Abstract
Dental caries is the most prevalent infection globally and a substantial economic burden in developed countries. Dietary sugars are the main risk factor, and drive increased proportions of acid-producing and acid-tolerating (aciduric) bacterial species within dental biofilms. Recent longitudinal studies have suggested that caries is most strongly correlated with total sugar intake, contrasting with the prevailing view that intake frequency is the primary determinant. To explore this possibility, we employed a computational model for supragingival plaque to systematically sample combinations of sugar frequency and total amount, allowing their independent contributions on the ratio of aciduric (i.e. cariogenic) to non-aciduric bacteria to be unambiguously determined. Sugar frequency was found to be irrelevant for either very high or very low daily total amounts as the simulated biofilm was predicted to be always or never cariogenic, respectively. Frequency was a determining factor for intermediate total amounts of sugar, including the estimated average human consumption. An increased risk of caries (i.e. high prevalence of aciduric/non-aciduric species) was predicted for high intake frequencies. Thus, both total amount and frequency of sugar intake may combine to influence plaque cariogenicity. These findings could be employed to support public guidance for dietary change, leading to improved oral healthcare.
Highlights
Dental caries, or tooth decay, is the most common infectious disease worldwide[1]; it lowers the quality of life for children and adults alike, and represents a significant economic burden in high-income countries[2,3]
The frequency of sugar intake has been held to be the principal driver in the selection of cariogenic bacteria, as typical concentrations of dietary sugar are thought to saturate microbial glycolysis, essentially resulting in utilisation of equal amounts of sugar per episode, while the remaining sugar is removed un-metabolised by saliva flow or converted to extracellular or intracellular polysaccharides
The established view that plaque cariogenicity depends on the frequency of intake of dietary sugars rather than on the total daily amount ingested was recently challenged by large-scale longitudinal studies, which concluded that clinical presentations of caries were more strongly correlated with the total intake[13]
Summary
Tooth decay, is the most common infectious disease worldwide[1]; it lowers the quality of life for children and adults alike, and represents a significant economic burden in high-income countries[2,3] This largely preventable disease is associated with diets that include a regular intake of refined sugars, resulting in the selection of cariogenic bacteria within the dental plaque biofilm[4,5]. In the studies described here, computer simulations were employed to separate the independent effects of sugar frequency versus sugar amount on the cariogenicity of an in silico model for supragingival plaque Both the frequency and total sugar intake were systematically varied over physiological ranges, and the terminal pH of the growing plaque biofilm quantified for each combination. This work extends preliminary studies using the same high-fidelity, aggregate-based model, developed by the authors to probe long-time changes in biofilm ecology, which investigated multiple factors influencing plaque composition and terminal pH22
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