Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Vitamins and plant ingredients

Influence of fruit consumption and fluoride application on the prevalence of caries and erosion in vegetarians—a controlled clinical trial

Abstract

Background/Objectives:

Caries and erosion are common diseases of the dental hard tissues. The influence of vegetarianism on the development of caries and erosion has scarcely been investigated in the past. The aim of the present study was to evaluate the influence of fruit consumption and topical fluoride application on the prevalence of caries and erosion in vegetarians.

Subjects/Methods:

In 100 vegetarians and 100 nonvegetarians, a dental examination was performed. The indices for decayed, missing, filled teeth (DMFT) and surfaces (DMFS) were determined. DMFT and DMFS were subdivided into decayed teeth (DT), filled teeth (FT), decayed surfaces (DS) and filled surfaces (FS). In addition, the hygiene index and the number of teeth with dental erosion (DE), root caries (RC) and overhanging restoration margins (ORM) were recorded. A questionnaire assessed patients’ eating habits, frequency of oral hygiene, dentist visits and topical fluoride application. For statistical analysis, unpaired t-test, Mann–Whitney test and Pearson’s chi-square test were applied.

Results:

Vegetarians had significantly more DT (P<0.001), DS (P<0.001), more teeth with DE (P=0.026), RC (P=0.002) and ORM (P<0.001) than nonvegetarians. Daily consumption of fruits was significantly more prevalent (P<0.001), and topical fluoride application was less prevalent (P<0.001) in vegetarians compared with nonvegetarians. In particular, fluoride-containing toothpaste (P<0.001) and table salt (P=0.039) were less frequently used in vegetarians.

Conclusion:

The presented data suggest that vegetarians have an increased risk for caries and erosion. Topical fluoride application was shown to be effective in preventing caries, but not in preventing erosion.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. Fejerskov O, Kidd E . Dental Caries: the Disease and its Clinical Management, 2nd edn. Wiley-Blackwell: Copenhagen, Denmark, 2008.

    Google Scholar 

  2. Selwitz RH, Ismail AI, Pitts NB . Dental caries. Lancet 2007; 369: 51–59.

    Article  CAS  Google Scholar 

  3. Lussi A, Hellwig E, Klimek J . Fluorides—mode of action and recommendations for use. Schweiz Monatsschr Zahnmed 2012; 122: 1030–1042.

    PubMed  Google Scholar 

  4. Petersson GH, Bratthall D . The caries decline: a review of reviews. Eur J Oral Sci 1996; 104: 436–443.

    Article  CAS  Google Scholar 

  5. Magalhães AC, Wiegand A, Rios D, Buzalaf MA, Lussi A . Fluoride in dental erosion. Monogr Oral Sci 2011; 22: 158–170.

    Article  Google Scholar 

  6. Lussi A, Jaeggi T, Zero D . The role of diet in the aetiology of dental erosion. Caries Res 2004; 38: 34–44.

    Article  Google Scholar 

  7. Lussi A, Jaeggi T . Erosion—diagnosis and risk factors. Clin Oral Investig 2008; 12: 5–13.

    Article  Google Scholar 

  8. Lussi A, Schlueter N, Rakhmatullina E, Ganss C . Dental erosion—an overview with emphasis on chemical and histopathological aspects. Caries Res 2011; 45: 2–12.

    Article  Google Scholar 

  9. Craig WJ . Nutrition concerns and health effects of vegetarian diets. Nutr Clin Pract 2010; 25: 613–620.

    Article  Google Scholar 

  10. Craig WJ, Mangels AR, American Dietetic Association. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc 2009; 109: 1266–1282.

    Article  CAS  Google Scholar 

  11. Venugopal T, Kulkarni VS, Nerurker RA, Damle SG, Patnekar PN . Epidemiological study of dental caries. Indian J Pediatr 1998; 65: 883–889.

