Other Factors Affecting Cariogenicity

Besides sugars and starches, other factors also influence the cariogenic potential of foods. These factors include frequency of intake, form and consistency, retention time, and position of a food in the meal.

The frequency of meals and snacks determines the number of opportunities for bacterial plaque to feed on carbohydrates. Acid production occurs as a result of carbohydrate exposure and is not necessarily dependent on the amounts of sugars or starches consumed. Thus, a single exposure to a large amount of sugary foods is less cariogenic than multiple exposures of small amounts of sugar spread throughout the day.

The consistency of foods, such as stickiness, also determines the length of time that carbohydrates are exposed to bacterial plaque. Foods that adhere to the surfaces and crevices of teeth include sticky candies, dried fruits, and sweetened flour products. The form of foods also influences the retention time of carbohydrates in the mouth. Liquids are cleared from the mouth more quickly than solids, and foods with coarse particles are preferable to finely divided particles that become lodged in the fissures and crevices of teeth. Foods that stimulate saliva secretion, including cheese, salt, and raw fruits and vegetables, help to limit oral retention of cariogenic foods.

The position of cariogenic foods consumed in a meal affects caries risk by influencing the magnitude of a decrease in plaque pH. For example, if a piece of aged cheese is eaten after an acid-producing food such as canned peaches in heavy syrup, the plaque pH rises above the critical pH very quickly.18 Likewise, a sugared beverage causes a rapid drop in pH, but it will rise if followed by an unsweetened food. Therefore, placing foods that stimulate a drop in pH between other foods or ending a meal with a low cariogenic food lessens the risk of tooth demineralization.5