Frequent sugary snacks and drinks can give cavity-causing bacteria repeated opportunities to attack the teeth. Here is what parents can do to protect their children’s smiles.
Grace’s mother was plaiting her hair when she first noticed a faint brown shadow on her six-year-old daughter’s upper front tooth, no larger than a grain of rice. Grace was laughing at a cartoon, eating normally and sleeping through the night. She had never complained of pain, so her mother assumed it was simply discolouration.
Three months later, the shadow had become a hole. By the time Grace flinched while eating a banana, the problem was more serious. What might have cost Shs50,000 to fix now required treatment running into several hundred thousand shillings, three missed days of work for her mother and a child too distracted by pain to concentrate at school.
Grace’s experience is not unusual.
Dental cavities are common among children in Uganda, with studies suggesting that roughly half have experienced tooth decay, much of it untreated. Unlike many childhood illnesses, tooth decay can develop quietly. By the time a child complains of throbbing pain, swelling or difficulty eating, significant damage may already have occurred.
Dr Musa Katende, managing director at M-Dental Care, says the problem is particularly common among children aged three to six, whose baby teeth are vulnerable to decay, and those aged six to 12, when permanent teeth are emerging and children may still need supervision with brushing.
The sneaky sources of sugar in your child’s diet
Sugar is one of the main drivers of tooth decay, but the issue is not simply how many sweets a child eats. When we think of sugar, we often picture candy bars, soda, and desserts. But sugar has a way of hiding in places we least expect, including foods we consider healthy. For parents trying to keep their children’s sugar intake in check, knowing where it lurks is the first step.
Breakfast cereals
The breakfast table is a common starting point for daily sugar exposure. Many cereals, especially those brightly packaged and marketed to children, ontain significant amounts of added sugar. What looks like a wholesome way to start the day can quietly deliver a sugar spike before school even begins.
Flavoured yoghurt
Yoghurt has a healthy reputation, and for good reason, it offers calcium, protein, and probiotics. But flavoured varieties often carry considerable added sugar. Fruit-flavoured tubs and drinkable yoghurts can contain as much sugar as a dessert, despite their wholesome image.
Tomato sauce and ketchup
Pasta night and burger night can be hidden sugar occasions. Tomato sauce and ketchup frequently contain added sugar, and because children tend to eat them often and in generous amounts, the sugar adds up quickly over the week.
Bread and baked snacks
Bread may not taste sweet, but sugar is often added during baking. The same goes for buns, cakes, muffins, and other common baked goods. Even savoury-looking bread products can contribute to a child’s daily sugar load.
Flavoured drinks
Energy drinks, sports drinks, iced teas, and flavoured waters are easy to overlook because they aren’t thought of as ‘sweets.’ Yet they can pour significant sugar into a child’s diet, often more than a piece of candy. Liquid sugar is especially easy to consume quickly and without notice.
Look before it hurts
A large, dark hole is not usually where tooth decay begins. One early sign can be a white spot on the tooth, indicating that minerals are being lost from the enamel. At this stage, improved oral hygiene and professional fluoride treatment may still manage the damage.
As decay progresses, parents may notice brown or black spots, visible holes, persistent, bad breath, food getting trapped around one tooth, sensitivity or a child avoiding certain foods.
Phiona Namata, a dentist, says parents should also pay attention to changes in behaviour.
‘Some children may be afraid of the dentist, worried about being blamed for eating sweets, or simply unable to explain what they are experiencing. Parents therefore need to look for changes rather than waiting for a child to report pain,’ she says.
A child who suddenly chews on one side, refuses hard foods, becomes irritable around mealtimes or wakes at night may be experiencing dental discomfort.
Swelling of the gums or face is more serious and requires prompt dental attention.
When decay is detected early, treatment is generally simpler. A small cavity may require only a filling. If decay reaches the nerve, a child may need pulp treatment, followed by a filling or crown. A severely damaged or infected tooth may eventually need to be extracted.
What about medicine?
Sugar is not found only in sweets and drinks. Some liquid medicines contain sugar because it helps mask bitter flavours and makes them easier for children to take.
Robert Mugabe, a pharmacist and head of department at Fort Portal Regional Referral Hospital, says prolonged use of sugary syrups can contribute to dental problems if sugar remains around the teeth.
‘Some liquid medicines, especially syrups, contain high amounts of sugar. When a child uses these for a long time, some of the sugar can remain around the teeth, encouraging bacteria growth,’ he says.
Parents should not stop prescribed medicine because of this concern. Instead, they can ask a doctor or pharmacist whether a sugar-free or lower-sugar formulation is appropriate when a medicine needs to be used for a prolonged period.
Good oral hygiene remains important during treatment.
The cost of waiting
For families, early dental care can also make financial sense. A child’s first dental visit should ideally happen by the first birthday or within six months of the first tooth appearing. The visit allows a dentist to check for early problems, advise parents about brushing and diet, and help a child become comfortable with dental care.
In Uganda, a routine dental check-up may cost about Shs20,000 to Shs50,000, while a simple filling may cost about Shs50,000 to Shs150,000. Pulp or root canal treatment for a child may range from about Shs150,000 to Shs400,000, while an extraction may cost about Shs30,000 to Shs100,000, depending on the facility, tooth and severity.
Prices vary between facilities, but the principle is straightforward: delaying treatment can make both the procedure and the bill more complicated.
There are other costs, too. Parents may have to miss work for emergency appointments, spend money on transport and painkillers, or deal with a child who is unable to sleep or concentrate at school because of a toothache.
Prevention starts at home
The World Health Organisation recommends limiting free sugar to about 25 grammes a day. Parents should watch not only sweets but also sugary drinks, biscuits and cakes. Plain water is best between meals, alongside nutritious foods such as milk, yoghurt, eggs, groundnuts, fruits and vegetables.
Children should brush twice daily with fluoride toothpaste, with younger ones supervised by parents. Sugary drinks should be avoided at bedtime. Regular dental check-ups can catch problems early, before they become painful and expensive.
The simple check
You do not need a nutrition degree to spot hidden sugar. Just turn the packet around and check two things: the ingredient list and the nutrition label. Sugar goes by many names; sucrose, glucose, fructose, corn syrup, maltose, dextrose, and the higher it appears on the ingredient list, the more the product contains.
Most importantly, remember this rule of thumb, the more often a sugary product appears in a child’s diet, the more important it is to rethink how frequently it is offered.
Occasional treats are one thing; daily habits are another. Small, repeated choices add up, and so do small, repeated improvements.
One more trap; labels often describe a serving size far smaller than what a child actually eats or drinks. A bottle of flavoured drink may contain two or three servings, meaning the sugar numbers must be multiplied accordingly. Always compare the stated serving size with what’s really being consumed.