Sugar-sweetened drinks and periodontitis: Is there a relationship?
We often associate sugar with tooth decay. A growing body of evidence suggests that frequent consumption of sugar-sweetened beverages (SSBs) may also increase the risk of periodontitis. This 2024 study, Sugar-sweetened beverage consumption and periodontitis among adults: A population-based cross-sectional study, published in the Journal of Clinical Periodontology examined whether drinking sugar-sweetened beverages is associated with periodontitis in adults aged 30 to 50 years.
The findings strengthen the importance of dietary counselling as part of periodontal prevention.
What did the study look into?
The researchers analysed data from 4,473 adults who received a periodontal examination as part of a large health survey in the United States. Periodontitis was defined using established criteria from the Centres for Disease Control and Prevention and the American Academy of Periodontology.
Sugar-sweetened beverage intake was recorded as how often these drinks were consumed each week. Participants were grouped according to frequency:
- Five or more times per week
- Seven or more times per week
- Fourteen or more times per week
The analysis considered factors that could influence periodontal health, including income, education level, smoking, alcohol intake, age and total daily calorie intake. Statistical methods were used to reduce the influence of these factors on the results.
What were the main findings?
Periodontitis was present in 27.4 percent (mild: 4.2%; moderate: 19.8%; and severe: 3.4%) of participants. A clear pattern was observed. As the frequency of SSB intake increased, the risk of periodontitis also increased.
After considering confounding factors (other factors that might impact the result) such as income, smoking, alcohol intake, age and other relevant lifestyle factors:
- Drinking five or more times per week increased the risk of periodontitis by 81 percent
- Drinking seven or more times per week increased the risk of periodontitis by 94 percent
- Drinking fourteen or more times per week increased the risk of periodontitis by 119 percent
The relationship followed a dose response pattern. Higher frequency was associated with higher risk and associated with deeper periodontal pockets and greater clinical attachment loss.
Why might sugar trigger inflammation?
The biological explanation is consistent with current scientific understanding. At a systemic level, rapid absorption of sugar can increase insulin resistance, increase oxidative damage in tissues and stimulate the release of inflammatory markers. These changes contribute to a general inflammatory state throughout the body.
In the mouth, oral bacteria convert sugars into acids and other metabolic by-products. This can increase gingival inflammation. As periodontal tissues break down, they create a protein-rich environment that favours the growth of harmful biofilm (dental plaque), further sustaining inflammation.
Periodontitis is a chronic inflammatory disease. Frequent exposure to added sugars may increase overall inflammatory burden and contribute to disease progression.
An important finding: diabetes awareness
The association between SSBS and periodontitis was stronger in individuals who did not report having diabetes. Among those who were aware of a diabetes diagnosis, the association appeared weaker. One explanation is behavioural change. After a diagnosis, one might reduce sugar intake. However, periodontitis develops slowly over time and may already be established. Because the study was cross-sectional, meaning it collected information at a single point in time, it cannot show that sweetened drinks (SSBS) cause periodontitis, only that they are associated.
Clinical relevance
This study changes how we think about prevention and periodontal disease. The frequency of sugar intake affects caries but may also affect periodontal health. When patients report drinking SSBS every day or several times per week, it should be included in their overall periodontal risk assessment. To sum it up. Cutting back on these drinks can have a positive impact on long-term periodontal health, especially in patients with pre-diabetes or diabetes.
