To reduce the frequency and quantity of dietary sugar is essential to promote a cavity-free future. The WHO has made the strong recommendation that intake of free sugars is reduced throughout the life course, and that the intake of free sugars constitutes less than 10% of total energy intake . They further suggest that over time nations seek to reduce the intake of free sugars to below 5% of total energy intake.
Use and Application
Delivery of chairside dietary advice is a complex skill and it is recommend that clinicians adopt a systematic approach:
- Agree an agenda relating to the importance of sugar reduction
- Assess current dietary sugar intake, as well as sources of support for change, barriers to change and motivational factors
- Advise the patient on the basis of the assessment regarding suitable targets for behavior change
- Assist the patient to implement behavior change through setting SMART goals/ Planning the behavior change/ Encouraging self-monitoring of their performance
- Arrange frequent follow up
There is also a need for policy advocacy to implement changes which will support a population level reduction in sugar consumption. Such initiatives could include:
- Taxation of sugar and calories dense foodstuffs
- Working with manufacturers to encourage reformulation of foodstuffs.
- Clearer labelling of food to enhance the ability to plan sugar intake
- Legislation around the advertising of calorie dense foodstuffs and limiting the placement of products particularly in settings where children and young people may access them.
Effectiveness and Efficacy
Motivational interviewing provides a positive framework for counselling individuals to support positive behavior change in families and mothers of children. There are few studies which have evaluated the effectiveness of this method . The implementation of taxation on high sugar products such as soft drinks has shown to significantly reduce the sale of these products .
Dietary counselling, when delivered appropriately, has no negative effects for patients.
Information on the long term cost-effectiveness of behaviour adjustment measures is scarce in the dental context. It is however clear that interventions such as sugar taxes and the reduction of sugar content in consumer products will show long term general and dental health benefits and cost savings .
Patients and members of the public should be advised and supported by dental and healthcare professionals to reduce the amount of sugar that they consume and to restrict their intake of sugary foods to mealtimes.
Key Further Reading
1- Sugars intake for adults and children.
Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015.
2- One-to-one dietary interventions undertaken in a dental setting to change dietary behaviour.
Harris R, Gamboa A, Dailey Y, Ashcroft A. One-to-one dietary interventions undertaken in a dental setting to change dietary behaviour. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD006540.
3- Effects of Taxing Sugar-Sweetened Beverages on Caries and Treatment Costs.
Schwendicke F, Thomson WM, Broadbent JM, Stolpe M. Effects of Taxing Sugar-Sweetened Beverages on Caries and Treatment Costs. Journal of Dental Research 2016; 95: 1327-1332.
ACFF Members can download the full reference document for Nutritional Counselling.