Among 74 children aged 3–6 years examined at TK Aisyiyah Bustanul Athfal, Bantul Regency, Yogyakarta, 96% were found to have dental caries, commonly known as cavities. This figure far exceeds the World Health Organization (WHO) target, which aims for 90% of five-year-old children to be caries-free. The study, published in the Journal of International Oral Health (2020), was conducted by Leny Pratiwi Arie Sandy, S.Kp.G., MDSc., and Prayudha Benni Setiawan, S.Kp.G., M.P.H. from the Dental Hygiene Study Program, Faculty of Dentistry, Universitas Gadjah Mada (UGM). The findings revealed an important risk factor: carbohydrate consumption exceeding 10% of total daily energy intake increased the risk of dental caries by up to 62 times, surpassing the influence of age and gender.
Snacking After Breakfast: A Small Habit with a Major Impact
The study was conducted in 2016 using a cross-sectional research design. Samples were selected through purposive sampling from 100 children, which were then screened until 74 children met the inclusion criteria. The mothers of each child were also involved by completing a 24-hour dietary recall questionnaire, recording all food and beverages consumed by their children in one day.
Nutritional intake data were processed using NutriSurvey 2007, while dental caries status was assessed using the DMF-T index (Decayed, Missing, and Filled Teeth), a WHO standard measurement used to evaluate the number of teeth that are decayed, missing, or restored.
Through direct observation in the field, researchers identified a consistent pattern: children who had already eaten breakfast at home still purchased snacks high in sucrose, such as biscuits, candy, and chocolate, while at school. This habit contributed to their total daily carbohydrate intake exceeding recommended levels.
The results showed that 89% of all participants consumed carbohydrates exceeding 10% of their total daily energy intake. Among this group, 92% experienced dental caries. In contrast, among children whose carbohydrate intake was below 10%, 67% were free from dental caries.
Why Carbohydrates Become the “Fuel” for Tooth Decay
Dental caries is not simply caused by poor toothbrushing habits. It is a multifactorial disease involving interactions between bacteria, teeth, and dietary factors.
Carbohydrates, particularly sucrose, serve as the preferred “fuel” for Streptococcus mutans, bacteria commonly found in dental plaque. These bacteria convert sucrose into glucans, substances that contribute to plaque formation, while also producing lactic acid through glycolysis. This acid gradually dissolves the enamel layer of teeth, eventually resulting in cavities.
The condition is further aggravated by the characteristics of primary teeth, which are structurally thinner and more vulnerable compared with permanent teeth. Once caries affects one primary tooth, the disease can spread more rapidly to other teeth.
“Carbohydrate intake caused risk in dental caries in preschool children. The majority of subjects who experienced dental caries had a habit of consuming carbohydrates more than 10% of total energy in one day.” — Leny Pratiwi Arie Sandy, S.Kp.G., MDSc., dalam simpulan penelitian
Monosaccharides and disaccharides—such as glucose, fructose, and sucrose—have been shown to be more cariogenic than polysaccharides. This means that small sweet snacks may actually have a greater potential to damage teeth compared with larger portions of staple foods such as rice.
The 62-Fold Risk: A Warning That Cannot Be Ignored
Logistic regression analysis in this study produced a striking finding. The risk associated with excessive carbohydrate consumption was 62 times higher than the risks associated with gender and age.
This means that whether a child is male or female, or whether they are 3 or 6 years old, is less influential than what they consume every day. A previous study by Palacios and colleagues in Puerto Rico reported a four-fold increased risk among children with excessive carbohydrate consumption. The much higher risk identified in Bantul may reflect more intensive consumption patterns of cariogenic snacks within the school environment studied.
Since 2015, WHO has recommended limiting free sugar intake to below 10% of total daily energy intake. This recommendation is supported by scientific evidence, and the findings from Bantul further emphasize its importance, particularly among preschool children.
From Bantul to Children Across Indonesia
The 96% caries prevalence found in this study is not merely a statistic. Behind every percentage point is a child who may experience tooth pain, difficulty eating, or disrupted sleep—all of which can affect overall growth and development.
This research emphasizes that the most realistic and effective interventions begin with simple actions: limiting sugary snacks at schools, educating parents about the risks of excessive carbohydrate consumption, and encouraging children to consume foods with controlled sugar content.
Indonesia has more than 29 million children aged 1–6 years. If their carbohydrate consumption patterns are not addressed from an early age, the already high prevalence of childhood dental caries may continue to increase as they grow older. A preventable oral health problem should not continue to leave lifelong consequences.
Authors: Achmad Zam Zam Aghasy, DDS, M.Kes.; Hazra Alifia Muharam
Photo: Freepik