Identificação de carboidratos em fórmulas infantis e sua contribuição para o desenvolvimento da cárie dental

Dayse Andrade Romão; Eudson Da Silva Ferreira; Gabriel  Pereira Nunes Maia; Raphaela Farias Rodrigues; Rafaela Andrade de Vasconcelos; Barbara Jéssica de Assunção Costa

doi:10.17765/2176-9206.2026v19e13322

Authors

Dayse Andrade Romão Universidade Federal de Alagoas https://orcid.org/0000-0002-7884-1657
Eudson Da Silva Ferreira Centro Universitário de Maceió https://orcid.org/0000-0001-9466-5377
Gabriel Pereira Nunes Maia Centro Universitário de Maceió- UNIMA https://orcid.org/0000-0003-0072-0166
Raphaela Farias Rodrigues Universidade Federal de Alagoas https://orcid.org/0000-0001-6917-1113
Rafaela Andrade de Vasconcelos Universidade Federal de Alagoas https://orcid.org/0000-0002-2941-6953
Barbara Jéssica de Assunção Costa Universidade Estadual de Campinas https://orcid.org/0000-0001-7496-0512

DOI:

https://doi.org/10.17765/2176-9206.2026v19e13322

Keywords:

Breast-milk Substitutes, Dental Caries, Dietary Carbohydrates, Sucrose, Infant Formula

Abstract

The objective of this study was to identify the types of carbohydrates present in infant formulas available on the market and to evaluate their contribution to the development of dental caries. This was an observational and descriptive study in which different aspects of commercially available infant formulas were analyzed, including age range, brand, manufacturer, overall label composition, and types of carbohydrates present. A total of 16 types of infant formulas were identified, purchased from pharmacies and supermarkets, and among the 15 samples analyzed, 14 brands contained maltodextrins, while one brand contained starch in its composition, both of which are carbohydrates fermentable by bacteria in the dental biofilm. Infant formulas are widely available on the market and present a diversity of carbohydrates in their composition, and all carbohydrates identified in the evaluated formulas demonstrated cariogenic potential. In addition, the practice of adding sucrose to bottle preparations may further induce the formation of a cariogenic dental biofilm.

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Author Biographies

Dayse Andrade Romão, Universidade Federal de Alagoas

Graduated in Dentistry from the Federal University of Alagoas (UFAL, 2011), a Master's degree in Dentistry with a concentration in Cariology from the State University of Campinas (FOP/UNICAMP, 2013), a Specialization in Public and Family Health from the State University of Campinas (FOP/UNICAMP, 2015), and a Doctorate in Dentistry with a concentration in Cariology from the State University of Campinas (FOP/UNICAMP, 2015). Currently serves as an Associate Professor in the field of Cariology in the Dentistry program at the Federal University of Alagoas, teaching the courses Cariology, Integrated Clinical Practice 1, and Pediatric Dentistry.

Eudson Da Silva Ferreira, Centro Universitário de Maceió

Graduated in Dentistry from UNIMA Centro Universitário de Maceió (2023). Has experience in the field of Dentistry, with an emphasis on Clinical Dentistry.

Raphaela Farias Rodrigues, Universidade Federal de Alagoas

Associate Professor in the field of Restorative Dentistry and Coordinator of the Dentistry program at the School of Dentistry of the Federal University of Alagoas (FOUFAL). Previously served as Coordinator (2015–2017) of the Dentistry program and as a Professor at Tiradentes University Center (UNIT-AL), and as an Assistant Professor (2016–2017) at the State University of Health Sciences of Alagoas (UNCISAL). Holds a degree in Dentistry from the Federal University of Alagoas (UFAL, 2010). Completed a Doctorate (2017) and a Master’s degree (2013) in Applied Dental Sciences, with a concentration in Restorative Dentistry, at the School of Dentistry of Bauru, University of São Paulo (FOB/USP). Also holds a Specialization in Restorative Dentistry (2012) from the Hospital for Rehabilitation of Craniofacial Anomalies at the University of São Paulo (HRAC-USP/Centrinho).