    Article  CAS  Google Scholar 

  12. Khan AA, Jain SK, Shrivastav A . Prevalence of dental caries among the population of Gwalior (India) in relation of different associated factors. Eur J Dent 2008; 2: 81–85.

    PubMed  PubMed Central  Google Scholar 

  13. al-Dlaigan YH, Shaw L, Smith AJ . Vegetarian children and dental erosion. Int J Paediatr Dent 2001; 11: 184–192.

    Article  CAS  Google Scholar 

  14. Linkosalo E, Markkanen H . Dental erosions in relation to lactovegetarian diet. Scand J Dent Res 1985; 93: 436–441.

    CAS  Google Scholar 

  15. Rafeek RN, Marchan S, Eder A, Smith WA . Tooth surface loss in adult subjects attending a university dental clinic in Trinidad. Int Dent J 2006; 56: 181–186.

    Article  CAS  Google Scholar 

  16. Staufenbiel I, Weinspach K, Förster G, Geurtsen W, Günay H . Periodontal conditions in vegetarians: a clinical study. Eur J Clin Nutr 2013; 67: 836–840.

    Article  CAS  Google Scholar 

  17. Klein H, Palmer C . Studies on dental caries. Pub Hlth Rep 1938; 53: 1353–1364.

    Article  Google Scholar 

  18. O’Leary TJ, Drake RB, Naylor JE . The plaque control record. J Periodontol 1972; 43: 38.

    Article  Google Scholar 

  19. Burt BA, Pai S . Sugar consumption and caries risk: a systematic review. J Dent Educ 2001; 65: 1017–1023.

    CAS  PubMed  Google Scholar 

  20. Grenby TH, Hutchinson JB . The effects of diets containing sucrose, glucose or fructose on experimental dental caries in two strains of rats. Arch Oral Biol 1969; 14: 373–380.

    Article  CAS  Google Scholar 

  21. Bowen WH . Do we need to be concerned about dental caries in the coming millennium? Crit Rev Oral Biol Med 2002; 13: 126–131.

    Article  Google Scholar 

  22. Paes Leme AF, Koo H, Bellato CM, Bedi G, Cury JA . The role of sucrose in cariogenic dental biofilm formation—new insight. J Dent Res 2006; 85: 878–887.

    Article  CAS  Google Scholar 

  23. Narisawa N, Kawarai T, Suzuki N, Sato Y, Ochiai K, Ohnishi M et al. Competence-dependent endogenous DNA rearrangement and uptake of extracellular DNA give a natural variant of Streptococcus mutans without biofilm formation. J Bacteriol 2011; 193: 5147–5154.

    Article  CAS  Google Scholar 

  24. Takahashi N, Nyvad B . Caries ecology revisited: microbial dynamics and the caries process. Caries Res 2008; 42: 409–418.

    Article  CAS  Google Scholar 

  25. Beighton D, Brailsford SR, Gilbert SC, Clark DT, Rao S, Wilkins JC et al. Intra-oral acid production associated with eating whole or pulped raw fruits. Caries Res 2004; 38: 341–349.

    Article  CAS  Google Scholar 

  26. Marinho VC . Cochrane reviews of randomized trials of fluoride therapies for preventing dental caries. Eur Arch Paediatr Dent 2009; 10: 183–191.

    Article  CAS  Google Scholar 

  27. Maguire A . ADA clinical recommendations on topical fluoride for caries prevention. Evid Based Dent 2014; 15: 38–39.

    Article  Google Scholar 

  28. Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VC, Shi X . Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2010; 1: CD007868.

    Google Scholar 

  29. Wong MC, Glenny AM, Tsang BW, Lo EC, Worthington HV, Marinho VC . Topical fluoride as a cause of dental fluorosis in children. Cochrane Database Syst Rev 2010; 1: CD007693.

    Google Scholar 

  30. Marinho VC, Worthington HV, Walsh T, Clarkson JE . Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2013; 7: CD002279.

