糖和龋齿：世界卫生组织技术说明，2025年5月

| Dental caries is a major public health problem globally and is the mostwidespread noncommunicable disease (NCD). It is prevalent throughout thelife course affecting both permanent teeth (2 billion people) and deciduous teeth(510 million children)(1).Consumption of free sugars*is a major risk factor for overweight, obesity anddental caries. Dental caries can be prevented by avoiding dietary free sugars.Simple and cost-effective interventions are available to support populations inreducing sugar consumption, preventing dental caries and providing minimallyinvasive treatment in primary health care settings.Severe dental caries can lead to tooth loss and impair quality of life. Theconsequences of untreated dental caries include:•physical symptoms such as pain, discomfort or chronic systemicinfection;•functional limitations such as challenges eating, speaking, breathing orsleeping; and•detrimental impacts on emotional, mental and social well-being.In low-income settings, the majority of dental caries goes untreated. Teethaffected by caries are often extracted (pulled out) when they cause pain orinfection. Prevention and treatment for dental caries is usually not part ofnational Universal Health Coverage (UHC) benefit packages. This oftenleads to catastrophic costs and significant financial burden for families andcommunities(6). Improving integration of essential oral health care servicesin primary health care and UHC benefit packages would improve access toprevention and management of oral diseases to better respond to the needs ofpopulations.Almost half of the world’s population is affected by oral diseases, and most ofthese cases are due to dental caries. High levels of dental caries occur in middle-income countries, where sugars consumption is high. In such countries, healthsystems are challenged to provide preventive population-wide strategies andprimary oral health care often is not available (1).Dental caries affects all age groups, starting with the eruption of the firstteeth (deciduous teeth) and increasing in prevalence until late adulthood, thenremaining at high levels until older age. In children, dental caries is associatedwith adverse growth patterns and a frequent cause of absence from school.For adults, untreated dental caries is associated with absence from work, maynegatively affect employment opportunities and reduce productivity (1).There is a clear dose–response relationship between sugars*consumption anddental caries for all age groups (7). Dental caries results when plaque forms onthe surface of a tooth and converts the free sugars*(all sugars added to foodsby the manufacturer, cook or consumer, plus sugars naturally present in honey,syrups and fruit juices) contained in foods and drinks into acids that destroy thetooth over time. A continued high intake of free sugars, inadequate exposureto fluoride and a lack of removal of plaque by toothbrushing with fluoridetoothpaste containing 1000-1500 ppm concentration can lead to dental caries. |IntroductionScope of theproblemWho is at risk? Social andcommercialdeterminants ofhealthSigns andsymptomsPrevention andcontrolGlobal impact |The burden of dental caries is also influenced by social determinants of oral health,which comprise the social, economic and political conditions that influence oraldiseases, including access to safe water, sanitation and hygiene. There is a strongand consistent association between socioeconomic status and the prevalenceand severity of dental caries. It disproportionately affects poor, vulnerable and/or marginalized members of societies, often including people who are on lowincomes; people living with disability; older people living alone or in care homes;people who are refugees, in prison or living in remote and rural communities; andpeople from minority and/or other socially marginalized groups.Additionally, the burden of dental caries is also affected bycommercialdeterminants of NCDs, which are the strategies used by some commercial sectoractors to promote products and choices that are detrimental to health. This includesmarketing, advertising and sale of products that cause oral diseases and otherNCDs, such as foods and beverages that are high in free sugars(8–21).Commercial entities with a vested interest in sugar include producers of cane,beet, and corn sugar, as well as sugars and other sweeteners. These entitiesrange from transnational corporations and national food and beverageindustries that incorporate sugars and sweeteners into their products to tradeassociations representing businesses with a stake in commercial use andconsumption of sweeteners. They may also include hybrid entities operatingin the public, private, and third sectors, which encompass voluntary and civilsociety organizations(22).A significant challenge in public health lies in comprehending the global reachand influence of these commercial entities. They not only oppose policies toreduce sugars intake but also actively shape the policy