{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T07:55:11Z","timestamp":1788162911849,"version":"build-2803163510"},"reference-count":52,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: The excessive consumption of free sugars adversely impacts health, contributing to systemic disorders and significantly increasing the risk of dental caries. Children are particularly vulnerable to dental caries due to their dietary habits and oral hygiene practices. This study aimed to examine the relationship between sugar intake and dental caries experience in a sample of children aged 6\u201312 years. Methods: Data were analyzed from the National Health and Nutrition Examination Survey (NHANES) covering the years 2011\u20132016. This cross-sectional study utilized nationally representative data from NHANES, which provides comprehensive health assessments on the U.S. population. This study focused on 3658 children aged 6\u201312 years. Free sugar intake and its association with dental caries were evaluated using the Decayed, Missing, and Filled Teeth (DMFT) index, a widely accepted measure for assessing cumulative caries experience in permanent teeth. Demographic and socioeconomic factors were also accounted for. The sample primarily consisted of generally healthy children, with mild to moderate health conditions included in the analysis. Results: The average Decayed, Missing, and Filled Teeth (DMFT) score was 1.69 (SD = 2.61). Untreated dental caries affected 19.1% of the sample, with disproportionately higher rates observed among Mexican American children (23.8%), children from lower socioeconomic backgrounds (24.2%), those with less-educated parents (25.1%), and overweight children (22.9%). Mean daily free sugar intake was 72.46 g (SD = 50.45), with significant variations across race\/ethnicity, parental education, and gender. A statistically significant association was found between free sugar intake and dental caries in U.S. children (p &lt; 0.001). Conclusions: Free sugar intake is strongly associated with an increased risk of dental caries. Disparities in caries prevalence were evident based on race\/ethnicity, socioeconomic status, and parental education levels. Regulating sugar intake and promoting dietary education are effective strategies to reduce the risk of dental caries and improve oral health outcomes among children.<\/jats:p>","DOI":"10.3390\/dj13020048","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T09:52:20Z","timestamp":1737539540000},"page":"48","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Impact of Free Sugar Consumption on Dental Caries: A Cross-Sectional Analysis of Children in the United States"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5985-6538","authenticated-orcid":false,"given":"Val Joseph","family":"Cheever","sequence":"first","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7277-1291","authenticated-orcid":false,"given":"Amir","family":"Mohajeri","sequence":"additional","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavina","family":"Patel","sequence":"additional","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7818-4260","authenticated-orcid":false,"given":"Richard Collin","family":"Burris","sequence":"additional","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2827-3740","authenticated-orcid":false,"given":"Man","family":"Hung","sequence":"additional","affiliation":[{"name":"College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA"},{"name":"Division of Public Health, University of Utah, Salt Lake City, UT 84108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025, January 05). WHO Calls on Countries to Reduce Sugars Intake Among Adults and Children. Available online: https:\/\/www.who.int\/news\/item\/04-03-2015-who-calls-on-countries-to-reduce-sugars-intake-among-adults-and-children."},{"key":"ref_2","unstructured":"Centers for Disease Control and Prevention (2024, June 17). Get the Facts: Added Sugars, Available online: https:\/\/www.cdc.gov\/nutrition\/php\/data-research\/added-sugars.html."},{"key":"ref_3","unstructured":"U.S. Department of Health & Human Services (2024, December 04). Understanding How Sugar Contributes to Tooth Decay, Available online: https:\/\/headstart.gov\/oral-health\/brush-oral-health\/understanding-how-sugar-contributes-tooth-decay?redirect=eclkc."},{"key":"ref_4","unstructured":"American Academy of Pediatric Dentistry (2025, January 05). Policy on Dietary Recommendations for Infants, Children, and Adolescents. Available online: https:\/\/pre-prod.aapd.org\/research\/oral-health-policies--recommendations\/dietary-recommendations-for-infants-children-and-adolescents\/."