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Dietary advice

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Dietary advice

Key recommendation

Advise all children and their parent/carers about how a healthy diet can help prevent caries, at intervals determined by their risk of developing dental caries.

(Strong recommendation; moderate certainty evidence)

There is moderate quality evidence that lower sugar consumption can prevent caries60 and low quality evidence that dietary advice in a dental setting encourages a change in dietary behaviour.61 Consequently, and in support of the common risk factor approach, a comprehensive approach to caries prevention in children should include advice about diet and the benefits of restricting sugar intake for both oral health and general health and be informed by current national guidance.62,63 Further details about the development of the recommendations in this guidance can be found in Methodology.

Standard Prevention for all children

At least once a year, advise or remind the child and/or parent/carer about how a healthy diet can help prevent caries, including the following points.

Limit consumption of food and drinks containing sugar

  • By confining sugar-containing foods and drinks to meal times, the time that teeth are exposed to acid attack is reduced. Therefore ‘grazing’ sugar-containing foods between meals and sipping soft drinks containing sugar or acid over prolonged periods should be avoided.
  • For children taking regular medication, advise parents to request an alternative sugar-free formulation if available or ensure medication is taken at mealtimes, where possible. The provision of a sugar-free formulation may involve communication with the child’s general practitioner and/or pharmacist to identify and arrange alternatives.

Drink only water or milk between meals

  • Cow’s milk is virtually non-cariogenic.
  • Drinks containing free sugars such as sugary drinks, sweetened milk, soy formula milk and fruit juices increase the risk of caries.
  • Exclusive breastfeeding is recommended for the first six months of life with continued breastfeeding along with appropriate complementary foods up to 2 years of age or beyond.64 
  • Full-fat cow’s milk may be introduced from 12 months and, after the age of 2 years, children can gradually move to semi-skimmed milk provided they are eating a varied diet and growing well. 
  • Skimmed milk is only suitable for children over 5 years of age as it contains too few calories and minimal vitamin A.

Snack on healthier foods, which are low in sugar, such as fresh fruit, carrot, peppers, breadsticks, oatcakes and occasionally a small amount of lower fat cheese.

  • Although fresh fruit does contain natural sugars within the fruit structure, there is no evidence that it is cariogenic at recommended consumption levels. When fruit is broken down in fruit juice or smoothies, the sugars are released making them cariogenic.

Do not place sugary drinks, fruit juices, sweetened milk or soy formula milk in feeding bottles or pacifiers

  • If a child has a bottle at bedtime, this should only contain water.

Do not eat or drink, apart from tap water, after brushing at night

Be aware of hidden sugars in food

  • Many processed foods (e.g. some yoghurts, cereals and crisps) contain free sugars, which may have been added, including, sucrose, glucose, maltose, dextrose, fructose, hydrolysed starch, honey, corn or maize syrup, molasses, raw/brown sugar, treacle and concentrated fruit juice.55
  • Note that labels should show values for sugars; a high sugar content is >22.5 g/100 g in food and >11.25 g/100 ml in drinks and may be coloured red on labelling; a low sugar content is ≤5.0 g/100 g in food and ≤2.5 g/100 ml in drinks.65

Be aware that the acid content of drinks, including fruit juices, smoothies, squashes and carbonated (fizzy) drinks, can contribute to non-carious tooth surface loss and should be restricted to meal times, choosing low or zero sugar varieties.

There are numerous sources of further advice and resources to encourage a healthy diet, including Drinks for Babies and Young Children; The Eatwell Guide; Better Health, healthier families.

Enhanced Prevention for children at increased risk of caries

Provide standard prevention dietary advice at each recall visit, as detailed above. 

  • Children and parent/carers in this group may require more in-depth support to change dietary habits, such as motivational interviewing. 

Based on your assessment of the child’s circumstances, if likely to be beneficial, use additional preventive interventions as follows: 

  • A food and drink diary: the child or their parent/carer keeps a record of all food and drink consumed over a three to five-day period, with at least one of the days being at the weekend. A member of the dental team reviews the diary and offers advice if necessary. Alternatively, a 24 hour recall food and drink diary can be completed by the parent/carer whilst in the surgery.66
  • Action planning to encourage change.

Utilise any community/home support for dietary change that is available locally (e.g. Health Visitor, School Nurse, Childsmile dental health support worker).

If at any time you have concerns about attendance, compliance or the child’s wellbeing, be prepared to provide additional support (see Providing additional support).

In addition to the dietary advice described for standard and enhanced prevention, whenever possible, provide age-appropriate dietary advice for general health. 

Support and promote breast feeding.