How healthy snacks ruin children’s teeth
London – When three-year-old Sophia Lister started complaining that the back of her jaw was hurting, her mother assumed the little girl’s adult molars must have started to come through.
“I gave her some Calpol to help her sleep and waited for the pain to go,” says Solveig, 40, who works part-time as a financial director and is married to Chris, 43, an insurance underwriter. But the pain didn’t ease, so two days later she took Sophia to the dentist.
“I nearly fainted when he told me that Sophia had serious decay in her baby teeth,” she recalls. “I hadn’t even noticed. I was mortified. She needed root canal work on one of her back teeth and fillings in three more. I kept thinking I must be a terrible mother to have let this happen.”
But Solveig isn’t the only middle-class mom horrified to discover her young child has severe tooth decay – a condition more commonly associated with children living in poverty.
According to new figures from the Health and Social Care Information Centre, almost 26 000 children in England aged between five and nine have been hospitalised for multiple tooth extractions in 2013-14 – that’s the equivalent of almost 500 a week.
Removal of rotten teeth is now the primary reason children in this age group are admitted to hospital. In some cases, dentists have no choice but to remove all 20 baby teeth from their young patients.
And those from comfortable lifestyles are at just as much risk as youngsters from disadvantaged backgrounds – with middle-class parents feeding their children so-called “healthy” snacks that cause more damage than junk foods, and working moms often too busy to take their children for check-ups.
The legacy can be far more serious than just a phobia of going to the dentist.
“The best predictor of adult tooth decay is dental health at the age of five,” says Dr Mervyn Druian, a dentist who specialises in cosmetic dentistry and reconstruction. “It’s not something that disappears when your baby teeth fall out.”
Dr Nicole Sturzenbaum, of Toothbeary Richmond, a private surgery in one of London’s wealthiest boroughs that caters exclusively for the under-18s, has seen a steady increase in the number of children needing extensive dental work to save baby teeth since it opened in 2008.
According to Dr Sturzenbaum, part of the problem is that parents think they are giving children “healthy” foods and drinks, but it is these that can cause the most damage.
“Parents don’t realise that fruit juices contain more sugar than cola,” she says. “And many so-called healthy snacks are packed with sugar, too.”
It’s a trap that Solveig, from Haslemere in Surrey, admits she fell into with Sophia, who is now five. While she never let her little girl have sweets, she was happy to let her have apple juice in a “sippy cup” beaker.
Cavities are caused by two factors: decay, which occurs when bacteria in the mouth react with sugar, causing acids to form that soften and dissolve enamel; and acid erosion, which happens when acid in food or drink comes into direct contact with enamel.
Although enamel on baby teeth is as hard as enamel on adult teeth, the layer is thinner, making children’s teeth more vulnerable.
Dr Sturzenbaum says that “sippy cups” containing juice are a short cut to dental decay. “Sipping on apple juice all day bathes your teeth in acid soup,” she says. “It’s doubly damaging because it’s both sugary and acidic.”
It immediately made sense to Solveig: her son, who is 11, has no cavities – but he has always preferred to drink water.
She also admits she wasn’t as strict about dental check-ups as she might have been. Current advice is that a child should see a dentist at least once a year.
“I assumed Sophia’s baby teeth would not cause too much trouble and that she could wait until she was older to go regularly to the dentist,” Solveig says.
“We did take her to the dentist after her teeth came through, but not often enough. Time flies by, and there’s always work or school commitments getting in the way.”
Then there are the dried fruit snacks – raisins, mango, apricots and the like – beloved by middle-class moms as a “healthy” alternative to biscuits and crisps.
Dr Nigel Carter, chief executive of the British Dental Health Foundation, says they are a significant problem. “Raisins are supposed to be healthy – one of your five-a-day – but they are concentrated forms of fructose, or fruit sugar, which reacts with bacteria in the mouth to create acid.
“They are sticky and cling to the space between the teeth, sometimes for an hour or more, all the time causing potential damage.”
This is something that stay-at-home mom Clare O’Reilly, 35, from Plymouth, is all too aware of.
While her eldest child Eddie, ten, and youngest, Annie, three, have had no problems, five-year-old Sammy first needed fillings at the age of three. Then, when he was four, he developed severe toothache as a result of an abscess beneath a decaying molar.
His dentist carried out an emergency extraction under local anaesthetic. Since then, Sammy has had another molar removed.
Clare says she always assumed she was doing the right thing with Sammy by encouraging him to eat lots of fruit and vegetables as a baby – and using sweet fruit to mask the taste of vegetables.
“I’d make him sweet potato and apricot, or stewed apple and spinach – and pat myself on the back believing he was getting the most nutritious food I could offer.”
As a toddler, he liked fresh strawberries and mango, and he loved munching raisins while out and about in his pushchair.
At the age of two, Clare took him to the dentist for the first time. “The dentist told me he’d got ‘pretty bad teeth’ and asked what I was feeding him,” she recalls. “When I mentioned raisins, he told me I might as well be feeding him sugar cubes.
“Although I stopped him eating dried fruits straight away, Sammy continued to snack on fresh fruit – though I’ve recently stopped this, too. And I won’t give him flavoured fromage frais now, because that’s packed with sugar.”
She points out that many “healthy” savoury snacks, such as breadsticks, wholemeal bread and bagels, also contain hidden sugar.
Dr Carter says that it’s not just the snacks themselves but the snacking habit that is dangerous.
“We’ve gone from three square meals a day to six or seven snacks,” he says. “This means that teeth are constantly bathed in acid – giving no time for saliva to neutralise it and let the enamel recover.”
Milk is another culprit. While many parents assume cow’s milk is a wholesome drink, it too contains a type of sugar: lactose. Formula milks for children aged from one year upwards also contain added sugar.
Decay is a particular problem if the milk is in contact with the teeth for extended periods.
There is even a condition called “bottle cavities” which develops because a child is left to constantly suck on a bottle of milk (usually to stop them crying).
While people tend to assume that because they’re “just baby teeth” they don’t matter, experts say the outcome can be a lifetime of poor dental health.
Dr Druian, who is based in North London, says it’s not just that bad habits are set for life, but if a type of bacteria that leads to cavities gets a foothold in childhood, it can ruin a child’s smile for life.
“There is an overlap period between the ages of five and nine when baby teeth and adult teeth exist in the mouth together,” he explains. “So bacteria from decaying baby teeth will get to work on the adult teeth, too.”
So what can parents do to stop their children developing cavities at such a young age?
“Proper tooth brushing, twice daily with a toothpaste containing fluoride, is vital,” says Professor Raman Bedi, dental public health consultant at King’s College London and chairman of the Global Child Dental Fund.
Dr Sturzenbaum advises parents to give children water rather than fruit juice, and to cut down on snacking. She also says that parents have to take responsibility for brushing their children’s teeth until at least age eight. Brushing should last at least two minutes twice a day, and she recommends that children floss from around the age of four. – Daily Mail