Tooth Decay

Tooth Decay

Levels of tooth decay have reduced over the past 40 years. However, more than 50 percent of children living in the North West have had some dental disease experience. This is higher in more deprived communities and lower in affluent communities. To see the actual decay rates for your local area go to the North West Public Health Observatory at

Tooth decay is caused by the amount and frequency of sugar in the diet. Sugary drinks and snacks should be kept to mealtimes only. Plain water and milk are safe drinks for children.

Fluoride in toothpaste, mouth rinses, milk or drinking water can protect teeth from tooth decay. Most tap water in the North West area is not fluoridated. For further information about water fluoridation go to the British Fluoridation Society at

Toothbrushing should start as soon as teeth come through, using a smear of family fluoride toothpaste twice a day. Parents should supervise or assist with tooth brushing until children can do it effectively, usually by the age of seven. Some children may need to be supervised after the age of seven.

As older people keep their teeth longer they can have problems with root caries (decay around the necks of teeth). In addition to twice daily brushing with a family fluoride toothpaste, fluoride mouth rinses and avoiding sugary drinks and snacks between meals can help.


Tooth decay is caused by acid attacking the surface of the tooth enamel. Bacteria present in the mouth (plaque) produce acid from sugar found in food and drinks. The most common sugars are sucrose and glucose as these are added to many foods and drinks, although fructose, dextrose, maltose, corn syrup and honey all have the same effect. The acid produced causes an acid attack. Controlling the number of ‘acid attacks’ and confining it to mealtimes is the key to preventing tooth decay.

  • Sugar + Bacteria (Plaque) = Acid
  • Acid + Enamel + No. of acid attacks = Decay

If acid attacks are not controlled destruction of the enamel occurs. Decay progresses very rapidly through the tooth and pain may be felt on eating and drinking. If this is not treated an abscess can form. This can be very painful and the tooth may have to be extracted or extensively restored.


Tooth decay is relatively easy to prevent by keeping sugary foods and drinks to mealtimes only. Toothbrushing twice daily with a fluoride toothpaste is a highly effective method of helping to prevent tooth decay. Other fluoride preparations are available – seek advice from a dentist.

However the most effective, safe and efficient public health measure for reducing tooth decay is the fluoridation of public water supplies.

Dental Erosion

It is important to note that erosion is very different to tooth decay and has different causes.


It is caused by acids entering the mouth. Either via gastric reflux (for example pregnancy, alcoholism, bulimia and obesity) or the frequent consumption of carbonated and fruit based drinks (e.g. in cans and bottles) Most dentists agree that the prevalence of erosion has increased over the last 20 years.


Erosion occurs on plaque free surfaces of the teeth. Most noticeably the rear of the front upper teeth and the biting surfaces of the back teeth. Enamel is lost and the teeth can become worn, marked and sensitive to changes in temperature. Erosion can be prevented by reducing the intake of erosive / acidic drinks and foods and by thorough toothbrushing twice daily with a family fluoride toothpaste. It is sensible to avoid toothbrushing straight after the consumption of acidic food or drinks.