Beverage Intakes and Toothbrushing During Childhood Are Associated With Caries at Age 17 Years

Published:October 24, 2020DOI:



      Sugar-sweetened beverages (SSBs) have been associated with childhood caries; however, associations among lifelong beverage intakes and adolescent caries have received less attention.


      To investigate associations between beverage intakes during childhood and adolescence and caries experience at 17 years of age, while adjusting for fluoride intakes and toothbrushing.


      Descriptive model analyses were conducted on data collected from a longitudinal birth cohort study.


      Participants included Iowa Fluoride Study members (n = 318) recruited at birth between 1992 and 1995 with at least 6 beverage questionnaires completed from ages 1 to 17 years and a caries examination at age 17.


      Predictors included mean daily milk, juice (100% juice and juice drinks before age 9), SSB (including juice drinks after age 9), and water/sugar-free beverage (SFB) intakes; daily fluoride intakes; and daily toothbrushing frequencies for ages 1 to 17.

      Main outcome measures

      The outcome was dental caries count at age 17, adjusted for the number of scored tooth surfaces (decayed and filled surfaces attack rate [DFSAR]).

      Statistical analyses performed

      Univariable generalized linear models were fit for each predictor and the outcome DFSAR. Multivariable models assessed combined effects of beverage types, fluoride variables, toothbrushing, sex, and baseline socioeconomic status.


      Based on multivariable models, each 8 oz of additional daily juice and water/SFB decreased expected DFSAR by 53% (95% confidence interval [CI]: 17%-73%) and 29% (95% CI: 7%-46%), respectively, and 8 additional oz SSBs increased expected DFSAR by 42% (95% CI: 5%-92%), after adjustment for other beverage intakes, toothbrushing, total fluoride intake excluding SSB fluoride (non-SSB total fluoride), sex, and baseline socioeconomic status. Each additional daily toothbrushing event decreased expected DFSAR by 43% (95% CI: 14%-62%) after adjustment for beverage intakes, non-SSB total fluoride intake, sex, and baseline SES.


      Higher juice and water/SFB intakes and more toothbrushing were associated with lower caries at age 17, while higher SSB intakes were associated with higher caries.


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      T. A. Marshall is a professor, Department of Preventive & Community Dentistry, College of Dentistry, The University of Iowa, Iowa City.


      A. M. Curtis is a graduate student, Department of Biostatistics, College of Public Health, The University of Iowa, Iowa City.


      J. E. Cavanaugh is a professor, Department of Biostatistics, College of Public Health & Department of Statistics and Actuarial Science, College of Liberal Arts and Sciences, The University of Iowa, Iowa City.


      J. J. Warren is a professor, Department of Preventive & Community Dentistry, College of Dentistry, The University of Iowa, Iowa City.


      S. M. Levy is a professor, Department of Preventive & Community Dentistry, College of Dentistry, The University of Iowa, Iowa City.