Modern methods for assessing the cariogenic and erosive potential of foods by M. E. J. Curzon and J. J. Hefferren Br Dent J 2000; 191 41–46


This is a report of a workshop convened in the UK to bring up-to-date methods for testing foods and drinks for their cariogenic and erosive potential. As such, it is to be welcomed. The workshop was held in November 1999 and involved most of the leading experts in the UK, supplemented by some knowledgeable and experienced researchers from the USA. The American Dental Association held a number of similar workshops between 1970 and 1985: the last one – The San Antonio Conference – being the most influential and widely quoted. It was important to revisit the San Antonio guidelines and, crucially, to bring in testing for erosive potential for the first time. John Hefferren, who masterminded much of the ADA's efforts, attended the UK workshop, providing valuable continuity of thought.

The best test for any product is the randomised clinical trial. Foods have been tested in clinical trials: there have been many trials of sugarless chewing gums, some trials of sugarless sweets and a few trials of the addition of protective factors (mostly calcium and phosphorus-based) to breakfast cereals and other foods. But clinical trials are expensive and not without ethical problems. What is badly needed are alternative tests, which are cheaper and can be undertaken by several centres in this country and abroad. It is essential that these tests are valid and the data reliable. The question of validity is central to this report, but maybe it needs to be dealt with more overtly in future workshops. Lack of validating criteria hampers progress and the question of certainty or risk needs to be discussed also. The question as to when a product can be called 'safe' has taxed government officials over recent years and the same philosophies are applicable here.

The bulk of the report discusses techniques used in testing cariogenicity and erosion. These include animal experiments, plaque pH experiments, intra-oral cariogenicity testing (for caries and erosion) and in vitro laboratory testing. It was recognised that animal testing is much less frequent now, and that intra-oral testing has much potential and needs to be developed further. Not everyone will agree with some of the recommendations and uncertainties remain. This report is not the definitive word on this subject, but it should be very useful in stimulating debate and the desire for a further workshop to take this important issue forward. It is also hoped that the next workshop may have less controversial sponsorship.