. I’ve included a sample script below you can use to share with your pediatric dentist if this is a concern for you.
This could read something along the lines of:
“We are taking every possible precaution to support our children in building a healthy relationship with food AND to help keep their teeth healthy. In effort to do this, we strive to keep language around food positive and to avoid any phrases that could potentially create fear, shame or guilt around eating. Can you please help us with this by keeping language positive about food in our visit with you today? We’d love to focus conversations on healthy teeth habits that don’t involve restricting or limiting sweets. Thank you in advance for understanding and helping us with this!”
Of course, this can be reworded and phrased in a manner that fits best for you and your family - this is just to give you an idea of how you can talk to your pediatric dentist, especially if you’re concerned about this.
For me in particular, as a mother with a history of an eating disorder, I know my eating disorder past puts my children at higher risk for this mental illness. While I can’t prevent them from potentially encountering triggers or keep them in a bubble, I can make the effort to help support them in building a positive relationship with food.
In the event your child was part of a conversation with a health professional in which certain foods were shamed or fear around eating certain foods was created, it’s not too late to help your child through this. In fact, this can be an even more powerful learning opportunity to talk with your child about some of the misunderstandings around food and empower them to trust themselves and their bodies. For more help on this, be sure to check out this post here: “End Mealtime Battles and Raise Intuitive Eaters With These Phrases”
I hope this helps you, friends! What are your thoughts on this? Feel free to leave your questions in the comments below.
Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your pediatric dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.