in food cariogenicity” . In addition, by 1978, the NIDR had terminated clinical trials on phosphates added to foods because they were ineffective .
The most successful interventions selected for funding following the 1971 NCP RFP were topical fluoride and sealants . While a 1980 prevalence survey found that the burden of dental disease in children had decreased by more than 30% since the last survey in 1971–1973, 64% of children still exhibited dental caries, far short of the NCP’s founding goal of eradicating the disease .
It is not clear why the NIDR adopted the position in 1969 that reducing sugar intake as a public health measure was impractical. Proposals centered on ways to limit sucrose consumption were just around the corner. In its multi-year review of foods generally recognized as safe initiated in 1969, the FDA deemed sucrose consumption at 1976 levels as unsafe for teeth . In the coming years, the FDA would consider food labels “to warn against the hazards to the teeth of consuming a particular product” and debate whether warning labels should be placed on foods based on the percentage of sugar content, or on some measure of cariogenic potential .
When reflecting on the NCP in 1990, Basil Bibby, a member of the Caries Task Force Steering Committee, noted that the NIDR approved only “one or two small research grants” related to food cariogenicity compared to the “hundreds of generous awards [that] were made for investigations with so-called high scientific content” . He also noted that since the NIDR was the major funding source for dental research in the US, “the failure of the National Institute for Dental Research to support research on foods meant that there was no group of investigators in the United States who had enough financial support to undertake significant research on food cariogenicity” .
In 1977, the NIDR finally moved to develop a standardized animal model to identify the tooth-decay-causing potential of foods “with the objective of its being widely accepted in industry, and in regulatory agencies and in academic research, as a basis for distinguishing cariogenic from non-cariogenic snacks” . While research on an animal model was initiated at the NIDR , the bulk of the research was conducted outside the NIDR, largely funded by the American Dental Association Health Foundation . Based on the promise of the development of a standardized model to identify harmful foods, in 1978 the US Federal Trade Commission proposed restrictions on advertising cariogenic products to children . The first US Department of Health and Human Services Healthy People objectives, issued in 1980, proposed banning cariogenic products from schools as a means to control dental caries . While lobbying efforts of the food, advertising, and broadcasting industries were a major reason for the failure of the FDA, Federal Trade Commission, and Healthy People proposals, another common factor cited for these policy failures is the lack of a standardized model to identify foods harmful to teeth [78,81,83].
With industry input, consensus was finally achieved on a standard method to screen foods for cariogenicity at a conference sponsored by the Foods, Nutrition and Dental Health Program of the American Dental Association in 1985, but only to support claims that food products were safe for teeth . In 1996, the FDA began allowing health claims (i.e., “does not promote tooth decay”) on food products containing sugar substitutes based on a standard screening method for cariogenicity . The FDA did not, however, require disclosure or labeling of harmful foods. In 1999, a group of clinicians and dental scientists updated the methodology agreed upon in 1985 with the aim of identifying which methods were “suitable as research tools but also for regulatory assessments” . However, the use of these methods to identify foods harmful to teeth remained controversial .
With the implementation of the nutrition facts panel on packaged food products in 1993, the FDA required the declaration of total sugars , a requirement that remained unchanged as of 