In 2025 there were 33,978 episodes of tooth extraction due to tooth decay among patients aged zero to 19 years old, according to the Royal College of Surgeons of England. That’s an 11 per cent increase from 2025 and represents 60.5 per cent of all tooth removals. That’s a lot – it’s, hauntingly, one extraction every 15 minutes. Yet, access to an NHS dentist has become increasingly difficult in many areas – with tooth decay the most common reason children aged five to nine are admitted to hospital.
Here, London-based dentist Dr Neil Sikka, director of dentistry at Bupa Dental Care, explains what he did with his own three children when it came to looking after their teeth – and the mistakes he sees even savvy parents make.
Believing that baby teeth don’t really matter
Protecting your children’s teeth early makes a massive difference to your child’s long-term oral health, the future of their general health, and their longevity. It’s a myth that because baby teeth fall out between the ages of six and 12, they aren’t important. First of all, if you get decay in a tooth, it can be very painful for a child, and if you get infections in a tooth, it can really affect the underlying development of the permanent tooth. For younger children, their enamel is softer and so it’s easier for decay to occur, and it decays really quickly once it starts. Enamel doesn’t fully harden and protect you until your late teens. So it’s key to keep those baby teeth as healthy as possible.
Only going to the dentist when something’s wrong
Take them young – two is a good age – for their first check-up, before anything needs doing to their teeth. Definitely don’t take them for the first time when they’re in pain. It’s about them getting used to the environment so that they enjoy it. That is actually possible! If you can find a dentist who is good with children, they’ll give them a ride in the chair. I get them to imagine they’re at the fairground, and they’re on a magic ride or in a spaceship – and they love that. You, as well as the dentist, can talk about toothbrushes being magic polishers, and give them a sticker after. The more relaxed and fun you can make it, the easier it will be if anything ever needs to be done.
Projecting your own dentistry fears on to your child
The worst thing a parent can say is, “If you don’t brush your teeth, you’re going to get holes, and then you’re going to have to go to the dentist.” Make the idea of a dentist as friendly as possible, as they actually are unlikely to feel the same sense of fear or mistrust that some adults will.
Making teeth brushing a boring chore
When your toddler grabs hold of that brush and chews it, and you can’t get it off them, it’s OK, let them. It can feel good, and fun, for them. Actually, by chewing it, they’re doing a bit of cleaning anyway, and you want to make it as enjoyable as possible. I know, though, that it’s not always easy to wrangle toddlers – I have three children! When brushing their teeth, don’t stand facing them, stand behind them so you’re both looking in the mirror. Then let them do it for a bit, and you brush your own teeth, too. If you’re all doing it together, that helps. What I’d normally start with is guiding their hand, but looking in the mirror, too, so they can see what you’re doing while you’re doing it. Make it regular, make it every day, and try to make it fun.
For older children, one of our dentists designed an app called Brush DJ, which plays a song for the two minutes you want your child to brush for. There are lots of other apps out there, including one where you paint a picture while you’re brushing. Kids love interactive things. You want them to start brushing on their own as soon as you possibly can with your support and presence. Studies show that over half of children fib about brushing their teeth and if they do brush when left to their own devices, lots of them do it for less than a minute. Be there with them, doing it with them. You have to be realistic, though – they’re not always going to manage two minutes twice a day from a really young age, but if at five or six you are managing to get them doing two minutes a day, that’s amazing.
Thinking that sugar is the thing that’s bad for teeth
We know that sugar is bad, and fizzy drinks also – but there are other things to avoid, too. The worst thing that you can do for a child is to give them a drink in a bottle that they suck on all day, if it’s not water. A bottle of milk at night is also not ideal, but I’m not recommending waking them up to brush their teeth at 2am. What you don’t want them to do, though, is suck on a bottle of milk all night. If you’re giving it to them, give it to them in a delineated period of time, and then that’s it. Water is always fine.
Forbidding sugar to the point that it’s tempting
When they’re young toddlers, they often don’t know what they’re missing. You may well get by without exposing them to sugar. But when they do discover sugar, you don’t want it to be forbidden fruit, so that as soon as they’re out of your sight they stuff their faces with it. I never had lollipops in the house as the one thing I hate above all else is anything which continues to deliver sugar for a long period of time. But whenever they went to a party they’d come home and go, “Look dad, we’ve got a lollipop and you can’t do anything about it!” I was OK with that.
There were parents who refused to give their children any chocolate at all, and they would then come round to our house, or go to the local shop with my kids, and buy lots and stuff it into their mouths in one go, which was really bad for them. The only thing I say is, if you’re going to give them something sugary, do it at meal times so that they’re not snacking throughout the day. As soon as you have snacks, you’re producing acid in the mouth, and the acid combines with the bacteria to cause decay. So make sure if you are doing snacks, they are not sugary. But in general, snacks are really not great for teeth.
However, not all sugary snacks do the same level of harm to teeth. You want children – if they’re having sugar – to be eating something that is not sticky and is not going to be hanging around their mouth for a long time. Things like fruit gums and Haribos and sticky sweets like that are the worst as they’ll stay in the teeth. Some sweets have less sugar content in them, and they are more likely to disappear quickly as well. Certain types of chocolate, for example, are much lower in sugar content and will disappear quickly.
As an aside, cheese is a good natural protector of teeth. It helps neutralise acids in the mouth and stimulates saliva, which helps protect teeth after sugar exposure. Options like cheese strings or small cubes of cheese make an easy, child-friendly snack after ice cream and lollies.
Buying fluoride-free toothpaste
There’s some anti-fluoride sentiment around, but I’m very pro-fluoride, and the vast majority of the dentistry profession is, too. [Official NHS guidelines advise starting fluoride toothpaste as soon as the first milk tooth appears.] We don’t have high levels of fluoride in the water in the UK, and the fluoride in our toothpaste is very, very safe, and it really helps to strengthen teeth. I always recommend parents use an age-appropriate fluoride toothpaste for their children. And yes, the toddler is going to swallow some of it because you can’t get the toothbrush off them, but don’t worry about that – the industry has made it safe.
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