As parents, we are very aware of the need to educate our children about dental hygiene but how often does this extend beyond twice daily brushing? And are you really aware of what damage is done to their teeth throughout the day? In a recent survey of 286 dentists undertaken by the British Dental Health Foundation, sugary drinks were identified as the most significant factor in children’s tooth decay.

In the second half of 2008 there were 1.27 million fillings in children’s teeth in England and Wales.

According to the British Dental Health Foundation, foods and drinks containing sugar cause tooth decay, and drinks such as citrus fruit juices and all fizzy drinks can be harmful if taken often and in large amounts. Tooth decay and enamel erosion results in pain, discolouring, sensitivity and decay. Dentist-favoured alternatives are water or milk, because even fruit juices and squashes consumed in between meals can have a negative effect on teeth.

It is important to educate that a balance needs to be struck, but if they have already been exposed to sugary drinks, how can you help change their perceptions – and their habits?

The Natural Hydration Council believes children should be educated in the healthier alternatives and is supporting the British Dental Health Foundation’s National Smile Month campaign. ‘Teeth4life’ runs from 16^th May to 16^th June 2010 and is aiming to raise awareness of good dental practices.

So if you need some advice, log onto our live webTV show where Dr Nigel Carter, Head of the British Dental Health Foundation, will be offering his top tips on keeping your children’s teeth healthy, and exposing just how much damage their favourite sugary drinks could be doing.

Dr Nigel Carter joins us live online at www.studiotalk.tv on Monday 24^th May at 4.30pm to discuss healthy teeth

For more information visit www.nationalsmilemonth.org

National Smile Week Webchat

H: Lis Speight, host

A: Dr Nigel Carter, head of British Dental Health Foundation

H: Hello. Now we all know the importance of our family brushing their teeth twice a day, but how many of us are fully aware of the consequences of drinking citric fruit juices, fizzy drinks and smoothies?

Titles

H: Hello and welcome to Health and Wellbeing, I'm Lis Speight. Now then as parents we are very aware of the need to educate our children about dental hygiene, but how often does this extend beyond brushing twice a day? In a minute we'll be meeting our guests but coming up on today's show – when drinking the wrong kind of drinks can leave your mouth looking like this, tips and hints on how to get your kids caring for their mouths. And answers to your questions on how to get your teeth looking like these. Well to discuss this and much more I'm joined in the studios by the head of the British Dental Health Foundation, Dr Nigel Carter, welcome along Nigel, really nice to see you

A: Good to see you

H: Now don't forget this is a live show so if you have any questions or comments for Nigel then please use the box on your screen and press click, and submit your question, it will come through to us here in the studio and we'll try to get through as many as we can. But we'll start with a bit of a shocking statistic actually because in the second half of 2008 there were over a million fillings in children's teeth in England and Wales, that's incredible and you believe that much of this is down to the consumption of sugary food and drinks don't you Nigel?

A: Well we have got a lot better over the last 30-40 years and that's been down to the addition of fluoride in toothpaste

H: Right

A: But we think we're now seeing rates of decay, particularly in under 5s beginning to increase again

H: That's depressing actually isn't it?

A: It really is, and it is down to frequency of sugary foods and drinks. We've turned from three square meals a day into 7-10 snack attacks

H: Right

A: Constantly sipping at those fizzy drinks, confectionary and so on, and the teeth just don't have time to recover

H: So even if you brush your teeth twice a day, if you're swilling sugar round your mouth all day, your mouth can't keep up really?

A: No, absolutely it takes about an hour from when we've had sugary food and drinks; the sugar reacts with the bacteria and the plaque that we leave on our teeth, to create acid which is the thing that causes decay. It takes about an hour, for the saliva to re-mineralise that tooth, now if we then have another attack in that time; we're going into the sort of decay cycle

H: Scary isn't it? But if our kids can't drink the sort of fizzy drinks and even the fruit juices and things, what should they be drinking?

