High sugar intake from sugar-sweetened beverages is associated with prevalence of untreated decay in US adults: NHANES 2013–2016

Objectives: To assess the association between sugar from sugar-sweetened beverages (SSBs) and untreated decay in permanent teeth and calculate the cost burden of sugar from SSBs on untreated decay in US adults. Methods: Cross-sectional data from the 2013–2014 and 2015–2016 cycles of the National Health and Nutrition Examination Survey (NHANES) were analysed in 2020 (n = 9001 adults aged ≥20). Multivariable analyses assessed sugar intake from SSB consumption with the presence of untreated decay in permanent teeth and number of untreated decayed teeth. Population attributable risk was used to estimate the cost burden arising from SSBs on untreated decay in US adults. Results: One fourth (25.1%) of US adults had untreated dental decay, and higher prevalence was observed among those with low income, low education and race/ethnicity of non-Hispanic Black. Overall, 53% of adults reported no intake of SSBs. For the remaining 47%, the median 24-h intake was 46.8 g of sugar from SSBs. The adjusted prevalence ratio (PR) for untreated decay was 1.3 (95% confidence interval [CI] 1.1–1.5) for consumption of 46.8 g or more of sugar from SSBs compared to those reporting no sugar from SSBs. Number of untreated decayed teeth increased with sugar intake from SSBs from lowest to highest tertile: 0.1, (p =.35); 0.4, (p =.006); and 0.6, (p <.001). The cost burden of untreated decay attributable to SSBs in US adults is estimated conservatively at $1.6 billion USD. Conclusions: Community level interventions directed at sugar from SSBs are justified to address disparities in the burden of untreated dental decay.