Effects of starch on oral health: Systematic review to inform WHO guideline
Open accessAbstract
A systematic review was conducted to update evidence on the effect of total dietary starch and of replacing rapidly digestible starches (RDSs) with slowly digestible starches (SDSs) on oral health outcomes to inform updating of World Health Organization guidance on carbohydrate intake. Data sources included MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, LILACS, and Wanfang. Eligible studies were comparative and reported any intervention with a different starch content of diets or foods and data on oral health outcomes relating to dental caries, periodontal disease, or oral cancer. Studies that reported total dietary starch intake or change in starch intake were included or where comparisons or exposure included diets and foods that compared RDSs and/or SDSs. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) statement, and evidence was assessed with the GRADE Working Group guidelines. From 6,080 papers identified, 33 (28 studies) were included in the RDS versus SDS comparison: 15 (14 studies) assessed the relationship between SDS and/or RDS and dental caries; 16 (12 studies) considered oral cancer; and 2 studied periodontal disease. For total starch, 23 papers (22 studies) were included: 22 assessed the effects on dental caries, and 1 considered oral cancer. GRADE assessment indicated low-quality evidence, suggesting no association between total starch intake and caries risk but that RDS intake may significantly increase caries risk. Very low-quality evidence suggested no association between total starch and oral cancer risk, and low-quality evidence suggested that SDS decreases oral cancer risk. Data on RDS and oral cancer risk were inconclusive. Very low-quality data relating to periodontitis suggested a protective effect of whole grain starches (SDS). The best available evidence suggests that only RDS adversely affects oral health.
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The rationale for the hypothesis that diet influences oral microbiota relies on historical observation of the Neolithic and Industrial revolutions, which altered macronutrient proportions, glycemic load, fatty acid composition, sodium and potassium levels, micronutrient levels, dietary pH, and fiber content.
“The rationale for this hypothesis relies on historical observation of two key periods in human history: the Neolithic and Industrial revolutions. These periods represented two critical junctures in our history with repercussions beyond economic, cultural, and social matters. Indeed, the foods and processing techniques that arose in these two historical periods significantly altered the central”
From A Cross-Talk between Diet and the Oral Microbiome: Balance of Nutrition on Inflammation and Immune System’s Response during Periodontitis (2022) · cites this paper as [50]
In the United States, carbohydrates constitute more than 50% of total energy intake, with refined cereal grains representing more than 85% of total cereal grains consumed.
“In the United States, carbohydrates constitute > 50% of total energy intake, with refined cereal grains representing > 85% of total cereal grains consumed.”
From The oral microbiome: Role of key organisms and complex networks in oral health and disease (2021) · cites this paper as [254]
Refined sugars constitute approximately 20% of caloric intake in the United States.
“Moreover, refined sugars constitute approximately 20% of caloric intake.”
From The oral microbiome: Role of key organisms and complex networks in oral health and disease (2021) · cites this paper as [254]
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References 42 · Cited by 51
- Authors
- Halvorsrud, K., Lewney, J., Craig, D., & Moynihan, P. J.
- Affiliations
- Queen Mary University of London (GB)
- Newcastle University (GB)
- Corresponding author
- Moynihan, P.J.
- Venue
- Journal of Dental Research
- Publisher
- SAGE Publications
- Published
- 2018-08-03
- Volume
- 98
- Issue
- 1
- Pages
- 46-53
- ISSN
- 0022-0345 (ISSN-L)
- 1544-0591
- OpenAlex
- W2809165117
- Cited by
- 51
- References
- 42
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 8 · 2023: 9 · 2022: 8 · 2021: 9 · 2020: 7 · 2018: 1
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Journal of Dental Research (publishedVersion)
- PubMed (publishedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- World Health Organization (not applicable)
- Topics
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Keywords
- dietary starch, rapidly digestible starch, slowly digestible starch, dental caries, oral cancer, periodontal disease, periodontitis, carbohydrate intake, WHO dietary guidelines, oral health
- MeSH terms
- Dental Caries, Dietary Carbohydrates, Humans, Oral Health, Periodontal Diseases, Risk Factors, Starch, Nutrition Policy
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