More health warnings on food are needed to reduce tooth decay, says BMA

BMJ 2018; 361 doi: (Published 16 May 2018) Cite this as: BMJ 2018;361:k2177
  1. Jacqui Thornton
  1. London

Almost a quarter of 5 year olds in England have tooth decay, and those from deprived backgrounds are the worst affected, a survey has found, prompting new calls for health warnings on food packaging.

Almost half of the 539 children examined from eastern European backgrounds had obvious caries, compared with around a fifth of those described as white or as black/black British.

Public Health England’s oral health survey 2017 involved clinical examinations of over 96 000 children aged 5 to determine the prevalence and severity of tooth decay.1 At that age children normally have 20 primary teeth.

Among the 23.3% of children with some experience of obvious decay the average number of teeth that were decayed, missing, or filled was 3.4. The corresponding average in the whole sample, including the 76.7% who were free of decay, was 0.8.

The survey found an almost 20-fold difference in severity between local authorities with the lowest level of decay (0.1 in Waverley in Surrey) and the highest (2.3 in Pendle in Lancashire). Children from deprived backgrounds had notably higher prevalence (33.7%) than those from the least deprived (13.6%).

Children in minority ethnic groups had markedly higher levels of decay. Those described as eastern European had a prevalence of 49.4% and children from Chinese backgrounds had 41.5%, compared with only 19.6% among black/black British children and 20.9% in white children.

The survey takes place every two years to collect dental health information on children aged 5 who attend mainstream, state funded schools around England and is carried out as part of the National Dental Epidemiology Programme for England.

This is the fourth consecutive survey to show improvement in the proportion of children who are free of obvious decay. But the BMA said that this latest report adds to a body of evidence showing that more must be done to safeguard young people’s oral hygiene.

Tooth decay is a major cause of hospital admissions in children: an analysis by the Local Government Association found that 42 911 hospital procedures to extract multiple teeth were recorded among under 18s in England in 2016-17.2 This cost the health service about £36.2m (€41.4m;$48.9m), and the total cost since 2012 is £165m.1

Tooth decay also places an increased burden on primary care. A study by the Royal College of General Practitioners3 in April 2016 showed that GPs see around 600 000 patients with dental problems each year. One academic study suggested that this costs GPs £26.4m a year.4

Parveen Kumar, chair of the BMA’s board of science, accepted the steady improvement in children who are decay-free but said that a significant minority still experience preventable, painful dental health problems.

She said, “If children are drinking less sugary drinks as a result of the soft drinks industry levy, this should improve children’s oral health. However, we must not take our foot off the pedal.

“Health warnings must make clear to parents the amount of sugar in the food and drinks they’re buying for their children. This should be in a way that’s easy to understand, like how many teaspoons of sugar are in one serving. They would also make explicit how too many sugary drinks can cause tooth decay.

“If the health secretary is serious about creating a healthier environment for our children we hope that he will consider legislating for the introduction of health warnings, regulated by the Food Standards Agency.”

The Local Government Association said that the new findings highlighted the need for urgent investment in oral health education so that parents and children understand the impact of sugar on teeth.

Izzi Seccombe, chair of the association’s Community Wellbeing Board, said, “Untreated dental care remains one of the most prevalent diseases affecting children and young people’s ability to speak, eat, play, and socialise. This study underlines how regular check-ups at a dentist can help prevent tooth decay and the need for hospital treatment.”


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