More than a quarter of children in Sussex have decayed or missing teeth or fillings by the age of five, according to a survey by the British Association for the Study of Community Dentistry. So what is being done to tackle the problem? SIOBHAN RYAN reports.

Ask most five-year-olds whether they want a bar of chocolate or a carrot stick and the answer is the sweet stuff every time.

A fizzy drink or a glass of water or milk? I'll have the lemonade, please.

Unfortunately, the end result of this high sugar and acidic diet is bad teeth at a very young age and a lifetime of expensive dental treatment if they continue.

Dentists and other health experts are not unrealistic enough to suggest children don't have sugar at all but recommend sweets and fizzy drinks are given in moderation and only at mealtimes rather than in between.

It is not just about cutting back either, cleaning teeth properly is the key. The head of oral promotion in Brighton and Hove, Sandy Stillman, says patterns need to be established from a very early age.

She said: "We recommend all children under eight are supervised when they are brushing their teeth because many are not doing it properly and thoroughly.

"Children are often very good about doing the front teeth but the ones in the back get neglected and that is where problems can start.

"It is vital children get into a good routine of brushing their teeth properly in the mornings and evenings and not simply spend a few seconds chewing on a toothbrush.

"A proper fluoride toothpaste needs to be used. Not many people realise some children's brands of toothpaste have less fluoride in them so they are not as effective."

Mrs Stillman said keeping sugary food to mealtimes gave the mouth time to recover between sessions, whereas if children are snacking throughout the day, the teeth are constantly getting attacked.

Although Brighton and Hove has a relatively average percentage of fiveyear- olds with missing, decayed or filled teeth - 32 per cent - the figure is higher in some areas of the city.

Mrs Stillman said: "There is a correlation between tooth decay and more deprived areas so this is something we are targeting at the moment. There is no point just assessing which children have bad teeth, you need to target areas to try to stop these problems developing in the first place."

The oral health team is targeting schools where more than 20 per cent of young children are needing treatment and giving advice on healthy eating and proper tooth brushing.

Mrs Stillman said: "It is not rocket science to prevent children developing tooth decay but it is expensive to put right."

Brighton and Hove has a relatively good record for access to an NHS dentist.

In March last year, the last set of figures available, about 71 per cent of children under 18 were registered with an NHS dentist, higher than the national figure of 64 per cent.

There are currently 18 practices offering NHS treatment to new patients and, of these, three are specifically children-only contracts.

The city has a Special Care Dental Service which has clinics in Morley Street, Moulsecoomb, Whitehawk and Hove and provides care for children with high needs such as learning and physical disability, challenging behaviour, severe management difficulties, social problems, on the Child Protection Register and travellers.

East Sussex Downs and Weald Primary Care Trust (PCT) is considering the provision of NHS dental services for children as part of its annual review of the dental contract.

Sarah Benwell, from the PCT's community dental service, said: "In order to tackle tooth decay in children across East Sussex, particularly in deprived areas, the oral health promotion programme works with parents of pre-school children, primary school children through schools and other health professionals who have regular contact with parents.

"Our advice to parents is to avoid any sweet and sugary food and drinks between meals."

Although Sussex as a whole is better performing than other areas of the country, there are still moves to bring the figures down further.

The worst performing area in Sussex was Hastings and Rother, where 39 per cent of five-year-olds had decayed, missing or filled teeth, while West Sussex recorded a figure of 33 per cent and East Sussex Downs and Weald area had the best-cared for teeth, with 28 per cent having problems.

The national average for England and Wales is 39 per cent and the worst rates are in Merthyr Tydfil, with 76 per cent of children having problems.

A spokesman for the West Sussex oral health services team said: "We endeavour to equip parents with information with which to make healthier choices in lifestyle, nutrition and parenting practice for their family.

"Tooth decay is preventable and understanding why baby teeth are at risk of decay and erosion is the key.

"In West Sussex, parents and child-carers are being made aware of how children's oral health has many risk factors, including going to sleep sucking on a bottle or feeder cup, being weaned on to a sugary diet, frequent snacking on biscuits and sweets and lack of oral hygiene."

The findings have prompted renewed calls for the fluoridation of water supplies as levels of decay were lower in areas where this happened.

South East Coast Strategic Health Authority, which covers Sussex, Surrey and Kent, does not put fluoride in the water but experts such as Mrs Stillman believe it could make a lot of difference and some dentists are calling on the authority to introduce it.

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