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Chi, D.L., Hopkins, S., O\u2019Brien, D., Mancl, L., Orr, E., and Lenaker, D. (2015). Association between added sugar intake and dental caries in Yup\u2019ik children using a novel hair biomarker. BMC Oral Health, 15.","DOI":"10.1186\/s12903-015-0101-z"},{"key":"ref_6","unstructured":"National Institute of Dental and Craniofacial Research (2025, January 14). Dental Caries (Tooth Decay), Available online: https:\/\/www.nidcr.nih.gov\/research\/data-statistics\/dental-caries#:~:text=Dental%20caries%20(tooth%20decay)%20remains,remain%20among%20some%20population%20groups."},{"key":"ref_7","unstructured":"Centers for Disease Control and Prevention (2025, January 14). 2024 Oral Health Surveillance Report: Selected Findings, Available online: https:\/\/www.cdc.gov\/oral-health\/php\/2024-oral-health-surveillance-report\/selected-findings.html#:~:text=Nearly%203%25%20of%20children%20aged,teeth%20across%20all%20sociodemographic%20characteristics."},{"key":"ref_8","unstructured":"National Center for Health Statistics (2025, January 14). Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015\u20132016, Available online: https:\/\/www.cdc.gov\/nchs\/products\/databriefs\/db307.htm."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1111\/ipd.12783","article-title":"The global prevalence of early childhood caries: A systematic review with meta-analysis using the WHO diagnostic criteria","volume":"31","author":"Uribe","year":"2021","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_10","unstructured":"Wartella, E., Lichtenstein, A., and Boon, C. (2010). Overview of Health and Diet in America. Front-of-Package Nutrition Rating Systems and Symbols: Phase I Report, National Academies Press (US)."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1093\/nutrit\/nuad147","article-title":"Impact of unhealthy food and beverage consumption on children\u2019s risk of dental caries: A systematic review","volume":"82","author":"Large","year":"2024","journal-title":"Nutr. Rev."},{"key":"ref_12","first-page":"505","article-title":"Caries risk assessment, prevention, and management in pediatric dental care","volume":"58","author":"Crystal","year":"2010","journal-title":"Gen. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"881S","DOI":"10.1093\/ajcn\/78.4.881S","article-title":"Sugars and dental caries","volume":"78","year":"2003","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Chen, L., Al-Bayatee, S., Khurshid, Z., Shavandi, A., Brunton, P., and Ratnayake, J. (2021). Hydroxyapatite in Oral Care Products\u2014A Review. Materials, 14.","DOI":"10.3390\/ma14174865"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Feldens, C.A., Pinheiro, L.L., Cury, J.A., Mendon\u00e7a, F., Groisman, M., Costa, R.A.H., Pereira, H.C., and Vieira, A.R. (2022). Added Sugar and Oral Health: A Position Paper of the Brazilian Academy of Dentistry. Front. Oral Health, 3.","DOI":"10.3389\/froh.2022.869112"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"149","DOI":"10.3945\/an.115.009365","article-title":"Sugars and Dental Caries: Evidence for Setting a Recommended Threshold for Intake","volume":"7","author":"Moynihan","year":"2016","journal-title":"Adv. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Anil, S., and Anand, P.S. (2017). Early Childhood Caries: Prevalence, Risk Factors, and Prevention. Front. Pediatr., 5.","DOI":"10.3389\/fped.2017.00157"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.cden.2018.08.003","article-title":"Added Sugar and Dental Caries in Children: A Scientific Update and Future Steps","volume":"63","author":"Chi","year":"2019","journal-title":"Dent. Clin. N. Am."},{"key":"ref_19","first-page":"81","article-title":"Influence of parental socioeconomic status on caries prevalence among children seen at the university college hospital, ibadan","volume":"11","author":"Popoola","year":"2013","journal-title":"Ann. Ib. Postgrad. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kaushik, M., and Sood, S. (2023). A Systematic Review of Parents\u2019 Knowledge of Children\u2019s Oral Health. Cureus, 15.","DOI":"10.7759\/cureus.41485"},{"key":"ref_21","unstructured":"Great Smiles Pediatric Dentistry & Orthodontics (2025, January 06). Great Smile Care: What Are the Long-Term Effects of Poor Oral Hygiene?. Available online: https:\/\/greatsmiles.com\/long-term-effects-of-poor-oral-hygiene\/#:~:text=Periodontal%20Disease%20(That\u2019s%20a%20Fancy%20Term%20for,yes%2C%20even%20kids%20can%20see%20these%20issues!."