Behavior Change
Rebecca Royten
Concordia University
MPH 588
Specific Behavior Change
Decreasing sugar consumption would be a great behavior change in helping to decrease early
childhood caries. Early childhood caries is a virulent form of dental caries. Streptococcus mutans are the
bacteria that causes cavities through their acid secretions which break down the minerals in a tooth. S.
mutans get their nutrients from diet, sucrose (sugar) is the most easily accessible for the bacteria. When
sugar is ingested in a meal enough saliva is secreted to buffer the effects, but when sugar is ingested
frequently that buffer lose its efficiency, which allows the bacteria to thrive. In children with early
childhood caries S. mutans average 30% of the bacteria in the mouth, while children without caries
activity S. mutans average 0.1% of the bacterial flora (Berkowitz, 2003). Diet plays a large role in this
infection. A decrease in sugar consumption would significantly improve early childhood caries.
Two Competitors to Behavior Change
A competitor to decreasing sugar consumption is parents giving bottles to their children at night
filled with juices or formula. Decay caused by this act is called Baby Bottle Tooth Decay. It causes a
frequent and prolonged flood of sugars to the upper front teeth and the back molars where the liquid
pools. We know that this is the cause of decay because a clefting in palate is visible from the nipple and
the decay is isolated to the upper front teeth and lower molars, leaving the lower front teeth without
any disease. The nipple in a bottle is shorter than when breastfeeding so the liquid is able to pool and
coat the front teeth (Palmer, 2000). When giving a child a bottle that is filled with formula or juices the
exposure time to S. mutans is increased and they are allowed to reproduce in large numbers due to the
lack of buffer from saliva. Children should not be put to bed with a bottle, the bottle should be finished
before bed. This is a difficult behavior to change because bottles at night are a staple for soothing and
make bedtime easier to obtain (Palmer, 2000). Replacing content with liquids that do not contain
sucrose, glucose or fructose would help decrease Baby Bottle Tooth Decay, a good substitute is water.
Another competitor to decreasing sugar consumption is monitoring the amount of sugar intake.
From 1989 to 2008 calories consumed in the form of sugar increased by 60% in children age 6 to 11, and
the percentage of children consuming them rose from 79% to 91% (Harvard T.H. Chan, 2015). According
to the Centers for Disease Control (CDC) 16% of total calorie intake in children comes from added sugar.
These added sugars are found in processed foods like breads, cakes, jams, chocolate, ice cream, corn
syrup, high fructose corn syrup and juices (CDC, 2012). The recommendations of sugar intake for
preschoolers is 170 calories a day or 4 teaspoons and for children aged 4-8 it is 139 calories or 3
teaspoons. In reality preschoolers are consuming 12 teaspoons and children aged 4-8 are consuming 21
teaspoons a day (American Heart Association, 2014). In most scenarios children do not design their
diets, it is the parent’s responsibility to monitor the sugar a child is ingesting. According the this data
children are consuming up to 7% the recommended intake of sugar, giving S. mutans nutrients that will
help them thrive and increase the breakdown of the minerals in teeth.
American Heart Association. (2014). Sugar 101. American Heart Association. Retrieved from
http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Sugar101_UCM_306024_Article.jsp
Berkowitz, R. (2003). Causes, treatment and prevention of early childhood caries: A microbiologic
perspective. Journal of the Canadian Dental Association Vol.69, No. 5.
Centers for Disease Control. (2012). NCHS data brief. Centers for Disease Control. Retrieved from
http://www.cdc.gov/nchs/data/databriefs/db87.htm#findings
Harvard T.H. Chan. (2015). The nutrition source. Harvard School of Public Health. Retrieved from
http://www.hsph.harvard.edu/nutritionsource/healthy-drinks/sugary-drinks/
Palmer, B. (2000). Infant dental decay is it related to breastfeeding?. [PDF Document]. Retrieved from
http://lcdn.rimg.tw/helenna/bc48233c.pdf