It is that time of year when children dress up and go door-to-door to collect bags full of candy. It is also that time of year where diet and nutrition are discarded, and parents face the unthinkable: their children will be consuming large quantities of Halloween candy. Sweets play one of the key roles in dental caries. However, the types of candy consumed can define the significance of the dental caries etiology.
Dental caries is the most common and most preventable childhood disease. Dental caries occurs when sugar, a fermentable carbohydrate, is hydrolyzed by salivary amylase, a process which provides an ideal surface for bacterial growth. In turn, the bacterial growth allows for the reduction in salivary pH, causing tooth demineralization.1
There are many factors involved in the etiology of the dental caries bacteria, Streptococci mutans, and Lactobacilli mutans. The factors that play a role in tooth demineralization include the forms of sugar consumed, the duration of teeth exposure to the sugar, the nutrient composition of the candy, the sequence of eating, the salivary flow of the recipient, the presence of acidic buffers, and the recipient’s daily oral hygiene.1
Therefore, based on the etiological factors involving the production of dental caries, choosing the types of candies to consume is very important. The following breakdown will provide information on candies with a higher and those with a lower incident of sugar fermentation. Also provided are some alternatives to candy consumption that still fulfill the child’s expectations of sweets without risking tooth decay.
Chocolate is one of the least cariogenic candies available for consumption. Its primary ingredient is cocoa, which is extracted from the cocoa bean husk and contains unsaturated fatty acids that display antibacterial properties against the caries-producing bacteria, Streptococci mutans.2 However, not all chocolates are the same. For example, dark chocolate contains higher concentrations of the cocoa bean extract than milk chocolate, while refined chocolate does not contain any cocoa bean extracts. Therefore, dark or milk chocolate should be a primary candy choice due to its bacterial defense which can reduce the potential for tooth decay.
Hard candy is primarily made of syrup containing one of the three main sugars, which include glucose, fructose, or sucrose. These types of sugars which constitute hard candy are only one of the risk factors involved in dental caries. The duration hard candy remains in the mouth is also an important factor. Hard candy takes more time to dissolve, thus exposing the mouth longer to fermentable carbohydrates, which increases the Streptococci mutan presence. Therefore, avoiding hard candies can decrease the risk of dental caries.
Sticky candy contains gelatins, sugars, and/or syrups containing sugar. The sugar is metabolized to acids by bacteria, decreasing the salivary pH, and increasing Streptococci mutans, as it feeds off sugars. Furthermore, the gelatin plays a role in long-term exposure due to its adhesion to the tooth surface. Sticky candy includes caramels, gummies, and nougats. These types of candies should all be avoided.
Citrus, Sour, or Powder Candy
Citrus or sour candies not only can contain citric acid but may also include an ingredient called malic acid. Both acids are low pH compounds which play a role in the breakdown of the enamel surface of the tooth, which is irreparable.3 These candies are typically found in sticky, hard, or powder form, and also contain the sugars that provide a perfect medium for the bacteria, Streptococci mutans. The dual dental caries risk put these candies at the top of the list of candies to avoid.
Alarmingly, a study conducted in 2016 found over two billion dollars are spent on candy during the Halloween season. Six hundred million pounds of candy per year are consumed by trick-or-treaters, resulting in the average trick-or-treater consuming three cups of sugar. Roughly one hundred fifty-eight million Americans participate in Halloween customs, of which ninety-five percent purchase candy.4
An alternative to sugar-based candy is consumable products containing xylitol, a natural resource which can reduce the Streptococci mutans levels in plaque and saliva, therefore causing a reduction in acid production. Some examples of xylitol-containing, trick-or-treats are chewing gum, mints, and hard candies. However, the American Academy of Pediatrics does not recommend children under the age of four to consume these products due to a choking risk.5
Although Halloween is a fun family custom, the key is to educate parents and children on how to maintain positive dental health during the holiday. By dental hygienists providing dental caries education, nutrition instruction, and alternatives to cariogenic candies, children can still enjoy their treats without compromising their teeth. These alternatives will provide the same satisfaction to trick-or-treaters as the more traditional Halloween candy.
Now Listen to the Today’s RDH Dental Hygiene Podcast Below:
- The American Journal of Clinical Nutrition, Volume 78, Issue 4, 10 October 2003, pages 881.s-892s. Retrieved from: https://academic.oup.com/ajcn/article/78/4/881S/4690063
- Sudarshana, A. Sakthi, S. Tooth Friendly Chocolate. Vol.17, Issue 1, 2015, 49-50. Retrieved from: https://www.jpsr.pharmainfo.in/Documents/Volumes/vol7Issue01/jpsr07011510.pdf
- Definition of Citric Acid, Definition of Malic Acid. Wikipedia Sourced from: www.wikipedia.com
- Creative Pr. Halloween Candy Consumption. 25 October 2016. Retrieved from: http://creativepr.com/halloween-candy-consumption-infographic/
- American Academy of Pediatric Dentistry; 2011. Retrieved from: http://www.aapd.org/media/policies_guidelines/g_xylitoluse.pdf