Why is there a children's oral health epidemic - and what can we do?

The state of children’s oral health in England has once again come under the spotlight, with recent studies highlighting some very worrying statistics.

According to analysis of official NHS data by the Local Government Association (LGA), there were nearly 43,000 extractions of multiple teeth in under-18’s in England during 2016/17, which equates to rotten teeth being removed from 170 children and teenagers every day.

Worryingly, these figures have increased in the past four years and it’s a sorry situation for the children who are suffering the consequences of tooth decay - which is almost always entirely preventable.

So what is fuelling the apparent epidemic of childhood tooth decay? 

Sugar and snacking

“Whilst dental access may be an issue for some families, the main driving factor behind childhood tooth decay is the sheer level of sugar that children are exposed to throughout each day,” says Henry Clover, Chief Dental Officer at Simplyhealth. “This can then be further compounded by an incomplete brushing routine.”

According to Henry, the nation’s snacking culture and the levels of sugar that manufacturers add to foods and drinks are exposing our children to a drip-feed of sugar. “Whereas we once had three square meals a day, we’ve now become a nation of grazers and we constantly snack between meals - a habit that we’ve passed onto our children,” he explains. “Having the occasional snack between meals isn’t too much of a problem if it’s a healthy choice, such as fresh fruit or vegetables, but often packaged convenience snacks are loaded with sugar. Children are also having far too many sugary drinks including fizzy drinks and juices – they should really only be having water or milk.”

Half the sugar children are having comes from snacks and sugary drinks, according to Public Health England. In its Change4Life campaign, it advises that children under 11 should have no more than two 100-calorie snacks a day (not including fresh fruit and vegetables).

“Limiting your children’s snacks to two per day is a sensible idea,” says Henry. “Every time we eat or drink something sugary, the bacteria in our mouths feed on it and produce acids that cause tooth decay. Our saliva will naturally reduce these acids within an hour, but if we’re constantly eating or drinking sugary things, our mouths never get a chance to recover from the acid attack, increasing the chances of dental decay.”

Henry advises that, if you have children, it’s helpful to take a step back and look at when they ask for snacks and why we offer them. According to YouGov research conducted for Simplyhealth1, 41% of parents admit to giving their child sugary food or drink as a bribe or reward for good behaviour. 

“Are they really hungry, or are they just bored or thirsty?” he says. “Children often confuse thirst for hunger, so it’s worth offering them lots of water in a fun bottle or cup and encourage them to keep hydrated throughout the day. Also, do we offer snacks to toddlers and young children because it sometimes makes life easier for us? Completely understandably, parents often leave the house armed with convenient snacks to avoid a potential toddler meltdown, but are they really hungry or is it something we offer to soothe them? Before your child learns to talk, it’s really hard to know if they’re truly hungry or not, so it can help to have a range of distraction techniques such as toys, songs and activities while you’re out, and not always assume they need a snack if they’re getting restless. If they do need a snack, fresh fruit or vegetables are ideal.”

Some tooth-friendly snacks of 100 calories or less include:

  • Fresh fruit
  • Vegetables and lower-fat hummus
  • A small portion of cheese (e.g Babybel)
  • Plain rice cakes or crackers
  • A hard-boiled egg
  • A small portion of nuts (if age and allergy appropriate)
  • Toast with Marmite, cream cheese or sugar-free peanut butter


“It’s a common misconception for parents to think that it’s ok for their children to have lots of sugary things as long as they have a good brush afterwards,” says Henry. “Brushing twice a day for two minutes with a fluoride toothpaste is a hugely important part of preventing childhood tooth decay, but it can only protect teeth up to a point if the child is also exposed to a drip-feed of sugar throughout the day.”

A recent study from Edinburgh and Glasgow universities2 on nearly 4,000 pre-school children found that snacking habits are most strongly associated with tooth decay, and that relying on tooth-brushing alone to prevent decay is not enough. They found that children who snacked all day, compared with those who just ate meals, were far more likely to have tooth decay. At age two, children who brushed less than once a day or not at all doubled their chances of tooth decay at age five compared with children who regularly brushed their teeth twice a day or more.

Regular dental visits

According to Henry, it’s never too early to take your child to the dentist – and it’s important to visit as often as your dentist recommends.  “It’s best to take your child for their first dental appointment when their baby teeth start to appear, which is usually around six months of age,” he says. “Taking your child to the dentist from an early age helps to get their dental routine off to a positive start. They can get used to the sights, sounds and smells of a dental practice and get to know the team. Also any dental problems, such as tooth decay, can be more easily spotted and treated early on before they need more invasive treatment.”

Next steps

“We need to take action and prevent the next generation of children suffering the same consequences of the current childhood tooth decay epidemic,” says Henry. “We really need to help families to make the right food and drink choices and significantly cut back on sugar consumption, as well as understanding the importance of a proper oral health routine.”

In 2017, Simplyhealth announced an exciting new partnership with national child dental health improvement programme, Teeth Team, providing school children with support, information and advice about how best to look after their teeth. Simplyhealth invested £137,000 into the partnership, enabling Teeth Team to further expand the initiative across the country, supporting thousands of children in nursery and primary schools, including a focus on those who are in greatest need in the most socially deprived areas, where the risk of dental disease and dental neglect is highest.


1. YouGov online survey conducted for Simplyhealth. Total sample size was 4,353 adults. Fieldwork was undertaken from 25th January to 2nd February 2017. Figures have been weighted and are representative of all UK adults (aged 18+).

Children's Oral Health Epidemic