New research has revealed that tooth brushing alone is not enough to protect children from tooth decay caused by snacking on sugary foods and drink.
The study, published in the Journal of Public Health, looked at nearly 4,000 pre-school children and discovered that snacking habits are the behaviour most strongly associated with dental decay1.
Researchers found under-five's who snack throughout the day, compared to eating just at meal times, are far more likely to have signs of dental decay and that relying on tooth brushing alone to prevent it is not enough.
Dr Nigel Carter, Chief Executive of the Oral Health Foundation commented: "This research supports messages about snacking being unhealthy; last week it was revealed that 170 children underwent operations in England every day to have rotten teeth removed and this research confirms that snacking on sugary foods and drinks is the key contributing factor.
"It is clear that tooth brushing with a fluoride toothpaste alone is not the magic wand that many people still believe it to be and preventing tooth decay also has to involve changing diet and lifestyle.
"Almost every single one of these operations, and the pain and suffering associated with them, could have been prevented with effective behaviour changes to help protect children's oral health.
"Snacking throughout the day on sugary foods and drinks means that children's teeth come under constant attack from acid and can quickly lead to severe problems.
"Children's snacking should be limited to no more than two a day and unhealthy sugary snacks should be replaced with healthier foods such as fruit and vegetables.
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"Even though a child's first set of teeth is temporary the oral health behaviour children learn early on they take into the rest of their lives, so it is vital that they get into good habits as early as possible."
Dental decay happens when the enamel and dentine of a tooth become softened by acid attacks after eating or drinking anything containing sugars. Over time, the acid makes a cavity (hole) in the tooth. ‘Dental decay' is the same as tooth decay and is also known as ‘dental caries'.
The study authors also identified parental socioeconomic factors, such as education levels, as a more important factor on children's dental decay than diet or oral hygiene.
Social scientists from the University of Edinburgh and the University of Glasgow used statistical models and survey data to predict dental decay by age 5. They used data collected on diet and oral hygiene from repeated observation of children from ages two to five.
They identified that children who brushed less than once per day, or not at all at age two, had twice the chance of having dental decay at age five compared with children who brushed their teeth twice per day or more often.
Lead researcher Dr Valeria Skafida, of the University of Edinburgh's School of Social and Political and Sciences says restricting sugar intake is desirable both for broader nutritional reasons and for children's dental health.
Dr Skafida said: "Even with targeted policies that specifically aim to reduce inequalities in children's dental decay it remains an ongoing challenge to reduce social patterning in dental health outcomes."
Study co-author, Dr Stephanie Chambers, of the MRC/CSO Social and Public Health Sciences Unit at University of Glasgow said: "Among children eating sweets or chocolate once a day or more, tooth brushing more often - once or twice a day or more - reduced the likelihood of decay compared with less frequent brushing."
The research was supported by The British Academy, the Medical Research Council and the Chief Scientist Office of the Scottish Government Health Directorates.
1. V Skafida, S Chambers; Positive association between sugar consumption and dental decay prevalence independent of oral hygiene in pre-school children: a longitudinal prospective study, Journal of Public Health, https://doi.org/10.1093/pubmed/fdx184