{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:34:08Z","timestamp":1786739648484,"version":"build-2736575974"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Dental caries is a widespread oral health issue with significant medical and socioeconomic consequences. Despite preventive measures, nearly 90% of US adults have experienced caries, disproportionately affecting lower-income and minority populations. While fluoride use and oral hygiene practices help mitigate caries development, dietary sugar remains a primary driver. However, nutrition counseling in dental settings remains underutilized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>This randomized, single-center, two-group clinical study assessed the impact of Stephan\u2019s curve-based nutrition counseling on snacking frequency and added sugar consumption over 2 weeks. One hundred adult participants were randomized into an intervention group receiving personalized nutrition counseling or a control group receiving no counseling. The nutrition counseling focused on reducing both the frequency of snacking and the amount of added sugar consumed during snacks. Participants used an app that calculates the amount of added sugar consumed. Additionally, the Stephan\u2019s curve was utilized as a visual tool to demonstrate how sugar or carbohydrate intake causes a drop in pH below the critical threshold. Examiners assessed the caries experiences expressed as decayed, missing, or filled teeth (DMFT) of participants at baseline and at the 2-week follow-up visit. Participants logged their snacking frequency and sugar consumption daily. Statistical analysis compared pre- and post-intervention data using t-tests and Random Forest modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The intervention group significantly reduced snacking frequency by 26.1% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.006) and sugar intake by 50.8% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001), while the control group showed non-significant reductions of 9.5% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.09) and 5.2% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.67), respectively. Random forest modeling identified younger participants as more responsive to the intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>Stephan\u2019s curve-based nutrition counseling effectively reduced sugar intake and, to a lesser extent, snacking frequency. These findings support incorporating dietary education into routine dental care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jehp.jehp_335_25","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T13:01:31Z","timestamp":1769778091000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of nutrition counseling on reducing sugar intake amount and frequency: A randomized clinical trial"],"prefix":"10.4103","volume":"15","author":[{"given":"Aylene","family":"Rios","sequence":"first","affiliation":[{"name":"Department of Dental Hygiene, Loma Linda University School of Dentistry, Loma Linda, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Perdomo","sequence":"additional","affiliation":[{"name":"Department of Dental Hygiene, Loma Linda University School of Dentistry, Loma Linda, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Grainger","sequence":"additional","affiliation":[{"name":"Department of Dental Hygiene, Loma Linda University School of Dentistry, Loma Linda, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassidy","family":"Negrete","sequence":"additional","affiliation":[{"name":"Department of Dental Hygiene, Loma Linda University School of Dentistry, Loma Linda, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Ko","sequence":"additional","affiliation":[{"name":"Biology Department, La Sierra University, Riverside, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udochukwu","family":"Oyoyo","sequence":"additional","affiliation":[{"name":"Department of Dental Educational Services, Loma Linda University School of Dentistry, Loma Linda, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Ran","family":"Kwon","sequence":"additional","affiliation":[{"name":"Division of General Dentistry, Loma Linda University School of Dentistry, Loma Linda, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1]]},"reference":[{"key":"R1-20260130","doi-asserted-by":"crossref","first-page":"e13501","DOI":"10.1111\/apm.13501","article-title":"Historical concepts and contemporary perspectives of dental caries \u2013 A tribute to Henrik Dam (1895-1976)","volume":"133","author":"Markvart","year":"2025","journal-title":"APMIS"},{"key":"R4-20260130","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.cden.2018.08.007","article-title":"Evidence-based dentistry caries risk assessment and disease management","volume":"63","author":"Fontana","year":"2019","journal-title":"Dent Clin North Am"},{"key":"R5-20260130","first-page":"270","article-title":"Fluoride and caries prevention: A scoping review of public health policies","volume":"36","author":"Veneri","year":"2024","journal-title":"Ann Ig"},{"key":"R7-20260130","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1093\/jn\/42.1.89","article-title":"The prevention of experimental tooth decay by tube-feeding","volume":"42","author":"Kite","year":"1950","journal-title":"J Nutrit"},{"key":"R8-20260130","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1038\/sj.bdj.4810406","article-title":"Fluoride supplements and changes in tooth decay on the Island of Tristan da Cunha: 1966\u20131996","volume":"195","author":"Mossey","year":"2003","journal-title":"Br Dent J"},{"key":"R9-20260130","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/j.1834-7819.1967.tb04263.x","article-title":"The biology of the children of Hopewood House, Bowral, N.S.W. 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