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Sugar, dental caries and the incidence of acute rheumatic fever: a cohort study of Māori and Pacific children
  1. Simon Thornley1,
  2. Roger J Marshall2,
  3. Katie Bach3,
  4. Pauline Koopu3,
  5. Gary Reynolds1,
  6. Gerhard Sundborn2,
  7. Win Le Shwe Sin Ei2
  1. 1Auckland Regional Public Health Service, Auckland, New Zealand
  2. 2Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
  3. 3Paediatric Services, Oral Health Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
  1. Correspondence to Dr Simon Thornley, Epidemiologist, Auckland Regional Public Health Service, Cornwall Complex, Greenlane, Auckland 1051, New Zealand; sithor{at}


Objective To determine whether dental caries, as an indicator of cumulative exposure to sugar, is associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease, in Māori and Pacific children aged 5 and 6 years at their first dental visit.

Materials and methods A cohort study was undertaken which linked school dental service records of caries with national hospital discharge and mortality records. Cox models were used to investigate the strength of the association between dental caries and rheumatic fever incidence.

Results A total of 20 333 children who were free of rheumatic heart disease at enrolment were available for analysis. During a mean follow-up time of 5 years, 96 children developed acute rheumatic fever or chronic rheumatic heart disease. After adjustment for potential confounders, children with five or more primary teeth affected by caries were 57% (95% CI: 20% to 106%) more likely to develop disease during follow-up, compared to children whose primary teeth were caries free. The population attributable to the risk for caries in this cohort was 22%.

Conclusions Dental caries is positively associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease in Māori and Pacific children. Sugar intake, an important risk factor for dental caries, is also likely to influence the aetiology of rheumatic fever.

  • Cohort studies
  • DIET

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  • Contributors All authors contributed to the design of the study. ST and RM devised the analysis plan. The data were analysed by ST and RM. ST provided the first draft of the manuscript. All authors provided substantial editing to the final manuscript.

  • Competing interests None declared.

  • Ethics approval New Zealand Health and Disability Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement These data, at present, are unable to be shared due to the conditions under which ethics approval was granted.