A: Well really the two safe drinks for teeth and young people's teeth in particular are milk and water

H: Right

A: And water indeed after fizzy drinks or squashes, we would say you know that helps to dilute the acid in the mouth and causes the problem, so really get as much water in there as possible. It's also got lots of benefits for things like concentration and general hydration and health as well. We tend as a nation not to drink enough water and we should be drinking more

H: If your child has an orange juice at breakfast, get them to have some water after it?

A: We would always say with juices actually, dilute them

H: Right

A: With water, but then yes wash the effect of the acid out by having some water after the juice

H: That's a really good tip

A: It's one of the interesting things that many parents think that they're giving their children something healthy

H: Yes

A: With a fruit juice

H: Well that's it, it's all 5 a day isn't it –

A: In fact it could –

H: We know that juice is one of those

A: Healthy for the diet, getting the vitamin C in there, but quite shocking for the teeth, and that's not in terms of decay so much but also in terms of erosion. In our children\'s teeth we're seeing much more erosion and this is where the flat surfaces of the teeth gradually get smoothed over, eaten away and we can get discolouration where the yellow dentine in the centre of the tooth is showing through. So you know quite a serious problem. So fizzy drinks, fruit juices, really a no-no as far as possible

H: Right ok. Interesting stuff. Quite scary as well though really because I think a lot of people wouldn't think necessarily that apple juice or something would be bad for their teeth, but we have quite a dramatic image here which is quite an extreme case of tooth decay and gum disease. It's very dramatic but it really does happen doesn't it? Why, what would cause this sort of decay?

A: Really does happen. It varies around the country and there are some decay black spots. Northern Island, Scotland, Wales, the North West and areas of Yorkshire probably have the worst levels of childhood decay, and this really though is due – clearly there you've got a picture of a lot of untreated disease, and it is due to far too much sugar in the diet, too often. So this constant grazing on snacks rather than confining the sugary foods to mealtimes

H: Ok. We all know we should be brushing our children's teeth but we don't take so much notice of the diet really because if they have a lollipop you think well I'll be brushing their teeth later so it's ok

A: Well we know but I'm not sure that we necessarily put it into action

H: No

A: I mean it's very good to establish that routine for children early on in life, and it can be quite difficult with a young child

H: Yes

A: To get them to concentrate for two minutes. So we would say use a little egg timer or have a game that you play for two minutes to make the time go past. Because if we can establish that two minutes twice a day, we get the fluoride in there, we teach the child how to clean its teeth properly and we're going to keep that good habit for life

H: Yes

A: If in childhood we're taught that quick scrub round in 20, 30 seconds is the thing to do, that's how we're going to carry on through the rest of life, so very important, and it's surprising the number of children and adults out there that don't actually clean twice a day, only clean once a day, so first thing in the morning, last thing at night, get that fluoride in there with the fluoride toothpaste and establish that two minute habit, because as a nation we only do 45 seconds on average

H: Yes

A: So some of us are doing the two minutes, some of the power toothbrushes with timers and things on, these days to help us

H: See they're good aren't they?

A: But as a nation overall, 45 seconds

H: We're a lazy lot

A: So there's a lot of 30 seconds and less, and that just isn't good enough

H: Isn't good enough, ok, you have been warned. But what about children that have developed a sweet tooth already because kids, they love their sweets don't they, all those little jelly sweets and the lollipops and what have you – if they've already developed a sweet tooth how do you sort of get them out that, how do you develop their palette into having something different?

A: Well actually we need to go back a little bit from developing the sweet tooth. Strangely if you put a very young child in a room full of food, it will pick itself a balanced diet

H: Right

A: And it won't have a sweet tooth

H: Aah

A: So very often it is actually the parents

H: Yes. It's our fault again

A: The grandparents. Being kind, wanting to – tending to give sweets as rewards. Think about different rewards, you know, either small toys or you know a healthy snack, carrots, celery, vegetables – any of these things, they're equally acceptable to the child, but we almost brainwash the child into thinking that sweet things are good for it

H: This is a treat for you

A: If you're going to be good you're going to get a treat

H: Yes

A: And it's going to be sweet, and it's bad for the teeth

H: Yes. And what about fruit, because that's – it's a bit of a double edged sword isn't it?