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Dumitrescu, R., Sava-Rosianu, R., Jumanca, D., Balean, O., Damian, L.-R., Fratila, A.D., Maricutoiu, L., Hajdu, A.I., Focht, R., and Dumitrache, M.A. (2022). The Impact of Parental Education on Schoolchildren\u2019s Oral Health\u2014A Multicenter Cross-Sectional Study in Romania. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191711102"},{"key":"ref_23","unstructured":"Evergreen (2025, January 06). The Importance of Early Dental Care for Kids. Available online: https:\/\/evergreenkidsdentist.com\/the-importance-of-early-dental-care-for-kids\/."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Gupta, P., Gupta, N., Pawar, A.P., Birajdar, S.S., Natt, A.S., and Singh, H.P. (2013). Role of sugar and sugar substitutes in dental caries: A review. ISRN Dent., 2013.","DOI":"10.1155\/2013\/519421"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1007\/s12098-017-2381-6","article-title":"Dental Caries: A Disease Which Needs Attention","volume":"85","author":"Mathur","year":"2018","journal-title":"Indian J. Pediatr."},{"key":"ref_26","unstructured":"World Health Organization (2024, December 04). Sugars and Dental Caries. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/sugars-and-dental-caries."},{"key":"ref_27","unstructured":"STROBE (2025, January 03). STROBE Checklists. Available online: https:\/\/www.strobe-statement.org\/checklists\/."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1177\/00220345221082918","article-title":"Systematic Review of the Effect on Caries of Sugars Intake: Ten-Year Update","volume":"101","author":"Moores","year":"2022","journal-title":"J. Dent. Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Mohajeri, A., Berg, G., Watts, A., Cheever, V.J., and Hung, M. (2024). Obesity and Dental Caries in School Children. J. Clin. Med., 13.","DOI":"10.3390\/jcm13030860"},{"key":"ref_30","unstructured":"Muswell Hill Smile (2025, January 03). The Transition Between The Primary And Permanent Teeth!. Available online: https:\/\/muswellhillsmile.co.uk\/blog\/transition-between-primary-and-permanent-teeth\/."},{"key":"ref_31","unstructured":"National Center for Health Statistics (2025, January 03). Data Quality Evaluation of the Dental Fluorosis Clinical Assessment Data from the National Health and Nutrition Examination Survey, 1999\u20132004 and 2011\u20132016, Available online: https:\/\/www.cdc.gov\/nchs\/data\/series\/sr_02\/sr02_183-508.pdf."},{"key":"ref_32","unstructured":"USDA (2025, January 03). Food Patterns Equivalents Database, Available online: https:\/\/www.ars.usda.gov\/northeast-area\/beltsville-md-bhnrc\/beltsville-human-nutrition-research-center\/food-surveys-research-group\/docs\/fped-overview\/."},{"key":"ref_33","unstructured":"Center on Urban Poverty and Community Development (2025, January 03). Census Poverty and Income Indicators. Available online: https:\/\/neocando.case.edu\/cando\/pdf\/CensusPovertyandIncomeIndicators.pdf."},{"key":"ref_34","unstructured":"Centers for Disease Control and Prevention (2025, January 03). Child and Teen BMI Calculator, Available online: https:\/\/www.cdc.gov\/bmi\/child-teen-calculator\/index.html."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.archoralbio.2010.03.005","article-title":"Relationship among microbiological composition and presence of dental plaque, sugar exposure, social factors and different stages of early childhood caries","volume":"55","author":"Parisotto","year":"2010","journal-title":"Arch. Oral Biol."},{"key":"ref_36","unstructured":"Wolfson Institute of Population Health (2025, January 06). Sugars and Tooth Decay. Available online: https:\/\/www.actiononsugar.org\/sugar-and-health\/sugars-and-tooth-decay\/#:~:text=Furthermore%2C%20the%20Scientific%20Advisory%20Committee%20on%20Nutrition,caries%20both%20in%20deciduous%20and%20permanent%20teeth."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Mohanty, S., Behera, D., Tripathy, S., Jena, M., Behera, M.R., and Panda, B. (2024). Prevalence, risk factors, and parental perspectives of dental caries in children in Odisha: A mixed-method study. Clin. Epidemiol. Glob. Health, 29.","DOI":"10.1016\/j.cegh.2024.101748"},{"key":"ref_38","unstructured":"World Health Organization (2025, January 06). World Bank and WHO: Half the World Lacks Access to Essential Health Services, 100 Million Still Pushed into Extreme Poverty Because of Health Expenses. Available online: https:\/\/www.who.int\/news\/item\/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses#:~:text=For%20example%2C%20only%2017%20percent%20of%20mothers,pe."