The Vipeholm study was a 5-year investigation conducted in Sweden in the 1950s that examined the relationship between sugar intake and dental caries among 436 mentally challenged adults. The study divided participants into control and experimental groups with varying sugar consumption levels and forms. The findings showed that increased sugar intake, especially in sticky form or between meals, led to higher rates of dental caries. Decreasing sugar intake rapidly decreased caries activity. The study demonstrated that sugar intake causes dental caries in humans and that physical form is more important than total amount consumed. However, it had drawbacks like lack of initial matching and difficulty obtaining informed consent.

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4. VIPEHOLM STUDY
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5. Specific Learning Objective
Student should be able to
• Describe purpose of conducting Vipeholm study
• Findings and drawback of study
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6. Contents
• Introduction
• Purpose of the study
• Methods
• Conclusion
• Drawbacks of the study
• MCQs
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7. Introduction
• Cumulative evidence strongly suggests that dental caries is related
mainly to carbohydrate intake, especially to the amount of sugar
consumed.
• Most of them are from animal studies, so whether conclusions from
these studies hold true for human beings or not which was doubtful.
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8. • This Vipeholm study was an interventional study where alteration in
diet made intentionally to see its link with caries.
• Described by Gustaffson et al in 1954 summarized by Davies in 1955)
• It was a(five year)investigation of 436 mentally challenged adult
inmates of Vipeholm hospital in Lund, Sweden.
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9. Purpose of the study
• To find out
1. Does an increase in carbohydrate (mostly sugar) intake cause an
increase in dental caries? If so, is it by the ingestion
• refined sugar (non sticky) at meals
• sugar (sticky) at meals
• sugar (sticky) between meals
2. Does a decrease in carbohydrate (sugar) intake produce a decrease
in dental caries?
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10. Method
• The experimental design divided the inmates into 1 control and 6
experimental groups;
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11. 1. A control group
• 60 males (average age of 34.9 years)
First 2
years
Low carbohydrate, high
diet free from refined
sugar
Caries activity
suppressed
Next 2
years
Ordinary diet + 110 gms
sugar/day at meal
Small but
significant rise
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12. 2. A sucrose group
• 57 males
First 2
years
300 gms of sucrose in
solution, at meals
Next 2
years
Reduced to 75gms
No
increase
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13. 3. A bread group
• 41 males and 42 females.
First 2 years
345 gms of sweet bread
containing 50 gms of sugar once
daily with afternoon coffee
No demonstrable
increase in caries.
Next 2
years
4 portions of sweet
bread daily with all
meals
significant
increase (M>F)
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14. 4. A chocolate group
• 47 males
First 2
years
300 gms of sucrose in
solution, at meal times.
low
Next 2 years
110 gms supplemented by
65 gms of milk chocolate
daily between meals
Significant increase
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15. 5. A caramel group
• 47 males
third year
22 caramels daily in 2
portions between meals
Significant
increase
4th year
22 caramels in 4
portions between
meals.
Significant
increase
5th year
caramels withdrawn and
replaced by isocaloric fat
with meals
fall in the caries
increment
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16. 6. An 8 toffee group
• 40 males
First
years
low carbohydrate,
high fat diet
low
2nd years
8 toffees a day during
breakfast and lunch
Significant
increase
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17. 7. A 24 toffee group
• 48 males.
3rd & 4th
years
24 toffees between
meals.
greatest increase
in caries
5th
years
Withdrawal of the
toffees
sharp drop in
caries icrement
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18. Conclusion
1. Increase carbohydrate
2. Sticky form sugar
3. Sugar in between meals
4. Increase in sugar clearance time
5. Sugar rich foods withdrawal Rapid decrease in caries activity.
6. Despite avoidance of refined sugar and maximum restrictions of
natural sugars Caries lesions may continue to appear.
INCREASES CARIES ACTIVITY
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19. Physical form more important than
amount in cariogenicity.
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20. Drawbacks of the study:
1. No matching of the age or initial caries status.
2. Mentally challenged patients, so difficulty in understanding of
instructions.
3. The dietary regimes of the various groups were not changed in a
consistent pattern, some groups having longer periods of sugar with
meals compared to others.
4. Unethical
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21. MCQs
1. Vipeholm study conducted for how many years?
a) 3 years
b) 4 years
c) 5 years
d) 6 years
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22. 2. Vipeholm study was described and devised respectively by
a) Sullivan et al, Harris
b) Davies et al, Gustaffson
c) Sheinin et al, Makinen
d) Gustaffson et al, Davies
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23. 3. Study conducted among mentally retarded patients
a) Hopewood house study
b) Turku sugar study
c) Vipeholm study
d) Tristan Da Cunha study
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24. 4. In which group of Vipeholm study there is no increment in caries
activity?
a) Bread group
b) Sucrose group
c) Caramel group
d) 8 toffee group
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25. Suggested Reading
• Peter S. Essentials of public health dentistry. 6th ed. New Delhi:Arya
medi publication;2017
• Marya CM. A textbook of public health dentistry. 1st ed. New Delhi:
Jaypee Brothers Medical Publishers; 2011
• Gustafsson BE, Quengel G-e, Swenander Lanke L, et al. The
Vipeholm dental caries study. The effect of different levels of
carbohydrate intake on caries activity in 436 individuals observed for
five years. Acta Odontol Scand 1954; 11: 232-364
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