There are many things running through our minds when we have young children and a busy lifestyle. Important things are often missed until they become an obvious problem, especially when it comes to a child’s oral health.  Oral health plays an important role in general health and wellbeing and contributes to the development of a healthy child and school readiness.  One of the most common oral diseases is tooth decay, which affects children and young people in England.

As reported by Public Health England (2018) a quarter of 5 year olds have tooth decay with on average 3 or 4 teeth affected.  The first survey of 3 year olds found that 12% had visible dental decay with on average 3 teeth affected. Also, the most common reason for hospital admission for children aged 5 to 9 years in 2012 to 2013 was tooth decay.

The burden of tooth decay on the NHS 

The average cost of a tooth extraction in hospital for a child aged 5 and under is £836.

Public Health England, 2018

£50.5m was spent on tooth extractions among those under the age of 19 in 2015 to 2016.

Public Health England, 2018

£7.8m was spent on tooth extractions among the under 5s.

Public Health England, 2018

Every 10 minutes a child in England has a rotten tooth removed in hospital.

British Dental Association 2018


“Tooth decay is the number one reason why children aged 5-9 are admitted to hospital in England” (British Dental Association, 2018)

Figure 1: Roseman University The Dental Clinic (2018)

What is tooth decay?

Tooth decay can occur when acid is produced from plaque, which builds up on your teeth. This can then lead to further problems such as dental caries, gum disease or dental abscesses. 

Dietary habits and tooth decay

When it comes to food and oral health there are many questions that you may have. For example can consuming too much sugar cause tooth decay? Which foods cause tooth decay?  How can I prevent tooth decay?

“Nearly a quarter of the added sugar in our diet comes from soft drinks and children aged 11-18 get 40% of their added sugars from soft drinks”.

British Dental Association (2018)

After many campaigns the government announced a levy on sugary soft drinks from 2018 but further changes need to be made to cover a wider range of sugary foods and drinks.  Surprisingly many people are unaware of the high level of sugar in fizzy drinks. 

There is a lot of talk about sugar and tooth decay but what does this exactly mean?  Sugar is one of the main causes of tooth decay. The sugar that we must be aware of and the type most adults and children in the UK eat too much of are “free sugars”.  These are:

The government recommends that free sugars – sugars added to food or drinks, and sugars found naturally in honey, syrups, and unsweetened fruit and vegetable juices, smoothies and purées – should not make up more than 5% of the energy (calories) you get from food and drink each day. Children aged 4 to 6 should have no more than 19g of free sugars a day (5 sugar cubes) (NHS, 2017)

  • Any sugars added to food or drinks. These include sugars in biscuits, chocolate, flavoured yoghurts, breakfast cereals and fizzy drinks. These sugars may also be added at home or at a restaurant
  • Sugars in honey, syrups (such as maple, agave and golden), nectars (such as blossom), and unsweetened fruit juices, vegetable juices and smoothies. The sugars in these foods occur naturally but still count as free sugars
  • Sugar found naturally in milk, fruit and vegetables does not count as free sugars. We do not need to cut down on these sugars, but remember that they are included in the “total sugar” figure found on food label (NHS, 2017)

With a 30g bowl of Coco Pops containing 10.5g and 500ml bottle of Ribena containing as much as 50g, it’s easy to see how easy it is for young children to exceed the sugar limits and put their health and teeth at risk.

How to prevent Tooth Decay?

Luckily, tooth decay is preventable – you just need to know how.

Start off by reducing the amount of food and drinks you have that contain free sugars – such as sweets, chocolates, cakes, biscuits, sugary breakfast cereals, jams, honey, fruit smoothies and dried fruit – and limit them to mealtimes.

Figure 2: The mailbox (2018)

The sugars found naturally in fruit and vegetables are less likely to cause tooth decay, because they are contained within the structure. But when fruit and vegetables are juiced or blended into a smoothie, the sugars are released. Once released, these sugars can damage teeth.

Limit the amount of fruit juice and smoothies you drink to a maximum of 150ml (a small glass) in total per day, and drink it with meals to reduce the risk of tooth decay. (NHS, 2017)

It can be tempting to distract your child with sweets or a snack high in sugar. So with that in mind, here are some simple tips to help you prevent tooth decay in your child and to make sure your child is having a healthy balanced diet. 

8 Tips for Good Oral Health

  • • Maintain a healthy balanced diet, eat a variety of foods from each of the five major food groups.
  • A good oral hygiene routine is essential, as well as regular dental check-ups.
  • Reduce sugary snacks: the risk of developing tooth decay increases as the amount and frequency of sugar consumption rises.
  • Swap sugary snacks with nutritious foods such as cheese, raw vegetables, plain yoghurt, or a piece of fruit.
  • Brush twice a day: keeping teeth clean by regularly brushing helps prevent decay. Children’s brushing should be supervised until the age of seven. Ask your dentist for more advice.
  • Use a fluoride toothpaste: all children up to three years old should use a toothpaste with a fluoride level of at least 1000ppm, both morning and night. From three to six years old, their toothpaste should contain more than 1000ppm. For children six years and older, the recommended amount is between 1350ppm-1500ppm (British Dental Association (2018))
  • Watch out for ‘hidden’ sugars: pure fruit juices can be a healthy choice, but the natural sugars these contain can still damage teeth. If you are offering fruit juice, drink it with a meal and only in a small glass (up to 150ml) (British Dental Association (2018))
  • Only provide water and milk as suitable drinks between meals and dilute fruit juice with water. If fruit juice is given it should be given with a meal and only consumed once a day.
Rammesha Alam
Postgraduate Dietic Student


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