Rafaela Andrade de Vasconcelos, Universidade Federal de Alagoas

Graduated in Dentistry from the Federal University of Alagoas (UFAL, 2007). Completed a specialization in Endodontics at the Bauru School of Dentistry, University of São Paulo (USP, 2009), and participated in the Professional Development Program (PROAC) in the Department of Restorative Dentistry, specializing in Endodontics, at São Paulo State University Júlio de Mesquita Filho (UNESP), São José dos Campos (2010). At the same institution, completed a Master’s degree (2012) and a PhD (2016) in Restorative Dentistry with a specialization in Endodontics, which included a research internship (2015) at the University of the Pacific, Arthur A. Dugoni School of Dentistry, under the guidance of Prof. Dr. Ove Peters. Research interests include endodontic diagnosis, endodontic instruments, root canal anatomy, root canal preparation, root canal obturation, dental trauma, and adaptation and adhesive strength of intraradicular posts. Currently serves as a professor of Endodontics at the School of Dentistry, Federal University of Alagoas (FOUFAL).

Barbara Jéssica de Assunção Costa, Universidade Estadual de Campinas

PhD student in the Dentistry program with a focus on Cariology at the Piracicaba Dental School, University of Campinas (UNICAMP). My research is focused on dental caries, biofilm, and its association with fermentable carbohydrates, with an emphasis on the mechanisms involved in the development and control of these conditions.

References

1. Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Promoção da Saúde. Guia alimentar para crianças brasileiras menores de 2 anos. Brasília: Ministério da Saúde; 2019.

2. World Health Organization (WHO). Guideline for complementary feeding of infants and young children 6-23 months of age. Geneva: World Health Organization; 2023.

3. Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices. Lancet. 2016 Jan 30;387(10017):491-504. https://doi.org/10.1016/S0140-6736(15)01044-2

4. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Aleitamento materno, distribuição de leites e fórmulas infantis em estabelecimentos de saúde e a legislação. 1ª ed., 1ª reimpr. Brasília: Ministério da Saúde; 2014.

5. Walker M. Formula supplementation of breastfed infants: helpful or hazardous? ICAN: Infant Child Adolesc Nutr. 2015;7(4):198-207. https://doi.org/10.1177/1941406415591208

6. Grenov B, Briend A, Sangild PT, Thymann T, Rytter MH, Hother AL, et al. Undernourished children and milk lactose. Food Nutr Bull. 2016 Mar;37(1):85-99. https://doi.org/10.1177/0379572116629024

7. Masum AKM, Chandrapala J, Huppertz T, Adhikari B, Zisu B. Effect of storage conditions on the physicochemical properties of infant milk formula powders containing different lactose-to-maltodextrin ratios. Food Chem. 2020 Jul 30;319:126591. https://doi.org/10.1016/j.foodchem.2020.126591

8. World Health Organization (WHO). Guideline: sugars intake for adults and children. Geneva: World Health Organization; 2015.

9. Ribeiro CCC, Silva MCBD, Nunes AMM, Thomaz EBAF, Carmo CDS, Ribeiro MRC, et al. Overweight, obese, underweight, and frequency of sugar consumption as risk indicators for early childhood caries in Brazilian preschool children. Int J Paediatr Dent. 2017 Nov;27(6):532-9. https://doi.org/10.1111/ipd.12292

10. Feldens CA, Vítolo MR, Maciel RR, Baratto PS, Rodrigues PH, Kramer PF. Exploring the risk factors for early-life sugar consumption: a birth cohort study. Int J Paediatr Dent. 2021 Mar;31(2):223-30. https://doi.org/10.1111/ipd.12713

11. World Health Organization (WHO). e-Library of Evidence for Nutrition Actions (eLENA). Geneva: World Health Organization; 2022.