A: Fruit is a little bit of a double edged sword. We would say no more than 5 of what I'm calling snack attacks a day

H: Right

A: So try and find the things around meal times, but yes get that 5 portions of fruit and vegetables a day, very important. There are fruit sugars there but they're not as damaging to teeth

H: No

A: As the sugar in confectionary and also very important to look at the labels on food because very often anything that ends in ose, so "ose"

H: Oh ok

A: We've got sucrose, maltose, lactose, fructose – these are all the sort of hidden sugars in foods

H: Right

A: Have a look at the label and see what's actually in there

H: And what about low calorie fizzy drinks, is that alright?

A: Low calorie fizzy drinks – you're still going to get the erosive problems which can be caused by some of the flavourings are still acidic so –

H: Right

A: Probably

H: So it's the acid as well as the sugar –

A: The acid as well as the sugar that we've got to look out for

H: Ok, interesting stuff

A: And not as hydrating so we're back to the message of water is best

H: And when they're at school for example, how do you sort of keep an eye on them when they're out of your –

A: Well quite difficult to do that at school, but we have of course now got rid of these awful fizzy drink vending machines in school

H: Yes

A: So you can have more control, send them off to school with their lunch box with their bottle of water or milk in there, and they will enjoy it and so on. Quite interesting studies, while the fizzy drinks machines were still in schools the companies that were providing the drinks obviously also sell bottled water, and if they replaced the fizzy drinks in the machines with water they actually sold more water in the schools than fizzy drinks, particularly when you get to adolescence, start to get acne and things like this

H: So they do know the children, don't they?

A: Children know that actually water is probably better for them

H: Well interesting stuff. Coming up in part two we'll be hearing about National Smile Month and how something called "Teeth for Life" can help your kids improve their smile

Break

H: Well welcome back and today we're talking about the health of your children's teeth and mouths, and Nigel I mentioned National Smile Month before the break, what exactly is that. It sounds lovely

A: Well we've been holding National Smile Month events now for 34 years so it's really a fun way of focusing on quite a serious topic which is the importance of our oral health, so they'll be lots of events going on all round the country, where we've got dentists clubbing together having exhibitions in shopping centres, supermarkets

H: Right

A: We'll have probably half a dozen pictures materialise of dentist's usually male dressing up as tooth fairies –

H: We like a bit of fun don't we?

A: Going into the community and getting –

H: Are you going to be dressing up as a tooth fairy?

A: I'm not going to be dressing as a tooth fairy, no

H: Ah shame!

A: Going out into the community, giving talks in schools, colleges, workplace

H: Yes

A: Really a you know time of year to focus in quite a light-hearted way on a very serious subject. The importance to us of our smile and our oral health, and two reasons for that, I mean we think about our smile being important as to how we get on with other people

H: Yes

A: Particularly really the opposite sex and friends, but it's been proven that how well you get on in your job is affected by how nice your smile looks, whether you get that promotion and indeed interview, whether you get that job in the first place

H: Yes

A: Can actually be affected by having a nice smile, so important from that point of view and then equally important for general health. We're seeing an increasing number of scientific papers being published now that are demonstrating links particularly between gum disease and things like strokes

H: Wow

A: Heart disease, diabetes, low birth weight babies. We don't quite yet understand the mechanisms but there are some definite links there

H: Yes

A: So look after your teeth, look after your gums and you're likely to have better general health as well

H: Yes. Healthy mouth, healthy you hopefully

A: Teeth for life

H: Ok. But going back to families though, what sort of tips can you give parents to help their kids have a nice smile, and a smile that's going to last?

A: Well it's going to be three key messages really. Brush twice a day, two minutes at a time as we said earlier on with a fluoride-containing toothpaste –

H: Right. Any particular toothpaste or as long as it's got fluoride in –

A: 0-3s we should be looking at 1000 parts per million fluoride

H: Right

A: And that will be on the packet

H: Yes

A: Over 3s, up to full strength adult fluoride toothpaste so 1350-1500 parts per million

H: And should they be spitting that toothpaste out or should they be swallowing it?