    Google Scholar 

  31. Weintraub JA, Ramos-Gomez F, Jue B, Shain S, Hoover CI, Featherstone JD et al. Fluoride varnish efficacy in preventing early childhood caries. J Dent Res 2006; 85: 172–176.

    Article  CAS  Google Scholar 

  32. Knutsen SF . Lifestyle and the use of health services. Am J Clin Nutr 1994; 59: 1171S–1175S.

    Article  CAS  Google Scholar 

  33. Attin T, Knöfel S, Buchalla W, Tütüncü R . In situ evaluation of different remineralization periods to decrease brushing abrasion of demineralized enamel. Caries Res 2001; 35: 216–222.

    Article  CAS  Google Scholar 

  34. Rios D, Honório HM, Magalhães AC, Delbem AC, Machado MA, Silva SM et al. Effect of salivary stimulation on erosion of human and bovine enamel subjected or not to subsequent abrasion: an in situ/ex vivo study. Caries Res 2006; 40: 218–223.

    Article  CAS  Google Scholar 

  35. Herman K, Czajczyńska-Waszkiewicz A, Kowalczyk-Zając M, Dobrzyński M . Assessment of the influence of vegetarian diet on the occurrence of erosive and abrasive cavities in hard tooth tissues. Postepy Hig Med Dosw 2011; 65: 764–769.

    Article  Google Scholar 

  36. Ganss C, Schlechtriemen M, Klimek J . Dental erosions in subjects living on a raw food diet. Caries Res 1999; 33: 74–80.

    Article  CAS  Google Scholar 

  37. Järvinen VK, Rytömaa II, Heinonen OP . Risk factors in dental erosion. J Dent Res 1991; 70: 942–947.

    Article  Google Scholar 

  38. Reussner GH, Coccodrilli Jr G, Thiessen R Jr . Effects of phosphates in acid-containing beverages on tooth erosion. J Dent Res 1975; 54: 365–370.

    CAS  PubMed  Google Scholar 

  39. Hughes JA, West NX, Parker DM, Newcombe RG, Addy M . Development and evaluation of a low erosive blackcurrant juice drink. 3. Final drink and concentrate, formulae comparisons in situ and overview of the concept. J Dent 1999; 27: 345–350.

    Article  CAS  Google Scholar 

  40. Magalhães AC, Moraes SM, Rios D, Buzalaf MA . Effect of ion supplementation of a commercial soft drink on tooth enamel erosion. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2009; 26: 152–156.

    Article  Google Scholar 

  41. Gedalia I, Ionat-Bendat D, Ben-Mosheh S, Shapira L . Tooth enamel softening with a cola type drink and rehardening with hard cheese or stimulated saliva in situ. J Oral Rehabil 1991; 18: 501–506.

    Article  CAS  Google Scholar 

  42. Gedalia I, Dakuar A, Shapira L, Lewinstein I, Goultschin J, Rahamim E . Enamel softening with Coca-Cola and rehardening with milk or saliva. Am J Dent 1991; 4: 120–122.

    CAS  PubMed  Google Scholar 

  43. Huysmans MC, Young A, Ganss C . The role of fluoride in erosion therapy. Monogr Oral Sci 2014; 25: 230–243.

    Article  Google Scholar 

  44. Schlueter N, Klimek J, Ganss C . Efficacy of an experimental tin-F-containing solution in erosive tissue loss in enamel and dentine in situ. Caries Res 2009; 43: 415–421.

    Article  CAS  Google Scholar 

  45. Which toothpaste to use?Available at http://www.swaminarayan.nu/useful/toothpaste.shtml.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to I Staufenbiel.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Staufenbiel, I., Adam, K., Deac, A. et al. Influence of fruit consumption and fluoride application on the prevalence of caries and erosion in vegetarians—a controlled clinical trial. Eur J Clin Nutr 69, 1156–1160 (2015). https://doi.org/10.1038/ejcn.2015.20

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2015.20

This article is cited by

Search

Quick links