12. Echeverria MS, Schuch HS, Cenci MS, Motta JVS, Bertoldi AD, Hallal PC, et al. Trajectories of sugar consumption and dental caries in early childhood. J Dent Res. 2022 Jun;101(6):724-30. https://doi.org/10.1177/00220345211068743

13. Paes Leme AF, Koo H, Bellato CM, Bedi G, Cury JA. The role of sucrose in cariogenic dental biofilm formation--new insight. J Dent Res. 2006 Oct;85(10):878-87. https://doi.org/10.1177/154405910608501002

14. Rezende G, Hashizume LN. Maltodextrin and dental caries: a literature review. Rev Gaúch Odontol. 2018 Jul-Sep;66(3):257-62. https://doi.org/10.1590/1981-8637201800030000103288

15. de Assunção Costa. Potencial cariogênico de fórmulas infantis e seu efeito na desmineralização do esmalte. [dissertação]. Piracicaba, SP: Faculdade de Odontologia de Piracicaba; 2023.

16. Sadan H, Shanthala BM, Zareena MA, Babu G, Vijayan V. In vitro evaluation of milk-based, soy-based, and amino acid-based infant formulas on Streptococcus mutans biofilm formation. J Indian Soc Pedod Prev Dent. 2020;38(4):350-4. https://doi.org/10.4103/JISPPD.JISPPD_241_20

17. de Mazer Papa AM, Tabchoury CP, Del Bel Cury AA, Tenuta LM, Arthur RA, Cury JA. Effect of milk and soy-based infant formulas on in situ demineralization of human primary enamel. Pediatr Dent. 2010;32(1):35-40. 20298651.

18. Bridge G, Lomazzi M, Bedi R. A cross-country exploratory study to investigate the labelling, energy, carbohydrate and sugar content of formula milk products marketed for infants. Br Dent J. 2020 Feb;228(3):198-212. https://doi.org/10.1038/s41415-020-1252-0

19. Reddy BVT, Chowdary BUK, Kumar JR, Kumar RH, Gunde V, Nagilla SR. Comparative evaluation of human breast milk, bovine milk, and infant milk formula on cariogenicity in children: An in vivo study. J Indian Soc Pedod Prev Dent. 2023 Oct 1;41(4):274-281. https://doi.org/10.4103/jisppd.jisppd_450_23

20. Gupta P, Shah D, Kumar P, Bedi N, Mittal HG, Mishra K, Khalil S, Elizabeth KE, Dalal R, Harish R, Kinjawadekar U, Indumathi K, Gandhi SS, Dadhich JP, Mohanty N, Gaur A, Rawat AK, Basu S, Singh R, Kumar RR, Parekh BJ, Soans ST, Shastri D, Sachdev HPS; Pediatric And Adolescent Nutrition Society (Nutrition Chapter) Of Indian Academy Of Pediatrics. Indian Academy of Pediatrics Guidelines on the Fast and Junk Foods, Sugar Sweetened Beverages, Fruit Juices, and Energy Drinks. Indian Pediatr. 2019 Oct 15;56(10):849-863. 31441436.

21. Boatwright M, Lawrence M, Russell C, Russ K, McCoy D, Baker P. The politics of regulating foods for infants and young children: a case study on the framing and contestation of Codex standard-setting processes on breast-milk substitutes. Int J Health Policy Manag. 2022 Dec 6;11(11):2422-39. https://doi.org/10.34172/ijhpm.2021.16

22. Neves PA, Ribeiro CC, Tenuta LM, Leitão TJ, Monteiro-Neto V, Nunes AM, et al. Breastfeeding, dental biofilm acidogenicity, and early childhood caries. Caries Res. 2016;50(3):319-24. https://doi.org/10.1159/000445910

23. Ricomini Filho AP, de Assis ACM, Costa Oliveira BE, Cury JA. Cariogenic potential of human and bovine milk on enamel demineralization. Caries Res. 2021;55(4):260-7. https://doi.org/10.1159/000515013

24. Ribeiro CC, Tabchoury CP, Del Bel Cury AA, Tenuta LM, Rosalen PL, Cury JA. Effect of starch on the cariogenic potential of sucrose. Br J Nutr. 2005 Jul;94(1):44-50. https://doi.org/10.1079/bjn20051452

