Note from FAN: Ireland is the only country in the European Union where fluoridation of drinking water is mandatory.
There is nothing quite like the moment a baby cuts his first tooth. That little gummy smile punctuated by his first pearly whites just couldn’t get any cuter. But despite their teeth being a gleaming shade of white upon first sight, an alarming number of young children and babies are developing cavities and decay at a very early age.
According to a report from the Royal College of Surgeons in the UK, extractions among children under the age of five have risen by almost 2,000 a year in the past decade. Experts say a combination of poor diet and too much sugar is to blame.
“When you see the numbers tallied up like this, it becomes abundantly clear that the sweet habits of our children are having a devastating effect,” says Prof Nigel Hunt of the RCS faculty of dental surgery.
“That children as young as one or two need to have teeth extracted is shocking. It’s almost certain that the majority of these extractions will be down to tooth decay caused by too much sugar.”
But the problem isn’t just confined to the UK, as dentists over this side of the water can attest to.
“When I did research for a talk on diabetes and dental health last year, I was shocked at the level of decay in children,” says Dr Richard Lee Kin, director of the Oral & Dental Health Symposium 2017. A 2015 study by the Irish Dental Association found that some 10,000 extractions were carried out every year – and that most of these were due to too much sugar in diets, he said.
Dr Anne Twomey, vice-president of the Irish Dental Association, agrees and says although parents are responsible for what they feed their children, it’s not entirely their fault: some are mistakenly buying products they believe are healthy.
“The level of decay among young children is catastrophic,” she says. “As recently as last week I examined an 18-month-old child whose front teeth were entirely decayed. This I put down to follow-on milk, which contains sugar and I totally believe contributes to tooth decay.
“Children are definitely consuming far too much sugar in their diet – whether it’s through treats, sweet cereals or sugary drinks. But also parents are being hoodwinked by companies into thinking certain products are healthy for their children. So aside from the follow-on milk, we can also blame yoghurts which are filled with sugar.
“When you think about it, yoghurt is supposed to be sour, but there wouldn’t be a child in Ireland who associates yoghurt with a sour taste – it is always sweet.
“There are so many different words for sugar out there [such as fructose, glucose, lactose and sucrose], so unless you know them all or make sure to only use homemade food for your child, this is always going to be a problem.”
Dr Lee Kin agrees and says the problem is heightened by lack of resources to prevent decay taking hold in the first place.
“As a periodontist, my passion is to preserve teeth of all ages. Yet sadly we have a situation where thousands of children are subject to unnecessary extractions that are entirely preventable,” he says. “As the [economic] recovery takes hold, some legacy issues from the recession will be hard to fix, such as the Victorian dental services for our children.
“Despite HSE dental treatment being free for the under-16s, in 2015, 16,000 children who were due to be screened did not receive an examination. And in many parts of the country school screenings, which should happen in 2nd, 4th and 6th classes, did not happen due to chronic staff shortages in the public dental service.”
The dental expert says prevention is crucial as children who lose teeth in early childhood can be affected for life.
“The effects of losing teeth at such an early stage of a child’s development can profoundly affect their health and smile forever,” he says. “There is a need to introduce preventive programmes targeting preschool-aged children to tackle the high levels of dental cavities within this age group and to provide a comprehensive preventive dental health programme for every child under 12.
“There is also a significant need for a new, comprehensive study into the oral and dental health of the population, the last of which was published more than 15 years ago. Collaboration is also needed with our health care colleagues and nurses as they have a role to play in educating parents and children about dental health.”
According to Dr Twomey, who is based in Cork, official figures from the HSE are misleading and the situation is actually far worse than reported.
“Reports from the HSE claim that the number of cavities found in children under five has been reduced and the current average is 1½ cavities per child,” she says. “However, this is not the reality as I see it, because in a group of, say, 20 children, 15 will have perfect teeth while the other five will have appalling levels of decay and need to have eight teeth or more extracted at a very young age.
“So this research is not a correct description of the situation we have at present, and something needs to be done urgently to help these children who are still presenting with catastrophic levels of decay.”
Making sugar more expensive is one way to help prevent cavities in children. Dr Lee Kin says this combined with more information for parents will make a difference.
