Why free sugars consumption should be below 15 kg per person per year in industrialised countries: the dental evidence.

The World Health Organization and COMA have recommended that free or non-milk extrinsic sugars intake should be below 10% of total energy intake and the COMA report on dietary sugars and human disease has strongly implicated sugars as the main causative factor in dental caries. The scientific basis for the conclusions of these important policy documents has been challenged by the sugar and confectionery industries. Dental evidence is presented to substantiate the WHO recommendation. The dose-response curve for sugar and caries is approximately sigmoid (S-shaped). At levels of sugar consumption below 10 kg/person/year the incidence of caries is acceptably low. Beyond 15 kg the incidence increases more rapidly. Fluoride increases the resistance of teeth to sugar--it moves the dose-response curve to the right. Thus, when fluoride is widely available, the acceptable level of non-milk extrinsic sugars increases to about 15 kg/person/year.