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Will a sugar shock work?

At the British Medical Association (BMA) conference in June, a motion was put forward to introduce pictorial health warnings on packets of sweet treats, to scare children off sugar. The images could include pictures of decayed teeth (borrowing a concept from the photographs on cigarette packets since 2008), or an overweight child, to highlight the dangers of over-consumption.

The sugar debate is one that all sections of the media keep coming back to and one that our patients will be well aware of. The long term, life changing consequences of excessive sugar intake are in no doubt. For children, a sweet habit is a scourge – sugar has a devastating impact on their teeth. The statistics continue to be horrifying, with a 24 per cent increase in the number of extractions performed on 0 to 4 year olds in hospitals over the last decade. If they keep the sugar habit up it can also lead to diabetes and obesity, but there remains no consensus about the best way to tackle the problem.

The government is aware that action needs to be taken. Details of the sugar tax were announced in April’s budget, with drinks containing 8g or more of sugar per 100ml to be levied by 24p per litre from April 2018 (drinks with 5g or more per litre 100ml will be taxed at an extra 18per litre).

The sugar tax is no black and white issue, though. Drinks manufacturers may have a year to reformulate their products – but isn’t it simply better to advise patients to avoid these drinks altogether, especially if they have younger children? The government currently recommends children aged 4 to 6 years old should have not more than 19g sugar per day (for 7 to 10 year olds, no more than 24g), so why not focus campaigns on the many ‘hidden’ sugars instead?

To go back to the BMA’s call for cigarette style warnings, we should be wary about relying on the fear factor when it comes to children. Assuming they would be cartoon-style rather than graphic photographs (as for cigarette packets) any parent will know that children are rarely, deterred by anything gruesome or grisly. Some of the most popular books and TV programmes for children have a definite dark side. Horrible Histories – that use blood, gore and black humour to comedic effect spring to mind here; Roald Dahl’s novel are full of macabre and violent content that they lap up. An attempt to scare them into choosing a tangerine over sherbet could easily fall flat, then. As for images of overweight children – is ‘fat shaming’ really a road we want to go down?

So although the idea of health warnings is worth discussing, the bigger picture must be taken into account. It is also very hard – if not impossible – for a parent to stop their children accessing all treats completely. Indeed, demonising cakes and biscuits could have the opposite effect and make them alluring, the forbidden fruit. When advising parents on how to reduce sugar, there may be more impact in telling them to adopt a ‘neutral’ attitude. A small, single scoop of quality ice cream after dinner every now and then is a good example – it encourages them to see something sweet as part of a meal, rather than a treat. The net result of this approach should be to lower their sugar threshold without them even noticing.

Well-meaning parents may feel that ‘hidden’ sugars aren’t given enough attention. This goes back to the sugar tax debate. You can eliminate obvious products, like fizzy drinks, but not realise that a jar of pasta sauce or a cereal bar you put in the lunch box is loaded with ever more, hidden sugar.

Sugar isn’t the only reason why extractions are increasing either. Any of us could come up with a list why – poor access in highly populated areas, not enough appointment time, a lack of oral health education in schools and bad brushing technique. A healthy diet is a supplement to a clean mouth – so teach patients how to clean their mouth properly. These skills will carry them through a lifetime; they need to use the right tools, too. TANDEX produces a range of brushes and adjunctive products that can be used from childhood to adulthood.

The BMA want to introduce scare tactics into the sugar debate; it is fair to say that sugar is the big bad wolf of oral health. The government can try to hit sugar addicts where it hurts – in the purse – but for children, scaring them might not be the answer. Balance and a neutral approach – while teaching good preventive techniques – is not only a positive one, but sustainable too. The statistics may be scary, but the jury is out on whether a scary strategy to fight sugar is the right one to adopt.