Nutr Res Pract.  2023 Oct;17(5):959-968. 10.4162/nrp.2023.17.5.959.

Association between diet quality and untreated dental caries: results from the Korea National Health and Nutrition Examination Survey

  • 1Department of Dental Hygiene, Baekseok University, Cheonan 31065, Korea
  • 2Big Data Statistics Institute, Cheonan 31065, Korea
  • 3Department of Rehabilitation Medicine, Green Hospital, Seoul 02221, Korea
  • 4Graduate School, Yonsei University College of Medicine, Seoul 03722, Korea
  • 5Department of Dental Hygiene, Dongnam Health University, Suwon 16328, Korea


Few studies have provided evidence of the association between diet quality and dental caries. This study aimed to examine the association between diet quality and untreated dental caries in a Korean representative population.
The study population included a sample of 13,815 participants, aged ≥ 19 from the Korea National Health and Nutrition Examination Survey during 2013–2015. The explanatory variable was diet quality and the outcome variable was untreated dental caries. Untreated dental caries were defined by the number of decayed teeth recorded according to the criteria established by the World Health Organization. Diet quality was defined by using the Korean Healthy Eating Index (KHEI) through the 24-h recall methods. We assessed the association between diet quality and untreated dental caries while adjusting for age, sex, education, income, smoking status, dental visits, toothbrushing frequencies, obesity, and diabetes mellitus.
The mean overall KHEI scores in the untreated dental caries group were significantly lower than those in the group without untreated dental caries. Significant differences were observed in the untreated dental caries group based on the KHEI quartiles (P < 0.001). After adjusting for potential confounders, the quartiles of KHEI scores showed an association with untreated dental caries, demonstrating a dose-effect trend (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.35–1.84 for 1st quartile; OR, 1.38; 95% CI, 1.19–1.59 for 2nd quartile; OR, 1.32; 95% CI, 1.14–1.53 for 3rd quartile; reference quartile highest]).
The findings indicated an inverse association between diet quality and untreated dental caries in Korean adults. Healthcare providers should take into account the significant role of diet quality in preventing and managing oral health.


Healthy Eating Index; dental caries; epidemiological study


1. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of untreated caries: a systematic review and metaregression. J Dent Res. 2015; 94:650–658. PMID: 25740856.
2. Frencken JE, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T. Global epidemiology of dental caries and severe periodontitis - a comprehensive review. J Clin Periodontol. 2017; 44(Suppl 18):S94–105. PMID: 28266116.
3. Kennedy ET, Ohls J, Carlson S, Fleming K. The Healthy Eating Index: design and applications. J Am Diet Assoc. 1995; 95:1103–1108. PMID: 7560680.
4. Ministry of Health and Welfare. Health plan 2020 [Internet]. Seoul: Ministry of Health and Welfare;2011. cited 2020 January 22. Available from:
5. Ministry of Health and Welfare. Dietary guidelines for Korean adults [Internet]. Seoul: Ministry of Health and Welfare;2010. cited 2020 January 22. Available from:
6. The Korean Nutrition Society. Dietary Reference Intake for Koreans. Seoul: The Korean Nutrition Society;2010.
7. GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019; 393:1958–1972. PMID: 30954305.
8. Hujoel PP, Lingström P. Nutrition, dental caries and periodontal disease: a narrative review. J Clin Periodontol. 2017; 44(Suppl 18):S79–S84. PMID: 28266117.
9. Sheiham A, James WP. Diet and dental caries: The pivotal role of free sugars reemphasized. J Dent Res. 2015; 94:1341–1347. PMID: 26261186.
10. Nunn ME, Braunstein NS, Krall Kaye EA, Dietrich T, Garcia RI, Henshaw MM. Healthy eating index is a predictor of early childhood caries. J Dent Res. 2009; 88:361–366. PMID: 19407158.
11. Zaki NA, Dowidar KM, Abdelaziz WE. Assessment of the Healthy Eating Index-2005 as a predictor of early childhood caries. Int J Paediatr Dent. 2015; 25:436–443. PMID: 25532620.
12. İnan-Eroğlu E, Özşin-Özler C, Erçim RE, Büyüktuncer Z, Uzamış-Tekçiçek M, Güçiz-Doğan B. Is diet quality associated with early childhood caries in preschool children? A descriptive study. Turk J Pediatr. 2017; 59:537–547. PMID: 29745115.
13. Kaye EA, Sohn W, Garcia RI. The healthy eating index and coronal dental caries in US adults: National Health and Nutrition Examination Survey 2011-2014. J Am Dent Assoc. 2020; 151:78–86. PMID: 31837744.
14. Sanders A, Cardel M, Laniado N, Kaste L, Finlayson T, Perreira K, Sotres-Alvarez D. Diet quality and dental caries in the Hispanic Community Health Study/Study of Latinos. J Public Health Dent. 2020; 80:140–149. PMID: 32031253.
15. AbdelAziz WE, Dowidar KM, El Tantawi MM. Association of healthy eating, Juice consumption, and bacterial counts with early childhood caries. Pediatr Dent. 2015; 37:462–467. PMID: 26531091.
16. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, Chun C, Khang YH, Oh K. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014; 43:69–77. PMID: 24585853.
17. Korea Center for Disease Control and Prevention. Guidelines for the Use of KNHANES 2013-2015. Cheongju: Korea Center for Disease Control and Prevention;2015. p. 3–11.
18. Shin HS. Association between periodontal status and non-alcoholic fatty liver disease in a Korean adult population: a nationwide cross-sectional study. J Periodontol. 2020; 91:524–532. PMID: 31484207.
19. Romandini M, Shin HS, Romandini P, Laforí A, Cordaro M. Hormone-related events and periodontitis in women. J Clin Periodontol. 2020; 47:429–441. PMID: 31912529.
20. Shin HS. The number of teeth is associated with diet quality in Korean adult population. Arch Oral Biol. 2020; 118:104882. PMID: 32835987.
21. Yun SH, Oh KW. Development and Status of Korean Healthy Eating Index for Adults Based on the Korea National Health and Nutrition Examination Survey. Cheongju: Korea Center for Disease Control and Prevention;2018. p. 1764–1772.
22. World Health Organization. Oral health Surveys: Basic Methods. 5th ed. Geneva: World Health Organization;2013.
23. Marriott BP, Hunt KJ, Malek AM, Newman JC. Trends in intake of energy and total sugar from sugar-sweetened beverages in the United States among children and adults, NHANES 2003-2016. Nutrients. 2019; 11:2004. PMID: 31450689.
24. World Health Organization. The importance of a low sugar intake in maintaining a normal body weight, avoiding type 2 diabetes and also preventing dental caries in children and adults [Internet]. Geneva: World Health Organization;2020. cited 2020 September 7. Available from:
25. World Health Organization. Sugar Intake for Adults and Children. Geneva: World Health Organization;2015.
26. Ko MO, Kim MB, Lim SB. Relationship between chemical structure and antimicrobial activities of isothiocyanates from cruciferous vegetables against oral pathogens. J Microbiol Biotechnol. 2016; 26:2036–2042. PMID: 27586534.
27. Ferrazzano GF, Amato I, Ingenito A, Zarrelli A, Pinto G, Pollio A. Plant polyphenols and their anti-cariogenic properties: a review. Molecules. 2011; 16:1486–1507. PMID: 21317840.
Full Text Links
  • NRP
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: