One of the challenges for the dental team is to give patients good nutritional advice on how they can improve their diets, and subsequently help prevent the build-up of caries.

Establishing good eating patterns in childhood sets a good foundation for life-long habits

There is a lot of confusion that exists amongst patients in trying to find foods that aren't damaging to teeth and sometimes it is difficult to know where to start when trying to give advice to patients on their diet. It is important, therefore, to get across the message to parents that establishing good eating patterns in childhood is important in setting down a good foundation for life-long habits.

Cathy Stillman-Lowe, an independent oral health promotion adviser says it is important that the dental team should promote a healthy balanced diet, and one which includes the reduction in the frequency of intake of sugar-containing foods and drinks. She says that this will help to prevent a range of conditions, from dental caries to cancer and heart disease.

Hanif Moti from Moti Dental Surgery in Leicester says that diet does not only affect the gums, it also affects the tooth structures. He asks his team to give dietary advice to patients who have clinically visible problems in the mouth. 'Clinical visible problems such as erosion of the tooth surfaces are caused by too much exposure to acids or fizz from fizzy drinks, citrus fruits, reflux of acid from the stomach, too many acidy apples,' he says. 'Traumatized gums are another visible sign - they are due to consumption of too much fibrous food. Such food can lacerate the gums and cause subsequent gum disease. A diet sheet is usually given to the patient to record all food and drinks consumption for two weeks, after which the patient is recalled and the sheets are analyzed.'

An assessment of oral health was the final component of the 1997 National Diet and Nutrition Survey of young people aged 4 to 18 years living in Great Britain. Overall, 53 per cent of young people aged 4 to 18 years had evidence of dental caries in their primary or permanent dentition. Of particular concern was the finding that over half of the young people examined were considered to have evidence of erosion in the upper incisors or in the first molars of either the primary or the permanent dentition.

Sensible habits should start at an early age

A number of recent reports have expressed concern regarding the state of children's nutrition, overall health and dental health. The UK's Health of Young People survey revealed that only one fifth of children reported eating fruit and vegetables once a day, despite efforts to encourage children to eat five portions per day. It appears that sweet foods and soft drinks still make up the larger part of a child's diet.

If thirsty a baby will drink water but parents think water and milk are boring

For babies whose teeth are starting to come through it is important that levels of sugar are kept very low. Baby juices in particular have a high sugar content and, there is still no commercial baby drink that is not cariogenic. Most health visitors say that if thirsty a baby will drink water, but juices tend to be introduced because parents think water and milk are boring. Once they've developed the taste, though, reverting to water is a problem. Hanif Moti from Leicester advises new mothers to provide babies and toddlers with sugar-free, diluted fruit juice. The use of fluoride supplements are advised after the age of six months if appropriate. This will make the tooth surfaces more resistant against caries.

Few parents have limitless time to devote to preparing exotic packed lunches or snacks for their children. Even small changes, however, can make a difference to the nutrient content and caries challenge of a snack between meals. By suggesting easily accessible or ready-made alternatives, both the child and the parent are more likely to comply.

Dr. Jeff Sherer from the Inspire Dental Practice in Rickmansworth found that this worked especially well with one of his patients. 'While working in Leeds I was treating lots of children with gross caries. I hate seeing young children with loads of decay, especially when it is preventable. One occasion when dietary advice played an important part in treatment, was when a six-year-old boy Zaki Waheed came to visit me. He presented with gross caries in his deciduous teeth, and some temporary dressings that had been placed by another dentist. His mother didn't speak very good English but his father did. They were convinced that he was brushing his teeth and not eating many sweets. They wanted to know why he had so many bad teeth. I began by explaining the carious process in simple terms (about bacteria converting sugar into acid, etc.). I gave them some paper, and asked them to record everything he ate and drank over a four day period. This was to include at least one day from the weekend. The interesting part was the results of his diet sheet, which showed he was having fizzy drinks more than two times a day... sometimes, quite late at night, nearly before bedtime. It was this frequency of sugar consumption that was causing his tooth decay. I explained to his parents to cut out fizzy drinks altogether, except for at meal times, and for him to follow the rule of five where he was not eating or drinking more than five times per day. Eleven months later, he did not require any more fillings and his first permanent molar were caries free. All thanks to dietary control. Without dietary advice, he would have no doubt required more fillings. Restorative dentistry without dietary advice and oral hygiene instruction is like building a house on poor foundations.'

Government taking action

There is considerable evidence to suggest that children do not eat enough fresh fruit - particularly in poor areas. However, the good news is that the Government appears to have taken notice. In January this year the Government announced an investment of £77 million over the next two years for a national school fruit scheme to promote healthy eating and prevent obesity. Until this year the project had been limited to four pilot regions who received a free piece of fruit every day at school in a bid change children's eating habits.

Ann Felton, hygienist and Oral Health Education Tutor, supports the initiative, 'It is vital to get children into the 'fruit habit' from their earliest days of eating a mixed diet. So many of us (I was a war-time baby!) missed out on fruit as a snack and found it hard to get used to later on. Children in their early years are very receptive to new tastes but may refuse 'different' foods if they have not been readily available from their pre-school days. Once at school, it is important to eat what the others are eating and not be 'different'. This is where school catering can help by ensuring that fruit is available to all and promoted over less healthy options.'

The British Dental Association is keen to see the Government's scheme succeed. A spokesman said, 'It's vital that children learn about healthy eating and adopt good habits early on, not just for their general health but their dental health too. If the scheme can help to lessen our love affair with the chocolate bar, then so much the better.'