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1007\/s40368-021-00627-0","article-title":"Early predictors of childhood caries among 4-year-old children: A population-based study in north-eastern France","volume":"22","author":"Hernandez","year":"2021","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_40","first-page":"1","article-title":"Consumption of sugar drinks in the United States, 2005\u20132008","volume":"71","author":"Ogden","year":"2011","journal-title":"NCHS Data Brief"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1016\/j.jada.2009.05.002","article-title":"Interrelationships of added sugars intake, socioeconomic status, and race\/ethnicity in adults in the United States: National Health Interview Survey, 2005","volume":"109","author":"Thompson","year":"2009","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Kimmie-Dhansay, F., Barrie, R., Naidoo, S., and Roberts, T. (2022). Prevalence of early childhood caries in South Africa: A systematic review. BMC Oral Health, 22.","DOI":"10.1186\/s12903-021-01982-6"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13690-020-00402-5","article-title":"The influence of education on health: An empirical assessment of OECD countries for the period 1995\u20132015","volume":"78","author":"Raghupathi","year":"2020","journal-title":"Arch. Public Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.jdent.2012.07.013","article-title":"Parental influence and the development of dental caries in children aged 0\u20136 years: A systematic review of the literature","volume":"40","author":"Hooley","year":"2012","journal-title":"J. Dent."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/j.ridd.2010.08.005","article-title":"The impact of dietary and tooth-brushing habits to dental caries of special school children with disability","volume":"31","author":"Liu","year":"2010","journal-title":"Res. Dev. Disabil."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"859","DOI":"10.2105\/AJPH.2011.300548","article-title":"Explaining Racial\/Ethnic Disparities in Children\u2019s Dental Health: A Decomposition Analysis","volume":"102","author":"Wehby","year":"2012","journal-title":"Am. J. Public Health"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Kabani, F.A., Stockbridge, E.L., Varghese, B.B., and Loethen, A.D. (2020). Acculturation and the oral health of a nationally representative sample of Hispanic children in the United States: An analysis of 2011\u20132012 National Survey of Children\u2019s Health data. BMC Public Health, 20.","DOI":"10.1186\/s12889-019-8045-x"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Crespo, E. (2019). The Importance of Oral Health in Immigrant and Refugee Children. Children, 6.","DOI":"10.3390\/children6090102"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s10995-007-0294-0","article-title":"An observational study of the association of fluoride varnish applied during well child visits and the prevention of early childhood caries in American Indian children","volume":"12","author":"Holve","year":"2008","journal-title":"Matern. Child Health J."},{"key":"ref_50","unstructured":"Chitlall, A. (2025, January 06). Closing the Gap With School-Based Dental Care. Available online: https:\/\/dimensionsofdentalhygiene.com\/article\/closing-the-gap-with-school-based-dental-care\/."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.3945\/jn.111.138727","article-title":"Food Portion Patterns and Trends among U.S. Children and the Relationship to Total Eating Occasion Size, 1977\u20132006","volume":"141","author":"Piernas","year":"2011","journal-title":"J. Nutr."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Muth, N.D., Dietz, W.H., Magge, S.N., Johnson, R.K., American Academy of Pediatrics, Section on Obesity, Committee on Nutrition, and American Heart Association (2019). Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents. Pediatrics, 143.","DOI":"10.1542\/peds.2019-0282"}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/2\/48\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:33:52Z","timestamp":1759919632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/2\/48"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,22]]},"references-count":52,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["dj13020048"],"URL":"https:\/\/doi.org\/10.3390\/dj13020048","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,22]]}}}