The Association of Dietary Fluoride Intake and Diet Variables with Dental Caries in Adolescents from the ELEMENT Cohort Study

Abstract

To examine the association of dietary fluoride intake, total carbohydrate consumption and other key dietary variables with dental caries experience among adolescents, a cross-sectional analysis was conducted in a sample of 402 participants from the Early Life Exposures in Mexico to Environmental Toxicants cohort. The presence and severity of dental caries were assessed using the Caries Detection and Assessment System (ICDAS) to calculate the number of Decayed, Missing, and Filled Teeth or Surfaces (D1MFT/D4MFT). Dietary intake of fluoride, energy, carbohydrates and food groups was estimated using a validated Food Frequency Questionnaire (FFQ). Multivariate zero-inflated negative binomial regression models and negative binomial regression models were run to estimate the association of fluoride intake (mg/d) and total carbohydrate intake (g/d) with the D1MFT/D4MFT index. We found that 80% of adolescents experienced dental caries (D1MFT>0), with 30% presenting cavitated lesions (D4MFT>0). Mean scores for D1MFT and D4MFT were 6.2 (SD 5.3) and 0.67 (SD 1.3), respectively. The median intake of fluoride estimated by the FFQ was 0.015 mg/d, this intake was statistically higher in those participants with a D4MFT=0 than those with a D4MFT>0 (0.90 vs 0.82 mg/d; 0.016 mg/Kg/d vs 0.014 mg/Kg/d, p<0.05). For D1MFT, D1MFS, D4MFT and D4MFS scores, there was a statistically significant reduction in the number of lesions with higher fluoride consumption (mg/d) from foods and beverages. The reported frequency of consumption of sugary foods in a whole day was statistically higher in those with D1MFT>0 than those with D1MFT=0 (p<0.05). Total carbohydrate intake (g/d) was positively associated with dental caries experience. We conclude that higher fluoride intake through foods and beverages was associated with lower dental caries experience among adolescents; this effect was seen even when the dietary intake of fluoride was 0.015mg/kg/d, which is lower than the average intake recommendation. In contrast, a higher amount of total carbohydrate intake and the frequency of intake of sugary foods were associated with higher dental caries experience, with no apparent threshold for the effects.