Even healthy eating can’t guarantee cavity-free kids, study reports

By Priyanjana Pramanik, MSc.Reviewed by Susha Cheriyedath, M.Sc.Jul 20 2025

Despite different snack and drink habits, no clear link was found between toddler diets and tooth decay, emphasizing that childhood cavities have many causes beyond what kids eat.

Study: Early-life snack and drink consumption patterns among children: findings from a U.S. birth cohort study. Image Credit: Sorapop Udomsri / Shutterstock

In a recent article published in the journal BMC Oral Health, researchers investigated the link between drink and snack consumption and dental caries in young children.

They identified three distinct dietary patterns but found no significant links between diet and the onset of early childhood caries (ECC), indicating the multifactorial origins of the condition in this Medicaid-eligible U.S. population.

Background

Early childhood diet plays a crucial role in shaping lifelong health, particularly in oral health. Children from low-income and, in some cases, racially minoritized communities in the US face greater risks of ECC, a chronic and prevalent oral disease.

This is largely due to dietary habits influenced by environmental, social, and cultural factors. While previous research has shown that high consumption of sugary snacks, beverages, or fermentable carbohydrates is associated with increased caries risk by promoting the growth of cariogenic (cavity-causing) bacteria in the mouth, this study did not find such an association in its sample.

The frequency and timing of food intake also matter, as frequent snacking is more harmful than structured meals due to prolonged sugar exposure on teeth.

As children transition to solid foods around six months, their diets change rapidly. Surveys indicate that many toddlers regularly consume vegetables and fruits, but a significant proportion also regularly consume high-sugar items, such as desserts and candy, on a daily basis.

These foods vary in their potential to cause caries, with sugary snacks posing a greater risk than unprocessed starches or whole foods. Additionally, early dietary habits may influence the composition of the oral microbiota, which is believed to affect caries development. However, this specific study did not directly analyze microbiota-outcome relationships, and oral samples were collected for Candida analysis, rather than for caries–microbiota links.

Despite strong evidence linking diet and ECC, gaps remain in understanding how broader patterns of drink and snack consumption contribute to disease onset, particularly in low-income groups.

About the Study

This study followed a birth cohort of 127 children from two university-affiliated clinics in upstate New York. All participants were Medicaid-eligible and met strict inclusion and exclusion criteria to ensure consistency and reduce health-related confounders.

Data collection occurred at 12, 18, and 24 months of age, including dental examinations and caregiver questionnaires on dietary intake. Dental caries were assessed using standardized protocols by trained dentists, and oral microbial samples were collected as part of a broader parent study (for Candida analysis, not bacterial microbiota analysis).

Mothers reported the frequency and quantity of 15 common snacks and drinks consumed by their children. These were categorized into high and low cariogenic potential based on sugar content. Consumption was scored using a weighted index that combined frequency and quantity, generating ‘sweet’ and ‘non-sweet’ indices.

Statistical analysis employed Latent Class Analysis (LCA) to categorize children into dietary consumption patterns based on data from 18 and 24 months. Items consumed by fewer than five children were excluded from the LCA, resulting in 13 variables for the 18-month analysis and 16 for the 24-month analysis, to ensure robustness.

Latent class regression, adjusting for oral and demographic health variables such as antifungal medication use, race, and plaque score, was conducted to explore the associations between these patterns and ECC. Finally, tests of proportion were used to determine if ECC occurrence differed significantly between dietary clusters.

Key Findings

The study found that both sweet and non-sweet snack and drink consumption increased over time among all children, with some differences observed by race. Non-Black children tended to consume more chips, crackers, and cookies, while Black children had a higher intake of 100% fruit juice, particularly at 24 months.

Despite these differences in individual items, statistical tests showed no significant overall differences between Black and non-Black children in their sweet or non-sweet consumption indices at any time point.

Using LCA, researchers identified three distinct dietary patterns at both 18 and 24 months: low sweet/high non-sweet, medium sweet/medium non-sweet, and high sweet/medium non-sweet.

These patterns reflected varying combinations of healthy and less healthy food choices. Children often shifted between these clusters over time, with some moving from healthier to less healthy patterns and vice versa. The healthiest dietary pattern (low sweet/high non-sweet) was the least common, although national survey data were only briefly cited in the discussion and were not a major focus.

Although dietary behaviors changed, the analysis found no significant association between these consumption patterns and ECC. Some children with healthier diets still developed ECC, and vice versa. Notably, the prevalence of ECC did not differ significantly between dietary clusters at either 18 or 24 months (all p > 0.05). The lowest and highest ECC rates were observed in specific transitions between clusters; however, sample sizes were small.

Other factors, such as race, gender, parental education, and feeding practices, were also not significantly linked to dietary patterns in this analysis, and none were found to be associated with ECC risk in the cohort. This highlights the complex and multifactorial nature of ECC development.

Conclusions

This study explored snack and drink consumption patterns among low-income children aged under two years and their relationship with ECC. Using latent class analysis, researchers identified three distinct dietary groups; however, none of these groups were significantly linked to ECC.

These results suggest that ECC arises from multiple contributing factors beyond just diet. Although similar studies have shown links between sugary intake and dental caries, this study's findings emphasize the complexity of ECC development in this Medicaid-eligible population.

The study's strengths include detailed and repeated dietary assessments, as well as the use of a validated analytical method. However, limitations include a geographically limited sample, reliance on caregiver self-reports (which may be prone to error), and the observational design, which limits the ability to draw causal conclusions.

Future research should involve larger, more diverse populations and incorporate factors like oral hygiene and fluoride exposure. Ultimately, while distinct dietary behaviors were observed, no clear pattern was found to predict ECC, underlining the multifactorial origins of the condition.