One in 10 people in Wales have lost all their natural teeth and the nation has higher levels of tooth decay than England and Northern Ireland. Why is this and what can we do to prevent it? Clare Hutchinson asks the experts

WHEN the Office for National Statistics (ONS) asked 11,000 people across Wales, England and Northern Ireland about their teeth, it discovered some shocking results.

It found that in Wales, 10% of adults who responded to the 2010 survey had no natural teeth – compared to 6% in England.

People in Wales also had significantly higher levels of visible tooth decay and the highest mean number of decayed and unsound teeth, with one in five adults boasting less than 21 teeth.

Things have improved – in 1978 a whopping 37% of the adult population in Wales had no natural teeth – but, according to Stuart Geddes, chairman of the British Dental Association (BDA) in Wales, things are not improving fast enough.

Mr Geddes is one of a growing number of dental professionals calling for fluoride to be added to the nation’s drinking water to try and tackle the widespread problem of oral health.

He said: “Instances of both tooth decay and gum disease are higher in Wales than they are in the rest of the UK and there is a recognised link between deprivation and oral health levels.

“Yet despite this there is a real lack of appetite for public health measures in this country.

“Adding fluoride to public drinking water is a tried and tested method and one of the most efficient and cost-effective ways of reducing dental decay.”

And it is not just tooth decay. According to the UK Gum Disease Information Bureau, gum disease is the UK’s biggest cause of tooth loss, affecting an estimated three out of four adults over the age of 35.

So what causes tooth decay and gum disease? And how can we prevent it happening to us?

Tooth decay

Causes: Most people know tooth decay is caused by too much sugary food, but what might be surprising is that as well as the usual suspects like fizzy drinks and sweets, fruit juices can also play a role in the problem.

According to Alison Lowe, a Cardiff-based dental hygienist, when we eat sugar the PH levels in our mouths drop, meaning they get more acidic.

This acid then attacks the teeth, causing decay.

Tooth decay is especially prevalent in children because they are more attracted to sweet foods – something which parents should be aware of and take steps to counter.

Alison said: “Children rely on their parents to encourage them to brush their teeth and to feed them the right foods in the first place.

“It is a real problem, especially in more deprived areas, and I see it a lot on Cardiff.”

Some programs, like the Assembly Government-run Designed to Smile, are tackling the problem of tooth decay in children by sending hygienists out to schools.

Since it was introduced last year, the programme has been hugely successful but, according to Alison, good dental health starts at home.

Prevention: The best place to start when it comes to keeping your teeth healthy is to invest in a good toothpaste, said Alison.

“Fluoride toothpastes can reduce tooth decay by 50%,” she said.

“The important thing with children is to get the measurements right.

“Packets tell you how many parts per million (ppm) of fluoride the toothpaste contains.

“For children aged between three months and two years, you should be using toothpaste with fluoride levels of 600ppm, moving on to 1,000ppm for children aged between two and four and 1,450ppm for those aged four and above.

“You should brush your teeth at least twice a day, most importantly before you go to bed, and when you get up in the morning.”

According to Alison, you should also brush your teeth before, not after, eating breakfast. This is because when you eat acidic foods and drinks, like fruit or fruit juice for breakfast, the acid can soften the enamel on your teeth and brushing immediately afterwards can wear that enamel away.

Similarly, brushing your teeth straight after eating something sugary will have the same effect, because sugar lowers the PH levels in your mouth.

Leaving at least an hour between eating and brushing your teeth gives your saliva enough time to restore your mouth’s PH balance.

But while the amount of sugar you eat has an effect on tooth decay, it is actually the time spent eating it that can make the most difference.

Alison said: “The problem gets worse the longer sugar is left in your mouth, which is why children are especially prone to tooth decay because they tend to take all afternoon to eat one packet of sweets, for example.

“It is much better to eat it all in one go, for example as part of a meal, than to take your time.

“Most people tend to eat five times a day and no more than three of these meals should contain refined sugars. Constant grazing of sugary foods means the teeth are under constant attack. Unfortunately it is very hard to know if you have tooth decay until you get a toothache and it is too late.

“That is why it is important to go to your dentist for regular check ups.”

Gum disease

Causes: Whereas tooth decay is caused by too much sugar, gum disease is caused by bacteria-hoarding plaque.

Alison said: “Gum disease is inflammation of the gums caused by bacteria, which is itself caused by a build-up of dental plaque.

“One of the symptoms of gum disease is bleeding, but I find that a lot of people seem to think this is normal.

“If they come in for a check up they will say, ‘everything’s fine, although my gums are bleeding a bit’. They don’t seem to realise the seriousness of the problem.”

Also known as gingivitis, gum disease can cause more serious periodontitis, which leads to complications like painful sores – which can destroy parts of the gums – and loose and unstable teeth.

Most people will have at least one case of mild gum disease in their lifetime and it is estimated that between 50% and 90% of the UK population has some degree of gum disease.

Smoking, ineffective oral hygiene and alcohol are some of the main causes.

Alison said: “Bleeding gums and smelly breath are both signs of gum disease.

“Smoking is dreadful. It’s the worst thing for gum disease and, along with alcohol, it can also cause oral cancer, which is on the rise in Wales.”

Prevention: The best way to prevent gum disease, according to experts, is to practice good oral hygiene.

“You can do this by ensuring you follow a few basic steps,” said Alison.

“Firstly, it’s not just about brushing your teeth – it is very important to floss as well to get between the teeth.

“Everybody should also be brushing their tongue because that is where a lot of the bacteria is.

“You can do this with a special toothbrush or by using a tongue scraper, which is great because it can get right to the back of your tongue.

“Mouthwash is no substitute for brushing or flossing but if you gargle mouthwash it can get rid of bacteria build up on your tonsils.”

If, as in Wales, your water supply does not contain fluoride, use a toothpaste with plenty of fluoride in it and, if you have one, use an electric toothbrush.

It is also important to floss your teeth at least three times a week and to make regular appointments with your dentist, at least once every one or two years.

Antibiotics and painkillers can be prescribed for more serious problems with gum disease, while your dentist may choose to scale and polish your teeth or clean the roots with what is known at root planing.

In worst-case scenarios you may need further treatment, such as surgery, to remove the affected tooth.

According to Alison, such treatment should only be necessary as a last resort.

She said: “The hardest thing in my job is seeing young children having one or more teeth taken out because of tooth decay or, sometimes, gum disease.

“What is frustrating is that we have known the causes of tooth decay and gum disease for a long time and it should have been stamped out by now.

“The important thing for everyone – and especially parents – to remember, is that prevention is the best cure.”