Wednesday Wisdom

January 19, 2022

Tooth Trouble

By Dr Cassie Rhodes

Tooth Trouble


It’s that time of year again, when my children and I troop off to see the dentist for our six-monthly check and clean (though I must admit that our appointments are a smidgen late due to an overpacked schedule before the holidays).

I’ve been thinking about teeth a lot lately because it is high on the agenda of the many schools that I work with. The government has recognised that oral health is a crucial issue and, as of 2020, both primary and secondary schools are required to teach pupils about dental hygiene and the importance of regular check-ups.

I was shocked to realise that, rather than tonsillitis, or any other common infection or virus, tooth decay is the most common reason for non-emergency hospital admissions in British children aged between five and nine. In addition, tooth extraction is actually the most common hospital procedure in six to ten year olds in England. Generally, our oral health is improving, but Public Health England’s most recent oral health survey revealed that, in 2019, 23% of children aged five had tooth decay. We know that almost 90% of hospital tooth extractions among the under-fives are caused by preventable tooth decay. What’s more, sadly, children from the most deprived areas of the country have more than twice the level of decay as those from less deprived areas.

Problems with teeth don’t only affect children’s mouths. Anyone who has ever experienced the horrors of toothache will know that the pain is intense and can impact on all areas of life. Public Health England data shows that tooth decay is causing a significant number of children to have problems with eating, sleeping (38% of children with tooth decay had sleepless nights due to the pain), communication and socialising, and results in an average of three missed days of school per affected child.

Tooth decay isn’t inevitable and we should be doing all we can to prevent it. So, what can we do at home?


We all know that cleaning our teeth twice a day is important, but what’s the most up to date guidance?

It’s simple really. Start brushing with a fluoride toothpaste as soon as children get their first baby tooth. They will need help with brushing until the age of seven (the two-toothbrush technique can work with young children – one with no toothpaste on for them and one with toothpaste for you to do the actual cleaning). There are lots of different brushes available, but the Oral Health Foundation notes that the most important thing is to use a small-headed toothbrush, suitable for the age of your child. Brush before breakfast, rather than after, and again before bed. Toothpaste being ‘too minty’ is a common complaint in my household, but there are flavourless or fruity options to suit all tastes.

We’ve all heard the old adage about ‘an apple a day’, but it’s important not to underestimate the importance of diet in preventing tooth decay. Did you know that our teeth will fare better if we avoid sugary snacks between mealtimes? Dentists advise that children’s teeth are actually much safer when sugary foods are eaten at mealtimes. So, try to keep snacks healthy and low in sugar (fresh fruit, veg, oatcakes or crackers, toast, cheese) and save the sweet stuff for pudding. Water or milk are the most tooth-friendly drink options.

It’s not uncommon for children to feel anxious about visiting the dentist and this is something we should seek to minimise. One of the best ways to combat this is to make it part of your regular routine from a very early age. It’s recommended that babies should visit the dentist for the first time as soon as they get their first tooth, so from about six months old (on average). The sooner children get into the swing of having their mouth checked, the better. Normalise oral health by making teeth cleaning part of your twice daily routine, taking them along to your regular dental check-ups, reading books about teeth and talking about the importance of looking after them in everyday life.

For children who already feel wobbly, it’s important to find a patient and supportive dentist. Familiarity can help, so try to drop into the practice with your child in advance of any actual appointments. Some children might find the big chair scary. Thankfully, most dentists will happily check your child’s teeth whilst they are on a normal seat in the corner, or whilst they are sitting on your knee. Be consistent with your choice of dentist and attend appointments regularly. Help children to manage feelings of fear by acknowledging them, but try to coach them through these emotions, rather than soothe or reassure. Ask them what they are worried about, or what they think might happen, and then encourage them to look for evidence to establish whether their fear is justified.

Children with particular neurodevelopmental conditions may face additional challenges. Recently I have spoken with the parents of an autistic child who struggles to set foot into the dentist’s clinic. Try to talk to your dentist about any additional care that your child might need and let them know if your child has any sensory requirements. This particular family was able to arrange a non-clinical appointment, where their child could come to the surgery during quieter hours for a look around and to familiarise himself with the room and the dental equipment. Getting the first appointment of the day may be a good idea in general for children with sensory difficulties.

Parents of children with autism may also benefit from the excellent advice given by The British Society for Paediatric Dentistry to help with oral health at home. Moreover, If your dentist doesn’t have much experience with autistic patients, consider sharing the Autism Society’s ‘guidance for dentists’ with them.

Whilst much of the available advice focuses on establishing good oral hygiene habits when children are young, we mustn’t forget older children and teens. A recent study found that 58% of children aged 12 and 45% of 15-year-olds reported that their daily life had been impacted by oral problems in the last three months. Sadly, this was most commonly due to feeling too embarrassed to smile or laugh because of how their teeth made them feel, followed by difficulties eating and with teeth-cleaning.

Lots of these issues could easily be prevented by regular dental visits and teeth cleaning from a young age. But many of our teens also have orthodontic procedures to straighten or move teeth. These can be lengthy and may involve adjustments to cleaning, daily routines and changes to their appearance. Talk with your teens honestly about any treatments that your dentist recommends and seek factual information about how they might improve the long-term health of their teeth, gums and jaw joints. If your teen’s self-esteem is being knocked by the state of their smile, remind them of the long-term benefits and do all you can to boost them up in other ways.


Cultivating healthy habits from an early age is crucial when it comes to oral health. Unlike sharks, we only ever get two sets of teeth (did you know that bull sharks have up to 50 rows?), so helping our children learn to care for them is absolutely vital.

We want teeth cleaning to be a twice daily habit; something that children don’t question, and which simply becomes a normal part of their everyday routine.

If you have a young child and find that their teeth-cleaning motivation regularly wanes, we’d recommend checking out HaBox. Started by two dentists (who are also parents), they offer a subscription service tailored to children’s age, which is designed to form positive dental-care habits. Children receive a teeth-cleaning box every three months (who doesn’t love a parcel?). The content varies to maintain their interest, but will always contain at least one toothbrush, enough toothpaste for three months and lots of information and fun, supportive, evidence-based resources, and goodies (like timers and games) to make cleaning their teeth more appealing. It’s also well worth following them on social media, for their top tips and handy information.

Parents and teachers wanting more information and resources about keeping children’s teeth in tip top condition can also check out The Oral Health Foundation, and download their Dental Buddy resources; a programme for early years and primary aged children, developed by dentists, designed for both home and school use.

Are you a Tooled Up member?

Keen to do all we can within Tooled Up to help our schools, in addition to highlighting the resources above, we are making our own video resources and tip sheets on dental hygiene for younger children (we’ve already created a list of relevant books), and are seeking an enthusiastic 3-5 year old who would like to kick-start their acting career. If interested, contact us: If any of our Tooled Up parents happen to be dentists in the London or South East of England, and would like to offer up their surgery for filming, do let us know. We would love to hear from you. We can all make going to the dentist part of our 2022 plans. Why not add it to our new goal planner?

And finally, we’ve added a new feature to the Tooled Up website this week. It is designed to help you find the resources that you need more quickly. Can you spot it? Let us know if you can – the first person to email the correct answer will win a Tooled Up water bottle.