Tooth decay is caused by sugars which you eat and drink. Plaque which develops on your teeth is full of bacteria. These bacteria feed on sugars and create acid, which damages teeth and leads to holes.

What causes tooth decay?

There are three simple steps to help stop teeth from decaying:

1. Only have sugar-containing foods and drinks at mealtimes, up to three times a day.
2. Brush all surfaces of your teeth twice daily with a fluoride toothpaste.
3. Visit your dentist regularly and ask about fluoride varnish to help prevent tooth decay.

This page gives further advice on each of these steps.

Diet advice

A tooth-friendly diet is also good for your overall health. There are two key points to follow:

• Reduce the overall amount of sugar you eat.
• Reduce the number of times a day you eat sugar, keeping sugary foods and drinks to mealtimes and avoiding sugar before bed.

Foods and drinks that often contain sugar

It can be difficult to tell when food or drinks contain sugar. Many products contain hidden sugars, even if packaging claims “no added sugar”, “natural ingredients” or “organic”. This does not mean they are sugar free.

Looking at ingredients can help. Sugar may be listed as:

Dextrose, glucose, fructose, fruit juice concentrate, corn syrup, hydrolysed starch, isoglucose, levulose, maltose, molasses, sucrose, honey, treacle, dried fruit or syrup.

Savoury foods

• Many sauces, such as pasta sauce or chilli sauce
• Fresh or tinned soups
• Flavoured crisps
• Sandwich meats and fillers
• Condiments such as tomato sauce, BBQ sauce, mayonnaise, pickles and relish

Drinks

• Flavoured water
• Flavoured milk
• Diluting juice, including those with no added sugar
• Fruit juice, including fresh fruit juice
• Smoothies

Tooth-friendly snacks

If you are hungry between meals, try to choose tooth-friendly options.

Bread and crackers

Plain bread such as wholemeal, brown, granary, white, high fibre or rye bread. Pitta, chapatti, rolls or baguettes. Small portions of plain breadsticks, plain rice cakes, plain oatcakes and cream crackers.

Fruit and vegetables

Whole fruits and vegetables. Do not choose juiced, dried or pureed options.

Dairy

Cheese such as cheddar, soft cheese, cheese spread and string cheese. Unsweetened natural yoghurt or plain fromage frais.

Protein

Eggs, tuna, hummus, beans and pulses.

Always check ingredients for flavoured foods, as added flavours often mean added sugars.

Tooth-friendly drinks

Plain milk and plain water are the safest choices during the day.

After brushing teeth at bedtime, only water should be drunk if needed. Milk taken during the night can cause tooth decay.

Tea and coffee with milk only do not contain sugar, but they can be high in caffeine and may reduce iron absorption, so they are not suitable for everyone.

All other drinks contain sugar and/or acid and should be avoided or kept to mealtimes.

Medicines

Some medicines contain sugar. Ask your doctor, dentist or pharmacist for sugar-free medicines where possible.

If a sugar-free option is not available:

• Ask if the medicine can be taken with a meal.
• Avoid taking it before bed.
• Rinse your mouth with water after taking the medicine.

Toothbrushing

What toothpaste should I use?

Most people should use toothpaste containing 1450 parts per million (ppm) fluoride.

People at higher risk of tooth decay or with a dry mouth may be prescribed higher strength toothpaste by their dentist.

How much toothpaste?

• Children under 3 years: a smear of toothpaste
• Everyone else: a pea-sized amount

How often should I brush?

• Brush twice a day.
• Once last thing before bed, with no food or drink afterwards.
• Once at another time, such as in the morning after breakfast.
• Brushing at school or nursery should be in addition to brushing at home.

Who should brush?

Children should be helped with brushing until they can brush well themselves, which is usually not before the age of 7. Parents should continue to supervise brushing until confident it is being done properly.

Some adults with additional support needs may also require help with brushing.

Spit or rinse?

After brushing, spit out excess toothpaste but do not rinse with water or mouthwash.

Not rinsing allows the toothpaste to work for longer and can reduce tooth decay.

Toothbrush type

Manual or electric toothbrushes can be used. Choose a toothbrush with a small head so it can reach the back teeth.

How long should I brush?

Brush for about two minutes. It may take longer when learning a new technique.

Using a timer or app can help children stay focused.

Brushing technique

Use a short scrubbing motion. A systematic approach helps ensure all surfaces are cleaned.

For the top teeth, then the bottom teeth:

• Brush the outside surfaces, starting at the back tooth on one side and working around to the other side.
• Brush the inside surfaces in the same way. For front teeth, hold the toothbrush vertically if needed.
• Brush the biting surfaces of the teeth, again working from one side to the other.

Using a mirror can help ensure all areas are brushed properly.

When brushing a child’s teeth, it may help to stand behind them or kneel in front of them.

Bleeding gums

If your gums bleed when you start brushing properly, this is common and usually settles as brushing improves.

If you are concerned, speak to your dentist, dental therapist or hygienist.