Trajectories of child free sugars intake and dental caries - a population-based birth cohort study

Despite favorable living conditions and healthcare services, many Australian children continue to suffer from oral diseases from a very young age. By school entry age, 40% of Australian children have dental caries experience [1]. This most prevalent childhood chronic disease has a substantial negative impact on both the affected children and their families, including their health-related quality of life [2], and the healthcare system [3]. It is important to understand the early-life factors that lead to dental caries development during the preschool years.

The effect of dietary free sugars intake on caries has been documented in reviews of mostly cross-sectional studies [4], [5], [6]. Infant feeding practices have been associated with the development of caries lesions; in particular, adding sugar-sweetened beverages (SSB) to feeding bottles is associated with early childhood caries [7]. The National Child Oral Health Study of Australia revealed a strong gradient in child dental caries prevalence and experience by SSB consumption, even after controlling for exposure to fluoridated water [8], confirming free sugars intake as a major determinant of child oral ill-health. However, the effect of the patterns and magnitude of free sugars intake during the first years of life on child oral health remains unclear.

The first years of life are a critical period in childhood development and health. The roots of chronic conditions such as dental caries need to be traced back to as early in life as possible [9]. The first five years of life see the eruption of the primary dentition and development of dietary patterns, which are strongly influenced by family circumstances and environment. Maternal consumption of SSB (a proxy measure of environmental exposure to sugars) was shown to affect dental caries experience in their offspring, indicating potential effect of the environment where a child grows up (8). The newly erupted primary teeth are exposed to and affected by both risk and protective factors operating across those early years. Understanding the nature, patterns and magnitude of those effects can inform timely preventive measures. To date, however, the effects of longitudinal changes of determinants such as free sugars intake (FSI) on child dental caries experience have not been investigated.

The study aimed to investigate the association of the patterns and magnitude of FSI in the first five years of life with child dental caries using a longitudinal design. To do so, longitudinal trajectories of FSI were identified and their effects on child dental caries experience by age five years determined.

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