Department of Health and Social Care
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Almost 9 out of 10 child hospital tooth extractions due to decay

PHE is encouraging parents to swap children's sugary foods and drinks for healthier alternatives and protect children’s teeth by using fluoride toothpaste.

Almost 9 out of 10 hospital tooth extractions among children aged 0 to 5 are due to preventable tooth decay, according to data published by Public Health England (PHE) yesterday.

Although the oral health of children is improving, significant inequalities remain and tooth extraction is still the most common hospital procedure in 6 to 10 year olds.

Tooth decay can cause problems with eating and sleeping, and results in at least 60,000 days being missed from school during the year for hospital extractions alone. Tooth decay could be prevented by cutting down on sugar and practicing good oral hygiene.

While children’s sugar intakes have declined slightly in recent years, they are still consuming the equivalent of around 8 sugar cubes more than the recommended daily limit – often eating 11g just at breakfast. Consuming too much sugar can lead to an increased risk of obesity and illnesses such as type-2 diabetes.

Change4Life is encouraging parents to ‘Make a swap when you next shop’ and switch to lower sugar alternatives to help reduce their children’s sugar intake from some everyday products, such as sugary drinks, yogurts and breakfast cereals.

PHE’s Change4Life campaign is encouraging parents to:

  1. Swap sugary drinks and snacks such as split-pot yoghurts for lower or no sugar alternatives, including lower-sugar yoghurts or no-added sugar juice drinks. The Change4Life website has plenty of easy ‘sugar swaps’ and helpful tips for families.
  2. Limit fruit juice and smoothies to a total of 150ml per day and only consume with meals – they count as a maximum of one portion of our 5 A Day.
  3. Ensure children brush twice a day with fluoride toothpaste (once before bedtime and once during the day) and remind them to ‘spit not rinse’, as rinsing washes away the protective fluoride. Brushing should start as soon as the first tooth appears.

Taking these steps can lead to fewer days off school and fewer trips to the dentist, although children should go as often as their dentist recommends.

Dr Sandra White, Dental Lead for Public Health England, yesterday said:

Children are consuming far too much sugar each day, and this can have a very serious impact on their oral health.

Parents can help reduce their children’s sugar intake by making simple swaps when shopping and making sure their children’s teeth are brushed twice a day with fluoride toothpaste. Small, consistent changes like these can have the biggest impact on children’s teeth.

Parents can also use the Change4Life ‘Food Scanner’ app when shopping in order to see the sugar, salt and saturated fat content in food and drinks and make healthier choices easier.

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  1. See the new PHE oral health data published yesterday.
  2. There were 59,314 tooth extractions in 2017 to 2018 (38,385 extractions because of tooth decay). In 2016 to 2017 the total number of tooth extractions was 61,301 (39,010 extractions because of tooth decay).
  3. Among 0 to 5 year olds there were 14,545 tooth extractions in 2017 to 2018 (12,783 because of tooth decay). In 2016 to 2017 the statistics were for 0 to 4 year olds, not 0 to 5 year olds so cannot be directly compared. More details in published tables.
  4. Although the total actual numbers of tooth extractions has decreased slightly since last year, the percentage of extractions as a proportion of the population has remained the same as in previous years (0.3% of the 0 to 19 year old population).
  5. Children’s oral health is improving with 77% of 5 year old children in England now free of obvious decay. Children from deprived areas have more than twice the level of decay (34%) than those from the least deprived areas (14%).
  6. Tooth decay can be largely prevented by reducing consumption of sugar in food and drink, adequate exposure to fluoride, and routine visits to the dentist.
  7. PHE has set up the Children’s Oral Health Improvement Programme Board bringing together over 20 stakeholder organisations with leadership roles for children and young people, sharing the ambition that every child should grow up free from tooth decay.
  8. At a community and population level, PHE recommends both water fluoridation and supervised toothbrushing as evidence-based and effective measures for reducing dental caries and inequalities.
  9. The childhood obesity plan contains measures to reduce sugar consumption which will have a positive effect on improving children’s oral health.
  10. Change4Life has developed a new set of lesson plans which help primary school children to understand the effects that sugar has on their teeth using a cartoon-themed Science lesson plan Tilly the Tooth.
  11. Apart from fruit juice, which counts as one of our 5 A Day, the 10 main sources of sugar in children’s diets are:
  • sugary soft drinks (including squashes, juice drinks, energy drinks, cola and other fizzy drinks) – 10%
  • buns, cakes, pastries and fruit pies – 10%
  • sugars, including table sugar, preserves and sweet spreads – 9%
  • biscuits – 9%
  • breakfast cereals – 8%
  • chocolate confectionery – 7%
  • sugar confectionery – 7%
  • yoghurt, fromage frais and other dairy desserts – 6%
  • ice cream – 5%
  • puddings – 4%

Additional quotes from public health professionals at PHE’s Healthy Schools conference

Jade Morris, Public Health Nutritionist, Health Promotion Coordinator at Healthbox CIC, yesterday said:

Sugar is a huge issue for schools and public health. Children are often unaware of just how much sugar they are consuming and the fact they are significantly over their recommended sugar limit.

Education and encouraging healthier sugar swap messages is key to raising awareness about this issue and helping children reduce their sugar intake at school and at home.

Sarah Howe, Oral Health Practitioner and School Programmes Manager at Healthbox CIC, yesterday said:

We know that sugar plays a huge part when it comes to poor oral health, so when we talk about sugar intake and swapping to lower-sugar foods and drinks it is really important that we make the connection between nutrition and oral health.

What we are asking is to look carefully at what young people are eating and drinking and to swap to healthier and lower-sugar alternatives. From an oral health perspective, keep sugary foods and drinks to mealtimes only. That is the big take-home message from my point of view.


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