Journal of the Royal Society of Medicine Volume 84 October 1991

635

I know that already the pathologist's lack of intimate clinical knowledge is being remedied by CPCs etc, but I would emphasize the need to find ways and means whereby this cross-fertilization process canb6improved. A D T GOVAN University Department of Obstetrics & Gynaecology Royal Infirmary, Glasgow G31 2ER

The Coma report: sugars and dental caries The letter by Walker and Walker on sugas and dental caries (May 1991 JRSM, p 320) made interesting reading. No one would disagree that the aetiology of dental caries is multifactorial, as is its decline in developed countries. However the key role of sugar in the development of dental caries must be emphasized. The Vipeholm Study' gave unequivocal evidence that sugar between meals results in an increase -in caries. Further evidence is reported by those who have examined the results of a change to a 'westernized' diet by communities such as t-he Eskimos2 or the inhabitants of Tristan da Cunha3. These and similar communities witnesse an increase in caries levels, accompanying their change in eating habits. In the Western world socially-deprived groups have seen less of a decline in caries levels compared to their more advantaged peers. Blinkhorn found caries and sweet-eating higher in deprived children4. Longitudinal studies relating caries experience to the level of consumption of sugar, are important as they relate diet to the number of new carious lesions initiated over the same time period. Rugg-Gunn et al. reported a positive correlation5 between confectionery, table sugar and soft drinks being particularly

implicated6. The Turku Study substituted sucrose in the diet, which resulted in a 66% reduction in aes7. In answer to the points made by Walker and Walker: (i) sugar is heavily incrimi-nated as the major cause of dental caries; (ii) even if one were to accept the claim of a 20-25% reduction following sugar reduction, this is significant both in terms of reduced suffering and cost; (iii) there is no reason that a reduction in sugar intake, particularly between meals need necessitate an increase in fat intake. C DEERY

Department of Dental Health, University of Dundee, Dundee DD1 4HN

References 1 Gustaffson BE, Quensel CE, Lanke LS, et al. The Vipeholm dental caries study. The effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odont Scand 1954;11:232-64 2 Curzon MEJ, Curzon JA. Dental caries prevalence in the Baffin Island eskimo. Pediatr Dent 1979;1:169-72 3 Fisher FJ. A field study of dental caries, periodontal disease and enamel defects in Tristan da Cunha. Br Dent J 1968;125:447-53 4 Blinkhorn AS. The caries experience and dietary habits of Edinburgh nursery school children. Br Dent J 1982;152:227-30 5 Rugg-Gunn AJ, Hackett AF, Appleton DR, Jenkins GN, Eastoe JE. Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent schoolchildren. Arch Oral Biol 1984;29:983-92 6 Rugg-Gunn AJ, Hackett AF, Appleton DR, Moynihan PJ. The dietary intake of added and natural sugars in 405 English adolescents. Hum Nutr Appl Nutr 1986;40a: 115-24 7 Scheinin A. Influence of the diagnostic level on caries incidence in two controlled clinical trials. Caries Res 1979;13:91(abstr. 20)

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The Coma report: sugars and dental caries.

Journal of the Royal Society of Medicine Volume 84 October 1991 635 I know that already the pathologist's lack of intimate clinical knowledge is bei...
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