25. Thurnherr T, Gierstsen E, Gmur R, Guggenheim B. Cariogenicity of soluble starch in oral in vitro biofilm and experimental rat caries studies: a comparison. J Appl Microbiol. 2008;105:829-36. https://doi.org/10.1111/j.1365-2672.2008.03783.x

26. Botelho JN, Villegas-Salinas M, Troncoso-Gajardo P, Giacaman RA, Cury JA. Enamel and dentine demineralization by a combination of starch and sucrose in a biofilm-caries model. Braz Oral Res. 2016 May 20;30(1). https://doi.org/10.1590/1807-3107BOR-2016.vol30.0052

27. Aires CP, Del Bel Cury AA, Tenuta LM, Klein MI, Koo H, Duarte S, et al. Effect of starch and sucrose on dental biofilm formation and on root dentine demineralization. Caries Res. 2008;42(5):380-6. https://doi.org/10.1159/000154783

28. Raju AS, Hirehal M, Manjunath PG, Reddy VV, Natraj CG. The acidogenic potential of different milk formulas on dental plaque pH. Oral Health Prev Dent. 2012;10(3):225-30. 23094265.

29. Tan SF, Tong HJ, Lin XY, Mok B, Hong CH. The cariogenicity of commercial infant formulas: a systematic review. Eur Arch Paediatr Dent. 2016 Jun;17(3):145-56. https://doi.org/10.1007/s40368-016-0254-0.

30. Stegues CG, Arthur RA, Hashizume LN. Effect of the association of maltodextrin and sucrose on the acidogenicity and adherence of cariogenic bacteria. Arch Oral Biol. 2016 May;65:72-6. https://doi.org/10.1016/j.archoralbio.2016.01.018

31. Koh SGS, Sim YF, Sim CJ, Hu S, Hong CHL, Duggal MS. Rinsing with water for 1 min after milk formula increases plaque pH. Eur Arch Paediatr Dent. 2021. https://doi.org/10.1007/s40368-020-00524-x

32. Bowen WH, Koo H. Biology of Streptococcus mutans-derived glucosyltransferases: role in extracellular matrix formation of cariogenic biofilms. Caries Res. 2011;45(1):69-86. https://doi.org/10.1159/000324598

33. Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective. Int J Paediatr Dent. 2019 May;29(3):238-48. https://doi.org/10.1111/ipd.12484

34. Feldens CA, Pinheiro LL, Cury JA, Mendonça F, Groisman M, Costa RAH, et al. Added sugar and oral health: A position paper of the Brazilian Academy of Dentistry. Front Oral Health. 2022;3:869112. https://doi.org/10.3389/froh.2022.869112

35. Ventura AK, Worobey J. Early influences on the development of food preferences. Curr Biol. 2013 May 6;23(9):R401-8. https://doi.org/10.1016/j.cub.2013.02.037

36. Feldens CA, Rodrigues PH, de Anastácio G, Vítolo MR, Chaffee BW. Feeding frequency in infancy and dental caries in childhood: a prospective cohort study. Int Dent J. 2018 Apr;68(2):113-21. https://doi.org/10.1111/idj.12333

37. Fidler Mis N, Braegger C, Bronsky J, Campoy C, Domellöf M, Embleton ND, Hojsak I, Hulst J, Indrio F, Lapillonne A, Mihatsch W, Molgaard C, Vora R, Fewtrell M; ESPGHAN Committee on Nutrition. Sugar in Infants, Children and Adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2017 Dec;65(6):681-696. https://doi.org/10.1097/MPG.0000000000001733

38. Awad R, Kowash M, Hussein I, Salami A, Abdo M, Al-Halabi M. Sugar content in infant formula: Accuracy of labeling and conformity to guidelines. Int J Paediatr Dent. 2023 Jan;33(1):63-73. https://doi.org/10.1111/ipd.13014