“A sugar levy is shortly to be introduced by the Government and while not a panacea, I believe a significant proportion of that money raised [due to the proposed sugar tax] should be spent on oral health education,” says the Dublin-based periodontist.
“Sugar has an almost immediate damaging impact on teeth and if we teach parents and children to cut down on sweet treats and look after their teeth properly, there will be a positive knock-on effect for childhood obesity and diabetes rates too.”
“For the main part, parents in Ireland definitely do not adhere to the guidelines regarding dental check-ups. Usually the first time we get to see a child is when they are between three and five and are suffering with toothache, which at this stage is most likely to be an abscess” she says.
“It costs around €30 to €40 for a child’s visit and about €80 to €90 for an extraction, but I believe that dental appointments should be free for children under one as this would be the most effective way to stop dental decay in the future.”
Level of decay
Dr Marion O’Reilly of Safefood.eu cites a number of ways in which parents can help to reduce the level of tooth decay in their children through their diet.
“Parents should replace sugary drinks, which include fizzy drinks, squashes, cordials and juices, as not only do these pose a risk to teeth but are linked with excess weight in children,” she says. “If your family loves soft drinks or other sweetened drinks, reduce them gradually – you can start by adding plenty of water to cordials and squashes. Add extra water each time to squashes and cordials to reduce your child’s taste for sweetness.
“Keep sweetened drinks for the weekend and make water freely available between meals. Water is tastier when it’s cold: so put a jug of water in the fridge and add a slice of lime, lemon or orange to give it flavour and colour.”
PANEL: Dr O’Reilly’s tips for reducing sugar
Make sure your child does not sleep with a bottle in his or her mouth. Children should be fed and put to bed – NOT put to bed and fed.
Avoid all sugar-containing liquids in nap or bedtime bottle.
Encourage drinking from a cup.
Discontinue bottle feeding by your child’s first birthday.
Do not dip a soother in sugar, honey or anything sweet before giving it to your child.
Between-meal snacks can be fruit, crisp raw vegetables, sandwiches, variety of breads, yoghurts, cheese, plain popcorn and scones.
Cereals such as porridge are excellent energy providers, but avoid the sugar-coated cereal types. In general, the sugar and salt content of breakfast cereals should be checked as some breakfast cereals are high in one or the other or both.
Milk and water are suitable to drink between meals.
Pure juices, fruit squashes and smoothies should be consumed at meal times.
Drinks containing added sugars, including probiotic and yoghurt type drinks, should be consumed at meal times.
Regular intake of carbonated drinks can lead to enamel erosion of the teeth and should be avoided.
PANEL: Safefood.eu tips for reducing treats
Cut down on treat foods, but don’t ban them. Banning them makes them more appealing.
Shopping is a danger time – just buy treats occasionally and don’t have a supply at home. If they’re not in the house, they can’t be eaten.
Keep the sweets cupboard or cookie jar out of sight – and out of mind.
Tell family and friends you’re making changes so they know about the new routine.
When you do have sugary foods, eat them with a meal. It’s better for their teeth and means they won’t fill up on treats between meals.
Say the kitchen is closed when mealtimes are over, but allow them access to healthy snacks such as fruit, chopped vegetables and water, and then send them off to play.
In the long run, it’s kinder to say no – so don’t be afraid to say it.
Praise them and offer non-food treats, like a trip to the park or swimming pool.
Limit the amount of treats by:
– Getting into the habit of having them every second day or less
– Keeping portions small – choose mini or snack versions
– Offering healthy alternatives, such as water instead of sugary drinks or juice and fruit instead of sweets or chocolate.
PANEL: Top tips for good dental hygiene
The key to preventing tooth decay is through reducing sugar consumption and a good oral hygiene routine. Good practice includes:
Teeth should be checked by a dentist at least twice a year from two years of age.
Teeth should be brushed twice a day after breakfast and last thing before bed for 2-3 minutes.
Use a toothpaste with fluoride of at least 1000ppm sodium (check the ingredients).
Leave toothpaste on teeth for a few seconds and then spit – not rinse.
Change your toothbrush regularly and do not share.
Electric toothbrushes are better than manual.
The additional use of small, interproximal tooth brushes is recommended over flossing.
It is recommended that children should have their first dental check-up before they reach 12 months and after that, every six months.