A: They shouldn't be swallowing it because that is what potentially can cause some problems with flurosis

H: Right so –

A: They should be spitting it out

H: So too much fluoride is a problem?

A: But not rinsing

H: Right ok

A: So we would always say spit it out, it leaves the fluoride in the mouth for longer there

H: Right

A: It's going to have maximum benefits at that time. Visit the dentist regularly, as often as they recommend and we're not quite so rigid these days on the four months for children and six months for adults

H: Right

A: So it depends on the condition of your mouth health, and you should be going where you are in the country, what you diet's like -

H: And how soon should you take your child to the dentist?

A: Ideally as soon as possible because –

H: As soon as they get their first teeth, get them used to it?

A: Well even before that, even as a baby, get them used to the environment, the sights, sounds, smells of a dental surgery, all of which can be slightly off-putting. The worst possible thing is to take the child along for their first visit when they've got to have some treatment done

H: Yes, yes, they'd never go back would they? Terrifying

A: Get them to go two or three times before anything's done

H: Yes

A: And then it's just a natural progression and a lot easier for the child.

H: I've taken my daughter, I mean she's four now, I've only taken her once I have to say because I think her teeth are pretty good, because I'm quite good at brushing, but I should take her again I know, but the first time I took her she just got in the chair and had a bit of a play around, and the dentist looked in her teeth and –

A: Very little, very little you can do at 2 / 2 ½ but the teeth are virtually through by then and you know just to have a look, sit in the chair, have a ride in the chair, have the teeth counted, it's ideal, it gets you into the environment

H: Yes ok. And last but not least, cut down on sugary snacks and drinks?

A: Absolutely, not just cut down on them but as we've said earlier on but cut down on how often you have sugary foods and drinks

H: Right ok, so throughout the day

A: Those are really our three key messages

H: Ok, so cut down on sugary foods and drinks, so should you try and have it all around in each of the meals –

A: Try and get it around the meal time and then maybe two snacks in between the three main meals. It is this constant grazing, constant snacking as a nation we're now on sort of 7-10 snacks a day

H: Yes

A: And really that means you know, if we're only up 10 / 12 hours -

H: You'd never stop eating!

A: It means we're eating virtually all the time. Knock-on effects as well, this is not just about oral health

H: No

A: This is about the increasing obesity that we've got as well

H: Yes, yes

A: So you know, try and cut down and get meals to meal times, gives us time to digest them, causes less obesity, and we'll have better health

H: And again it's good habits isn't it, gets your body used to eating and drinking in that way

A: Yes absolutely

H: Ok. Now I understand you've got some games and facts for parents and children to try and get them to look after their teeth and make it fun?

A: We have, there's all sorts of activities and material out there during National Smile Month, and you can find some of those on the website at nationalsmilemonth.org

H: Ok .org, lovely ok well go and have a look because it is good fun on there, but coming up in the final part of the show, more of your questions on caring for your children's teeth

Break

H: Ok well we've had a number of questions from you guys at home so let's take a look at some of those. How can we keep our gums healthy from Sam Williams. That's quite a good one actually because we talk a lot about teeth; you do tend to forget your gums a little bit don't you? Well I do – how do I keep those healthy?

A: Well same mechanism, excuse me, same mechanism really, we are talking about removing the plaque so the brushing's the key thing here

H: Right

A: But it's two different mechanisms, the acid that the plaque and sugar form causes decay, but then the toxins that the bacteria form in the plaque actually causes gum disease so plaque's the big culprit, that brushing twice a day's going to be the thing that's going to remove it. As we get older going into cleaning in between our teeth with inter-dental brushes or dental floss, because that's where both decay and gum disease are going to start

H: Right

A: So very essential to add that extra bit on of actually starting to use inter-dental brushes or floss to clean in between the teeth

H: Ok. But not so much for children?

