Cariogenicity: Expanding the Public Health Lexicon

Dieting is ingrained in Western Society. Even as children we learn that cookies are a “sometimes food” and that an apple a day keeps the doctor away. Similarly, all other foods are placed in a good foods/bad foods binary. However, when it comes to oral health many of our nutritional instincts are off target. This is true because it is not just sugar that is dangerous but stickiness as well. For instance, dates and raisins are far more harmful than hard candies.1 A food that can stick to teeth or soft tissues in the mouth can provide a steady supply of nutrients for bacteria, greatly increasing their growth. This idea is captured by the term “cariogenicity”, a particular food’s ability to cause a dental caries. Cariogenicity is not set in stone. Because adhesion plays such an important role proper brushing and flossing after a meal can greatly reduce the damage caused by bacterial growth.

This often presents a dilemma at dental offices; advising patients to brush and floss is obvious, but what should be said about diet? Many dentists simply encourage a “healthy diet”. It is easy to argue that this is good advice in our era of endemic obesity, diabetes and heart disease. Furthermore, following USDA guidelines will ensure that one gets adequate calcium levels, and eats a diet high in fiber but low in processed sugar, all of which are as important for oral health as they are for general health. However, this advice is incomplete if the idea of cariogenicity is not introduced.

This dilemma for dentists has drastic implication for public health. Despite such advances like fluoridation of water and dental hygiene products, broadened provision of dental insurance and services and the advent of synthetic sweeteners, cavity rates are skyrocketing.2 Also, this problem disproportionately impacts the poor because they are less likely to have a dentist that can regularly prevent, diagnose and treat cavities before they become painful or require extraction.3 This problem is most severe in developing countries that are rapidly improving.4 Usually, these countries have a stable food supply and are capable of treating and preventing common causes of death like diarrhea, perinatal hemorrhage, and infectious diseases; however, they have not yet developed the knowledge and capital-intensive infrastructure to cope with chronic diseases such as dental decay. For example, America, despite its diet laden with high fructose corn syrup, has a much lower oral burden of disease than India.5

This pattern poses two separate problems for developing and developed countries. Frequently, a developing country’s ability to deal with this double burden of disease, managing both the communicable diseases and non-communicable diseases, will predict their ability to undergo a successful socioeconomic transition. The challenge is to obtain the productivity benefits from quality health care without draining essential funds from other public services, such as sanitation and education, that are crucial for development. For developed countries the challenge is to maintain the mentality that a cavity is something to be prevented rather than treated despite the widespread availability of dental care.

In many ways this problem mirrors larger trends in health-care. Many developed countries are focusing on expensive treatment for diseases such as diabetes and coronary heart disease instead of emphasizing prevention. Similarly, many developing nations are struggling to provide basic health care for their citizens and suffering a economic and quality of life reductions as a result. Investing in cavity prevention and cariogenicity is a step in the right direction for solving both of these problems.


  1. Robert C. Caldwell. 1970. Physical properties of foods and their caries-producing potential. Journal of Dental Research 49: 1293.
  2. B.L. Edelstein, 2005. The Dental Caries Pandemic and Disparities Problem. BMC Oral Health 2006, 6(Suppl 1):S2
  3. Dan Witters. 2011. Resdents in Mass., Conn., Lead Nation in Dental Visits. Gallup
  4. Petersen P.E., Bourgeois D., Ogawa H., Estupinan-Day S., Ndiaye C. 2005. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 83 : 661–669.
  5. Petersen P.E., Bourgeois D., Ogawa H., Estupinan-Day S., Ndiaye C. 2005. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 83 : 661–669.
  6. Boutayeb, Abdesslam. “The Double Burden of Communicable and Non-communicable Diseases in Developing Countries.” Transactions of the Royal Society of Tropical Medicine and Hygiene 100.3 (2006): 191-99. Print.
  7. Image credit (CC-BY-NC-SA): “Dentist 1,” Flickr, taken November 8, 2009, accessed July 4, 2012,

Petar Georgiev is a Georgetown University undergraduate student whose principal interests are global public health and dentistry. Follow The Triple Helix Online on Twitter and join us on Facebook.