Intake of sweet drinks and sweet treats versusreported and observed caries experienceAbstractAIM: This was to study the intakes of sweet drinks and sweettreats of children and their caries risk using the PaediatricRisk Assessment Tool (PRAT, 2003) and Caries-risk AssessmentTool (CAT, 2007-8). STUDY DESIGN: Parents of 266healthy primary school children completed the PRAT questionnaireduring their child’s dental appointment at the RoyalDental Hospital of Melbourne, Australia, describing their fluidand sweet treat intakes in the past 24 hours, oral hygienepractices and past caries. A subgroup (n=100) was examinedclinically (CAT) for caries requiring restoration, visibleplaque, gingivitis, orthodontic appliances, enamel defects,and use of dental care. RESULTS: The estimated meandaily fluid intake was 1.5±0.5L; fluids were consumed 3-5/day by 57% of children and 78% usually had evening/nightdrinks. Fluids consumed were: tap water by 90%, milk by74%, juice by 50%, regular soft drink by 30%; sweet treatswere consumed by 62% and confectionery by 25%. Mostchildren (69%) brushed their teeth ≥2/day; 5% flossed daily.Parentally-reported caries was associated significantly withincreasing treats frequency (p=0.006). In the subgroup, 81%were at high caries risk; 47% had irregular dental care; 21%had sweet drinks/foods frequently between meals; 49% hadvisible plaque/gingivitis, and 34% had enamel demineralisation.Caries observed in the past 12 months was associatedsignificantly with evening sweet drinks (p=0.004), and suboptimalfluoride exposure (p=0.009). Caries observed inthe past 24 months was associated significantly with treatsfrequency (p=0.006), intake of sweet drinks plus treats(p=0.000), enamel demineralisation (p=0.000) and irregulardental care (p=0.000). CONCLUSIONS: The PRAT and CATare valuable tools in assessing children’s caries risk. The riskof caries from frequent intake of sweet drinks, either alone orin addition to sweet treats, must be emphasised to parents.All parents, and particularly those of children assessed athigh risk from intakes of sweet drinks and sweet treats, suboptimalfluoride exposure, or enamel demineralisation, mustbe encouraged to obtain regular dental care for their children.IntroductionAn increase in dental caries in young children in Australiawas reported recently by the School Dental Service (SDS).Since SDS data collection commenced in 1977, decreasingdmft/DMFT scores and improved dental health of Australianchildren had been attributed to the introduction of communitywater fluoridation [AIHW, 1998]. However, increasingcaries experience of 6 yr-old and 12 yr-old children has beenreported from the mid to late 1990’s by the SDS [Armfieldand Spencer, 2008]. In the most recent Australian child dentalhealth survey conducted in 2002 and reported in 2007,47.4% of 6 yr-olds had experienced caries in the primarydentition; the mean dmft was 1.96 (SD: 3.01), and the 10% ofchildren with the greatest caries experience had more thannine cariously-affected teeth [Armfield et al., 2007]. For 12yr-olds, over 40% had experienced caries in their permanentteeth; the mean DMFT was 1.02 (SD: 1.73) and the 10% ofchildren with the greatest caries experience had nearly fivecariously-affected teeth, exceeding the national average byalmost five and a half-fold [Armfield et al., 2007]. Children livingin low-fluoride areas had poorer dental health than thoseliving in optimally-fluoridated areas, regardless of socioeconomic

disadvantage [Armfield et al., 2007].Speculation on the caries increase has focussed on fluidintakes, noting that societal changes such as expandingurbanisation and ready access to sweet drinks and fast andprocessed foods, have altered children’s diets in Australiaand elsewhere [Sivaneswaran and Barnard, 1993; Ismail etal., 1997; Shenkin et al., 2003]. International reports indicatea common trend of increasing consumption of soft drinksby children. In 2000, the most frequently-reported formof added sugars in the USA diet was regular soft drink,accounting for one third of dietary sugar intake [Touger-Decker and van Louveren, 2003]. In the UK, soft drink intakein 11-12 yr-old children increased in the last 20 years [Tahmassebiet al., 2006; Rugg-Gunn et al., 2007]. A similar shiftin fluid consumption towards sweet drinks may be occurringin Australia [NHMRC, 2008], and concerns over increasingchildhood obesity in Australian children has led to the restrictionof sales of sweet drinks in public schools [Sanigorski etal., 2006; Tam et al., 2006].The intake of dairy products by Australian children appearsto be decreasing. In 1998, the National Nutrition Survey(conducted in 1995) reported a low intake of dairy productsin children, with about 30% of 2-18 yr-olds consuming lessthan one serving of dairy product daily, and a mean milkintake for 4-7 yr-olds of 0.38L and 0.39L for 8-11 yr-olds[ABS, 1999]. The Australian dietary guidelines recommend