The frequency of sugar/refined carbohydrate intake may be the main dietary variable in caries etiology, affecting colonization with cariogenic bacteria and the development of caries. After bacteria metabolize sugar into acid, it takes 20 to 40 minutes for the acid to be neutralized or washed away by saliva. Therefore, the more frequently simple sugars and/or refined carbohydrates are consumed, the greater the potential period for demineralization.

The graph shows how easy it is for a young child to keep his or her teeth in the “danger zone” all day unless the frequency of sugar/refined carbohydrate intake is restricted. Intake of sugar-containing drinks should also be restricted.

Refined carbohydrates are present in most processed foods; parents/ guardians and children need to be made clearly aware of this fact. Also, it is not possible currently to “rank order” cariogenicity of foods; a rapidly dissolving caramel may be less acidogenic than a bit of cookie lodged between teeth for hours.