A: Less for children. The Americans get very fanatical on floss and they have their kids flossing from sort of 8 or 9

H: But then they do have good teeth don't they, the Americans?

A: Oh that's a bit of a falla – that's a bit of a myth, the sort of Austin Powers British smile is not really true. You go to Middle America and you'll find some pretty horrendous smiles out there

H: Yes

A: There. It's not all Hollywood

H: No

A: But I would say you know, get into those routines early on, do learn how to floss, it pays dividends

H: Yes

A: If you can't master that, these little bottle brushes that you can move in and out are great

H: I find those fantastic actually, yes. And as you get older the gap between your teeth does get bigger doesn't it so it's more difficult for kids to floss

A: Doesn't naturally, that's indicative of a little bit of gum disease

H: Right – oh

A: And gums receding a bit, so that's what we need to get on top of, and we can stop it progressing any further

H: Right

A: But we can't put back what's gone

H: Ok, ok. And if it all goes you're in trouble aren't you?

A: Then they start to get wobbly and eventually fall out

H: And we don't want that do we? Eek. Ok, moving on to more of your questions before you terrify me too much, Susie from Norfolk says "hi there, should I encourage my 4 year old son to be using mouthwash as well as regular brushing. So mouthwash for toddlers?

A: Mouthwash, good added benefits – some of them contain fluoride if the child's got a particular decay problem, some of them contain anti-bacterial as you s tart to get into the gum disease area. For children look at a mild one, they'll be mouthwashes out there with no alcohol in

H: Right

A: Suitable for children. Good to establish as part of the routine. Lot of dentists probably don't recommend them and that's because they know that the key thing is the brushing

H: Right, so you can't just sling a bit of mouthwash round and –

A: You can't do it instead, and you do need to get that brushing right

H: Yes

A: So don't dilute the original message

H: Yes

A: Of the importance of brushing twice a day by bringing in mouthwash until you know that the child's mastered cleaning the teeth

H: Yes

A: And we would say supervise them up until about age 7

H: Right, with the teeth cleaning?

A: Yes with the teeth cleaning, to make sure that they are cleaning all the way round, getting every tooth surface

H: Right. It's quite difficult for them to do, what about an electric toothbrush, is that a good idea for a child?

A: Power toothbrushes work very well, there are some out there available for children. A lot of them have timers on –

H: Yes

A: Which will encourage the two minutes in the mouth which is obviously a good thing because we're encouraging that good routine

H: And the cartoon characters and what have you are just – lovely, yes

A: Cartoon characters, and the ones with the little round heads that rotate,

H: Yes

A: That encourages you because the head is so small to brush every tooth

H: Right, oh I see

A: So we don't get any of this skipping across that we get with a manual toothbrush

H: Yes

A: You've got to go round and clean every tooth. And it also makes it fun for the children as well, so a power toothbrush is a good thing

H: Yes ok. And it – what is the best way to clean your children's teeth? Should you get them in headlock? I found that works for my little girl, she's quite good now but it is difficult to encourage them sometimes

A: It's quite difficult; you probably need to clean them from behind, almost as if you were cleaning your own teeth

H: Right yes

A: Rest their head, or perhaps on a changing mat or something like that for the very young children, and then gradually, when you feel they're ready for it, take over, they can take over, but do supervise it up until age 6 or 7 you know, don't think this is two minutes out the day let's send them to the bathroom

H: Just 'cos the toothbrush is wet it doesn't mean to say they've done a good job

A: Doesn't mean they've done anything no

H: And what exactly is fluoride, because we hear a lot about fluoride in water and in toothpaste but why does it help the teeth?

