Effect of sugar-sweetened beverages on oral health: a systematic review and meta-analysis

Background: The impact of consumption of sugar-sweetened beverages (SSB) on health outcomes such as obesity have been studied extensively, but oral health has been relatively neglected. This study aims to assess the association between SSB consumption and dental caries and erosion. Methods: Systematic review of observational studies. Search strategy applied to Medline, Embase, Cochrane Library, SciELO, LILACS, OpenGrey and HMIC. The risk of bias was assessed using the NIH Quality Assessment Tool for Observational Cross-Sectional Studies and evidence certainty using Grading of Recommendation Assessment Development and Evaluation. Relationships between SSB consumption and caries and erosion were estimated using random-effects model meta- and dose-response analyses. Results: A total of 38 cross-sectional studies were included, of which 26 were rated as high quality. Comparing moderate-to-low consumption, there was significantly increased risk of both caries [OR= 1.57, 95% CI: 1.28-1.92; decayed, missing and filled teeth weighted mean differences (DMFT WMD) =0.82, 95% CI: 0.38-1.26] and erosion (OR= 1.43, 95% CI: 1.01-2.03). Comparing high-to-moderate consumption, there was further increased risk of caries (OR= 1.53, 95% CI: 1.17-1.99; DMFT WMD =1.16, 95% CI: -0.59-2.91) and erosion (OR= 3.09, 95% CI: 1.37-6.97). A dose-response gradient and high certainty of evidence was observed for caries. Conclusions: Increasing SSB consumption is associated with increased risk of dental caries and erosion. Studies were cross-sectional, hence temporality could not be established, but the positive dose-response suggests this relationship is likely to be causal. These findings illustrate the potential benefits to oral health of policies that reduce SSB consumption, including sugar taxation.