I have spent the past week working on my new book about sugar, delving deeper into the sugar-and-health rabbit hole. Back in 2015, I wrote.
What about the tooth decay – is that still a problem? When I was growing up in the 1960s, I disliked visiting the dentist; I always seemed to end up having a large hole drilled in one of my teeth and having it filled with lead.
When my children were growing up, they seemed to eat more sweets and candies than I ever did, yet all four of them reached adulthood without a single filling. They even looked forward to their visits to the dentist; they could read the latest comics in the waiting room. I attributed this intergenerational change to the fluoride in the tap water.
Recent research suggests it may not have been the fluoride in the water, but rather that our kids rarely drank sugar-sweetened soft drinks (SSBs).
Other children are less fortunate. Recent NHS England data show that tooth decay is the leading cause of hospital admissions among 5- to 9-year-olds in England, surpassing other common childhood conditions, including acute tonsillitis. The data showed that 21,162 children aged 5 to 9 were admitted to hospital in 2024/2025 due to tooth decay.
Dr Charlotte Eckhardt, Dean of the Faculty of Dental Surgery (FDS) at the Royal College of Surgeons of England (RCS England), said:
“These figures are a public health emergency. Tooth decay is entirely preventable, yet thousands of children are hospitalised every year for procedures that could have been avoided with simple daily habits and better access to an NHS dentist.”
But is sugar to blame? In a 2018 study, the authors wrote:
Based on data from the 2011-2012 U.S. National Health and Nutrition Examination Survey (NHANES), there is a positive and statistically significant relationship between added sugar intake (grams/day) and dental caries (defined as the number of decayed, missing, or filled primary and permanent tooth surfaces as proportion of the total number of tooth surfaces in the mouth) for children ages 18 years and younger.
Research published in 2023 confirms a strong link between sugar consumption and dental caries among children. The study found that SSBs contributed significantly.
An earlier review of 6–12-year-olds found that higher intake of dietary free sugars, especially soft drinks, was linked to increased caries incidence in both deciduous and permanent teeth, including an incidence rate ratio of 1.75 when soft drink consumption moved from low to high over two years. The authors explicitly stated that sugar-sweetened beverages contribute to the development of caries.
However, we should not put all the blame on SSBs. A 2023 meta-study found that unhealthy processed foods also contribute to tooth decay. My own dentist told me that potato chips were now the number one tooth public enemy; they stick to your teeth while sugar doesn’t. Even so, drinking sugar-containing soft drinks, sugar-flavoured milk, and fruit juices between meals also keeps the pH level in your mouth high throughout the day, which favours tooth decay.
So, what to do? What should you do as a parent?
I was at least partially correct about the fluoride. In a review, the Oral Health Alliance (yes, that is a thing) writes.
Decades of research demonstrate how preventive oral health practices can help decrease the development of certain oral health conditions, including dental caries, or cavities. Preventive oral healthcare starts good oral hygiene practices, such as brushing with fluoridated toothpaste, drinking fluoridated water, flossing daily, chewing sugar free gum, and avoiding excess sugar and fermentable carbohydrates, and not smoking. Prevention also includes addressing socio-economic and racial/ethnic inequalities that impact access to oral healthcare and education.
Moving on, I wrote the following in 2015,
Although tooth decay is a recognised and genuine issue, child hyperactivity is not. Here, the medical profession owes an apology to all children raised during the 1980s and 1990s who had to endure sugar-rationed birthday parties. We now understand that sugar does not cause hyperactivity; being a child causes hyperactivity. Until a child is old enough to “hang out,” they will only have two speeds: “flat out” or “stop.”
A 2019 meta-study confirmed that view, finding that sugar had no significant effect on children’s behaviour. I tried to explain that to my two daughters-in-law, but failed to convince them. It seems my grandchildren will continue to have low-sugar birthday parties. (It won’t do them any harm!)
© Commodity Conversations® 2026