Public policy must do more to confront tooth decay and childhood obesity, according to the British Society for Paediatric Dentistry (BSPD), especially as these conditions are more common among underserved families.
The BSPD is calling for coordinated, multi-agency approaches to managing obesity and tooth decay including the support of dietary changes that are age-appropriate, affordable, culturally sensitive, and consistent with healthy eating advice as well as clearer food labeling.
Plus, the BSPD said it supports healthy lifestyle campaigns such as those led by Change4Life in England and Wales and the Eat Better, Feel Better initiative in Scotland.
The BSPD also is asking the United Kingdom’s government to develop measures to halve the prevalence of childhood obesity by 2030 such as the soft drinks sugar levy and restrictions on the advertisement of unhealthy food and drinks, particularly high-sugar products.
Common risk factors for childhood obesity and tooth decay are socioeconomic, genetic, biological, and environmental, with diet playing a prominent role, the BSPD said. Also, children and young people consume up to three times more sugar than recommended, the BSPD said.
Tooth decay is the most common oral disease affected children and young people in the United Kingdom, the BSPD said, disproportionately affecting children and young people from areas with non-fluoridated water as well as those from more deprived backgrounds.
By the numbers, according to the BSPD:
- 5-year-olds from deprived areas in England had more than twice the level of decay (34%) than those from the least deprived areas (14%)
- 40% of 5-year-olds in Northern Ireland had obvious tooth decay
- 26.5% of 5-year-olds in Scotland had obvious tooth decay
- In Scotland, 44% of children from deprived areas had obvious tooth decay, compared to 14% from the least deprived communities
Frequent consumption of sugary food and drink is the main cause of tooth decay among children, the BSPD said, and tooth decay in childhood also predicts future tooth decay.
Untreated decay additionally can lead to a wide variety of functional, social, and psychological impacts in children, negatively affecting their quality of life, cognitive development, and growth, the BSPD said. Dental pain also can lead to disturbed sleep, school absences, difficulty eating, emotional difficulties, and wider family impacts, the BSPD said.
In England, approximately 41,558 children age 16 and under were admitted to hospitals in 2018 and 2019 with a diagnosis of tooth decay, making it the most common reason for children to be admitted to a hospital, the BSPD said.
The estimated annual cost to the National Health Service for dental extractions for children under the age of 19 in hospitals was £50.5 million in 2015 and 2016, the BSPD said.
In 2015, Public Health England (PHE) found an emerging pattern of increasing prevalence or severity of dental caries among underweight and overweight children. While dental caries have declined since 2015, the BSPD said, obesity levels have remained unchanged.
A 2019 PHE analysis of 67,033 5-year-olds also found an association between weight and tooth decay prevalence and severity, even when other potential influences such as deprivation were considered.
Overall, children who were underweight, overweight, or very overweight were more likely to have experienced tooth decay than those of a healthy weight, the BSPD said. When ethnicity, water fluoridation, deprivation were controlled for, the likelihood of experiencing dental caries was significantly higher for those children who were overweight and very overweight.
The PHE also found a specific association in children who were underweight, overweight, or very overweight and tooth decay in their primary dentition. Pain in primary dentition can affect optimal food intake, leading to between-meal hunger and then frequent snacking and sugary drinks in younger children. These foods have low nutritional value, the BSPD said, which can lead to failure to thrive and possibly contribute to being underweight or overweight.
Additionally, the BSPD said that the latest evidence suggests an association between underweight, overweight, and very overweight children and tooth decay in their permanent dentition when standardized definitions for the assessment of childhood obesity are used, with tooth decay more common in obese children than in those of normal weight.
Older children who are overweight or obese often frequently eat and are more likely to experience tooth decay, the BSPD said, though childhood obesity and tooth decay are multifactorial diseases with potentially numerous shared risk factors as well as diet.
Noting the higher prevalence of obesity and tooth decay among more deprived areas of the population, the BSPD said that there are widening health inequalities related to socioeconomic status alongside broader social and commercial determinants such as marketing and advertising influences.
And while the Eatwell Guide outlines the government’s recommendations for a healthy diet, the BSPD said, more than half of UK households’ current food budgets are unable to meet these recommendations, potentially increasing the risk of excess weight and tooth decay. Children in poverty are most likely to experience tooth decay and obesity and have poorer access to healthcare, the BSPD said.
The BSPD, then, said it welcomes the Green Paper Advancing Our Health: Prevention in the 2020s, chapter 3 of the Childhood Obesity Plan, Change4Life Sugar swaps, and the Eat Better, Feel Better initiative, as well as:
- The Action on Sugar campaign
- The Kind to Teeth campaign
- The NHS Eatwell Guide, with considerations of affordability
- The Soft Drinks Sugar Levy and Sugar Reduction Programme
The BSPD said it is keen to work within a healthcare system where:
- All clinicians have a responsibility toward the overall well-being of their patients
- Collaborative patient care is supported and encouraged
- Referrals are made to providers or specialists with optimum training and skills for diagnosis and treatment
Also, the BSPD encourages pediatric dentists to have conversations with children and their families about healthier weight and to be proactive within local teams to ensure that children below and above a healthy weight are accurately and sensitively identified and referred to local dietetic services for support.
Overall, the BSPD said it supports calls for a coordinated approach to clearer food labeling and further sugar reduction in food and beverages frequently consumed by children. The BSPD also supports close liaisons with dieticians and networks established in weight management programs to facilitate appropriate referrals and to raise awareness of common risk factors.
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