Fluoride Action Network


Dental caries, although preventable, remains one of the most prevalent chronic disease worldwide. Most studies focused on the relationship between sugar intake and caries. However, examining multidimensional dietary patterns is becoming increasingly important. Here, we examined the relationship between dietary patterns from ages 6 to 12 months and early childhood caries (ECC) at age 2 to 3-years. Infant dietary data was collected from caregivers and dietary pattern trajectories from 6 to 12 months derived. Oral examinations were carried out by trained calibrated dentists at ages 2 and 3 years. Associations between dietary pattern and ECC were estimated using generalized estimating equation. We found a 3.9 fold lower prevalence of decayed surfaces among children with high Guidelines dietary pattern scores at 6-months (IRR 0.26; CI [0.12–0.53]; p-value <0.001) and 100% reduction of decayed surfaces with increased intakes of Guidelines dietary pattern foods from 6 to 12-month (IRR 2.4 × 104; CI [4.2 × 107–0.13]; p-value = 0.01). Suggesting that following the Guideline dietary pattern, which corresponds most closely to current World Health Organization weaning guidelines, at 6 months and an increase in pattern score between 6 and 12 months were protective against ECC development compared to Predominantly breastmilk, Easy-to-prepare foods and Noodles (in soup) and seafood dietary patterns.


Materials and Methods

The GUSTO cohort and study design

The GUSTO cohort is a mother-offspring cohort study that recruited over 1200 pregnant women aged 18–50 years delivering at the National University Hospital (NUH) and KK Women’s and Children’s Hospital (KKH) between June 2009 and September 2010. The participants were of self-identified homogenous ethnic background representing the 3 major ethnicities of Singapore: Chinese, Malay and Indian. Subjects were followed very closely from birth with detailed observations and samples collected to provide insights into the management and prevention of important diseases. The study received ethical approval from the institutional review boards of the National Healthcare Group and Singapore Health services. (DSRB reference D/09/021)(CIRB reference 2009/280/D) Informed consent was obtained from all participants and their legal guardians. Additionally, all experiments were performed in accordance with relevant guidelines and regulations.

This is a cohort study utilizing the GUSTO data where the various domains of the GUSTO study examined nested groups for different health parameters including nutrition and oral health. Demographics such as household income, maternal age, maternal education, and birthweight were recorded at the initial recruitment visit…

Excerpts on toothpaste:

DS =  number of decayed surfaces with white spot/cavitation lesions (International Caries Detection and Assessment System (ICDAS) II codes 2–6).

ECC = early childhood caries at age 2 to 3-years.

..Additionally, ds was found to be higher in subjects who used fluoride toothpaste at 3 years (p-value = 0.014) when compared to subjects who did not. (Table 4).

… As expected, the caries rate was higher at 3 years old when compared to at 2 years old as it is a chronic disease with a cumulative prevalence. The finding that Indian participants had lower rates of caries was similar to a previous study on a larger sample of the GUSTO cohort25. Interestingly, the use of fluoride toothpaste at 3 year old was associated with an increase in ECC. Similar to our previous report, this may be a result of an increased use of fluoride toothpaste due to recommendations from dentists after the child had caries in the first place25, a case of reverse causality.