A: It's a naturally occurring mineral, it occurs naturally in most water supplies around the country, but there's an optimum level for the protection of teeth, and what it does, is it changes in this demineralisation softening and remineralisation hardening cycle. It changes the tooth to be harder and more resistant -

H: Ok

A: To decay, so great thing in water but unfortunately 90% of us haven't got it in the water, it's only in the West Midlands and the North East

H: I didn't know that, that's quite a political thing I know, but I thought everyone had fluoride in their water

A: No, only about 10-12% of the population

H: I had no idea about that

A: We'd love to see it increase but in the meanwhile that's why the fluoride in toothpaste is so important

H: Right ok interesting

A: And also getting along with children to the dentist and having topical fluoride supplied these days, probably with a fluoride varnish that's just dabbed on the teeth, that will help to protect teeth as well

H: Ok, well I've not heard of that ok. Ok, Katrina says "is there such a thing as brushing your teeth too much?" And I know the answer to this because my husband brushed all the enamel off his teeth

A: You can do and it depends – if you brush too hard

H: Yes that's what he was doing

A: And you can have too much of this sort of scrubbing movement

H: Yes you're not scrubbing a floor; you're only scrubbing your teeth

A: And if you've got a little bit of recession then you've got sensitive and softer dentine exposed which you can brush away with a toothbrush

H: Eek

A: So angle the brush down onto the gum margin, little rotatary movements, not this sort of big, heavy handed scrub, because you can damage both the teeth and the gums, so you can overdo it

H: So brushing three times a day – I used to work with a lady who always brought her toothbrush to work, and after she had her lunch she'd go and clean her teeth and I sort of thought that's a bit overkill. Is it?

A: It is a little bit and we would always say you're better removing the plaque before a meal, so that you've got rid of the plaque, you can't get the acids. If you have had sugary foods and then you've got this sort of you're starting to soften the teeth, if you go straight in there with a toothbrush you're going to be brushing away at softened enamel

H: Right

A: And you can cause more problems by actually removing some of that softened enamel, so you really need to leave it ¾ hour to an hour after you've eaten if you are going to clean

H: So breakfast time, should you clean your teeth before breakfast?

A: We would say before breakfast when you get up

H: Wow, you see that's going to change - that's the habit of a lifetime for a lot of people isn't it because –

A: Habit of a lifetime for a lot of people, perhaps makes your orange juice taste a little bit strange –

H: Yes

A: But it does mean that that orange juice hasn't softened the tooth enamel and then you brush it all off

H: Right. And what about chewing gum then, because I have quite a lot of chewing gum, because it sort of freshes your mouth – is that good, bad –

A: It increases the salivary flow, as we said earlier on saliva is your protective mechanism, that's what neutralises these plaque acids, so yes great idea and if you can't brush your teeth after a meal, and we would say that you know twice a day is probably enough, if you really want to add the third one that's fine, but you know chewing gum after a meal is going to help or even a little piece of cheese

H: Oh ok that's a good idea

A: Because cheese neutralises plaque acid but emphasis there, particularly with children, on a small piece of cheese because we need to look at the sugar and fat content

H: Yes, oh so much to think about isn't there?

A: Nothing's good for us!

H: No it isn't! Anyway last question because we're almost out of time actually. Sean from Wembley says "are fizzy drinks worse than smoothies in terms of their sugar content?"

A: Really we've got to say they're both bad. Fizzy drinks probably worse. You can have 12 spoons of sugar in some of those fizzy drinks

H: Wow

A: So lots of sugar there but you have got fruit sugars in smoothies, you've got acid in smoothies and they stick to the teeth so really both bad. The – back to the key message only safe drinks for teeth milk and water, so you know increase the water and cut down on those gloupy things, the smoothies and the fizzy drinks

H: Ok and lastly question from me really, my little girl has her milk just before she goes to bed, should she clean her teeth before or after?

A: Before ideally but we would always say after cleaning last thing at night, the only really safe drink is water

H: Water, lot of parents –

A: So have the milk earlier on and then after they've cleaned their teeth if they do want anything else to drink it really should be water

H: Ok, message to all parents then. Well we've run out of time so thanks very much for coming in, it's been really interesting talking to you actually

A: It's been a pleasure

H: And if you want any more information you can go to the website which is nationalsmilemonth.org, well happy brushing everybody and remember your teeth are for life. Thanks very much and we'll see you next time, bye bye

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