Young British Smiles May Be Getting Better

Richard Gawel


Pediatric tooth decay has reached epidemic proportions in England, impacting the well being of tens of thousands of children as well as the finances of the National Health Service. Public Health England (PHE) reports that modest gains are being made, but other dental organizations say further improvements are necessary.

A PHE survey reports that fewer than 25% of 5-year-olds now suffer from tooth decay, compared to 27% in 2012 and 31% in 2008. There also has been a 9% increase in the number of children with no obvious decay since 2008. According to PHE, these changes show the effect parents and caregivers can have in establishing good dental habits from an early age.

“This is great news. However, one child with tooth decay is one too many, and there is still much inequality in dental health around the country,” said Dr. Sandra White, director of dental public health at PHE. “Tooth decay is painful and too often results in teeth extraction, some under general anesthetic.”

For example, 33.4% of 5-year-olds in the Northwest of England have tooth decay, while only 20.1% of them have it in the Southeast. Regions with greater economic challenges tend to have higher levels of tooth decay, according to the PHE.

Additionally, 2.5% of 5-year-olds had teeth removed due to decay, compared to 3.5% in 2008. Regionally, only 1.9% of 5-year-olds in the East Midlands had extractions due to decay, compared to 3.9% of children in Yorkshire and the Humber.

Overall, though, the number of extractions may be increasing. The British Dental Association (BDA) says that there were 40,970 extractions in 2014 and 2015, but there were only 32,457 in 2010 and 2011. The BDA, then, is calling on the government to provide a strategy and a contract based on prevention.

“We are seeing modest improvements in oral health, not the breakthrough our children deserve. We are paying the price for decades of government indifference, which has left persistent oral health inequalities and an ever-growing number of kids facing extractions in hospital,” said Henrik Overgaard-Nielsen, chair of the BDA General Dental Practice Committee.

According to a BDA survey, 83% of NHS dentists felt its contract system, which is based on government targets, was holding them back from preventive work. Also, 93% said these targets limit their ability to care for high-needs patients who need complex or repeat treatment.

The BDA also partially blames the prevalence of decay on the amount of sugar in typical diets. While the organization praises the impending tax on sugary beverages, it believes more could be done, including tighter controls on marketing and labeling, investment in prevention, and making oral health part of the wider health discussion.

The Liverpool City Council already is taking action with a campaign titled “Is Your Child’s Sweet Tooth Harming Their Health?” It will spotlight the amount of sugar in popular drinks like Lucozade, which has 15.5 cubes of sugar in a 500-mL bottle, and Coca-Cola, which has 13.5 cubes in a 500-mL bottle. The recommended daily allowance for children is 5 to 7 cubes.

“There is a myth that baby teeth are not important, but the fact is that they are vital as they help guide adult teeth into position,” said Sondos Albadri, reader and consultant in pediatric dentistry at the University of Liverpool. “Persistent infections can be detrimental to the child’s general health, and early loss of baby teeth can also lead to problems with adult teeth later in life.”

Public Health Liverpool reports that 2,000 children in the city will have had tooth extractions by the age of 5, with more than a third suffering from tooth decay. In fact, Albadri recently extracted 15 adult teeth from a 14-year-old patient—a procedure that the teen could have avoided with a less sugary diet and brushing twice a day.

And while the Faculty of General Dental Practice (UK) agrees that the overall news is good, it also says further improvements are needed. These changes include better education for parents and children in improving their diet and oral care through their doctors and dentists as well as in their schools. Furthermore, the group agrees the government should focus on prevention.

“The further increase in the proportion of young children free of tooth decay is great news,” said Dr. Mick Horton, dean of the group. “But the fact remains that a quarter of 5-year-olds have an almost entirely preventable disease, and a quarter of these are not even receiving treatment.”

Still, PHE says that the average number of teeth affected by decay per 5-year-old was 0.8, compared to 1.1 in 2008. And while further analysis is needed to understand the factors contributing to this decline, local authorities can use the data to extend improvements in decay levels to all sectors of their populations, PHE said.

“This is further evidence that we can stop tooth decay in its tracks,” White said. “Limited sugary food and drink, supporting children to brush their teeth twice a day with fluoride toothpaste, and regular trips to the dentist will help prevent a great many more children suffering at the hands of tooth decay.”

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