Pregnancy and child

High levels of tooth decay found in three-year-olds

"Tooth decay affects 12% of three-year-olds, says survey," BBC News reports. The survey, carried out by Public Health England, found big variations in different parts of the country. Experts believe sugary drinks are to blame for this trend.

The survey looked at the prevalence and severity of tooth decay in three-year-old children in 2013. This is the first time the dental health of this age group has been surveyed nationally. It found 12% of children surveyed had tooth decay – more than one in eight children.

Tooth decay (also known as dental decay or dental caries) occurs when a sticky acidic film called plaque builds up on the teeth and begins to break down the tooth's surface. A diet high in sugar can help stimulate the production of plaque.

As it progresses, tooth decay can cause an infection of underlying gum tissue. This type of infection is known as a dental abscess and can be extremely painful.

Who produced the children's dental health report?

The survey and subsequent report was produced by Public Health England (PHE), part of the Department of Health. PHE's role is to protect and improve the nation's health and wellbeing, and reduce health inequalities.

This survey of the prevalence and severity of tooth decay in three-year-olds was performed to help identify which age group interventions to improve tooth decay should be aimed at.

What data did the report look at?

The report looked at the prevalence and severity of dental decay in three-year-old children in 2013. At three years of age most children have all 20 milk teeth (also known as primary teeth).

PHE randomly sampled children attending private and state-funded nurseries, as well as nursery classes attached to schools and playgroups. The children's teeth were examined to see if they had missing teeth, filled teeth or obvious signs of tooth decay.

What were the main findings of the report?

Of the 53,814 children included in the survey, 12% had dental decay. Of the children with dental decay, on average these children had at least three teeth that were decayed, missing or filled.

Across all the children included in the survey, the average number of decayed, missing or filled teeth was 0.36 per child.

The report found a wide variation in the levels of decay experienced by three-year-old children living in different parts of the country. The four regions with the most dental decay were:

  • the East Midlands
  • the north west
  • London
  • Yorkshire and the Humber

What are the implications of the report?

Where there are high levels of tooth decay among three-year-olds, Public Health England wants earlier interventions to target this younger age group, rather than waiting until the age of five (when these interventions usually take place).

Where there are high levels of tooth decay found in the primary incisors (a condition known as early childhood caries), PHE wants local organisations to tackle problems related to infant feeding practices.

Early childhood caries are associated with young children being given sugar-sweetened drinks in a bottle – especially when these are given overnight or for long periods of the day.

Where tooth decay levels increase sharply between the ages of three and five, PHE wants local organisations to tackle this by helping parents reduce the amount and frequency of sugary food and drinks their children have, as well as increasing the availability of fluoride.


There are two important steps you can take to protect your children's teeth against tooth decay:

  • limit their consumption of sugar, especially sugary drinks
  • make sure they brush their teeth at least twice a day with fluoridated toothpaste


Sugar causes tooth decay. Children who eat sweets every day have nearly twice as much decay as children who eat sweets less often.

This is caused not only by the amount of sugar in sweet food and drinks, but by how often the teeth are in contact with the sugar. This means sweet drinks in a bottle or feeder cup and lollipops are particularly damaging because they bathe the teeth in sugar for long periods of time. Acidic drinks such as fruit juice and squash can harm teeth, too.

Don't fall into the trap of thinking that a fruit juice advertised as "organic", "natural" or with "no added sugar" is inherently healthy. A standard 330ml carton of orange juice can contain almost as much sugar (30.4g) as a can of coke (around 39g).

As Dr Sandra White, director of dental public health at PHE, points out: "Posh sugar is no better than any other sugar … our key advice for [children] under three is to just have water and milk."

Tooth brushing

A regular teeth cleaning routine is essential for good dental health. Follow these tips and you can help keep your kids' teeth decay free:

  • Start brushing your baby's teeth with fluoride toothpaste as soon as the first milk tooth breaks through (usually at around six months, but it can be earlier or later). It's important to use a fluoride paste as this helps prevent and control tooth decay.
  • Children under the age of three can use a smear of family toothpaste containing at least 1,000ppm (parts per million) fluoride. Toothpaste with less fluoride is not as effective at preventing decay.
  • Children between the ages of three and six should use a pea-sized blob of toothpaste containing 1,350 to 1,500ppm fluoride. Check the toothpaste packet for this information or ask your dentist.
  • Make sure your child doesn't eat or lick the toothpaste from the tube.
  • Brush your child's teeth for at least two minutes twice a day, once just before bedtime and at least one other time during the day.
  • Encourage them to spit out excess toothpaste, but not to rinse with lots of water. Rinsing with water after tooth brushing will wash away the fluoride and reduce its benefits.
  • Supervise tooth brushing until your child is seven or eight years old, either by brushing their teeth yourself or, if they brush their own teeth, by watching how they do it. From the age of seven or eight they should be able to brush their own teeth, but it's still a good idea to watch them now and again to make sure they brush properly and for the whole two minutes. 

NHS Attribution