Comparing Mediterranean, Dietary Phytochemical Index, and Healthy Eating Indices with a Theoretical Model of a Dental Diet Risk Score: An In-Silico Modeling Study

Diet plays a central role in oral health. Free sugars and acidic beverages are major risk factors, whereas phytochemical-rich and fiber-dense foods exert protective effects. Widely used indices such as the Mediterranean Diet Adherence Score (MEDAS), Dietary Phytochemical Index (DPI), and Healthy Eating Index (HEI) were not originally developed to capture oral health outcomes. This study aimed to develop a theoretical Dental Diet Risk Score (DDRS), integrating sugar intake, acidic beverage exposure, protective foods, and overall dietary quality, and to compare its alignment with MEDAS, DPI, and HEI through in-silico modeling. A total of 10,000 synthetic dietary profiles were simulated. MEDAS, DPI, and HEI were normalized to a 0-100 scale. DDRS was calculated as 0.40S + 0.20A + 0.25(100-K) + 0.15(100-Q), where S = sugar, A = acidic beverages, K = protective foods, and Q = overall quality. Pearson correlations, variance decomposition, scenario testing, and sensitivity analyses were performed. DDRS correlated inversely with all three indices: MEDAS (r = -0.62), DPI (r = -0.68), and HEI (r = -0.54). Sugar explained 42% of DDRS variance, followed by protective foods (28%), acidic beverages (18%), and overall quality (12%). Scenario analyses demonstrated DDRS medians of 28 for high-quality diets and 76 for low-quality, high-sugar diets. Sensitivity analyses confirmed sugar exposure as the most influential determinant. In conclusion, MEDAS, DPI, and HEI were all inversely associated with theoretical dental diet risk, with DPI showing the strongest protective alignment. The DDRS represents a novel conceptual framework linking dietary indices with oral health outcomes and warrants validation in real-world populations. No empirical validation was performed in this in-silico study; however, the DDRS framework provides a theoretical basis for future benchmarking against clinical oral health outcomes.