The British Dental Association has warned that obscene levels of sugar in popular baby food pouches underline the need for wide-ranging government action across the early years’ food and drink sector.

Despite widespread claims of ‘no added sugar’ in these products, dentists have stressed that as far as teeth are concerned there’s little to no difference if the sugar is added or naturally occurring.  

Market analysis by the British Dental Association of 109 pouches aimed at children aged under 12 months indicates:  

• Over a quarter contained more sugar by volume than Coca Cola, with parents of infants as young as 4 months marketed pouches that contain the equivalent of up to 150% the sugar levels of the soft drink. Those pouches are without exception fruit-based mixes.   
• ‘Boutique’ brands appear to have higher levels of sugar than traditional baby food brands or own brand alternatives, with market leaders Ella’s Kitchen and Annabel Karmel coming in for criticism. While high levels of ‘natural’ sugar have been described by manufacturers as inevitable with fruit-based pouches, some brands offer products based on similar ingredients that contain around half the levels of sugar of the worst offenders.  
• Some products examined aimed at 4 months+ contain up to two thirds of an adult’s recommended daily allowance (RDA) of sugar. Neither the World Health Organisation (WHO) nor the UK Government’s Scientific Advisory Committee on Nutrition (SACN) cite an RDA for children, simply stressing that as little should be consumed as possible.  
• Both UK and WHO guidance recommends weaning from 6-months-old, so no products should be allowed to be marketed as ‘4months plus’. Nearly 40% of products examined were marketed at this age group.  
• The sector has consistently adopted disingenuous language highlighting the presence of only “naturally occurring sugars” or the absence of “added sugars”, with others making opaque claims of products being “nutritionally approved” or in line with infants’ “nutritional and developmental needs”. All high sugar products adopt ‘halo labelling’ principles, focusing on status as ‘organic’, ‘high in fibre’ or ‘containing 1 of your 5 a day’, misleading parents into thinking they are making healthy choices.   
• Over two thirds of the products examined exceeded the 5g of sugar per 100ml threshold set for the sugar levy applied to drinks. Dentists stress expansion of fiscal measures would likely have favourable outcomes in terms of encouraging reformulation.  

These pouches have surged in popularity among parents, owing to their convenience. Beyond encouraging a preference for sweet tastes – which carries lifelong health risks – the BDA warns they also carry oral health risks when compared to foods available via jars. Contents are often sucked directly from the pouch, ensuring the food spends more time in contact with baby teeth, just as they are erupting, and putting teeth at risk of erosion and decay

Tooth decay is the number one reason for hospital admissions among young children, and the SACN has warned infant feeding practices and delayed or poor dental hygiene may be associated with decay prevalence and have recommended a preventive focus on both areas. Public Heath England (now the Office for Health Improvement and Disparities) national guidance states that from 6 months of age, infants should be introduced to drinking from a free-flow cup or beaker, and from the age of 12 months they should be discouraged from drinking from a bottle. Open-topped cups or cups with spouts that are free-running rather than valved are recommended so that there is no need to ‘suck’.  

The BDA has lamented the lack of clear messages from manufacturers not to consume products straight from the pouch in both packaging and their wider marketing collateral, with Annabel Karmel products explicitly stating “eat straight from the pouch.” 

The Department of Health and Social Care is expected to consult imminently on the marketing and labelling of infant foods. Dentist leaders say the excessive levels of sugar in many of these products clearly warrants government action across the sector, including confronting the tactics used by sales teams, implementation of a clearer ‘traffic light’ style for labelling, and potentially expansion of fiscal measures such as the Sugar Levy to encourage reformulation.  

Oral health inequality is now set to widen as a result of the pandemic, owing to ongoing disruption to routine care, the suspension of public health programmes, and the impact of sugar-rich ‘lockdown diets’.

Analysis in 2021 by Action on Sugar that showed among 73 baby and toddler sweet snacks such as rusks, biscuits, oat bars and puffs, only 6 products (8%) would get a green (low) label for sugars.

British Dental Association Chair Eddie Crouch said: “Disingenuous marketeers are giving parents the impression they are making a healthy choice with these pouches. Nothing could be further from the truth. Claims of ‘no added sugar’ are meaningless when mums and dads end up delivering the lion’s share of a can of Coke to their infants. Tooth decay is the number one reason for hospital admissions among young children, and sugar is driving this epidemic. These products sadly risk hooking the next generation before they can even walk. Ministers need to break the UK’s addiction. They must ensure sugar becomes the new tobacco, especially when it comes to our youngest patients.”  
                                                                                                                 
Methodology:   
Market analysis of brands undertaken May-June 2022, examining 109 products marketed at infants under 12 months, covering both sweet and savoury.  Full data here: https://www.bda.org/advice/Documents/Infant-pouch-market-scan-table-June-2022.pdf

The worst offenders 

*Ella’s Kitchen and Annabel Karmel fruit pouches dominate the top reaches of the market, in terms of the highest sugar levels per 100g. Other brands captured represent outriders from boutique, traditional mass-market baby food manufacturers and own-brand lines.

Motions on the existential crisis in NHS dentistry took centre stage at this year’s local dental committees’ (LDCs) annual conference, amid 3,000 dentists who walked away from the NHS in England.

The urgent need for contract reform and funding NHS dentistry properly were among the 35 motions debated at the conference held in Newport, Wales, on June 10^th, and chaired by Dan Cook.  250 delegates attended, the majority in-person, with those unable to travel joining virtually.

In his update to conference, GDPC chair, Shawn Charlwood warned that NHS dentistry is in intensive care and the government needs to resuscitate it from catastrophic decline before it’s too late. “I told Jeremy Hunt and his Health Select committee colleagues that I feared a slow death for this service,” he said. He expressed his disappointment that, contrary to expectation, the Minister for Dentistry, Maria Caulfield, did not attend, citing ‘urgent departmental business’. In her absence,  Shawn presented a number of pressing questions he would have asked the Minister had she attended, including whether there is a future for NHS dentistry.

Delegates passed motions calling for dentistry to be ‘built back better’ following the pandemic, with contract reform that delivers for patients and the profession. Given the real terms cuts over the past decade, there was significant debate about the limits to what NHS dentistry can provide. A motion from ‘Red Wall’ Wakefield LDC urging NHS England to ensure that everyone can access an NHS dentist was passed.  A motion from North Yorkshire on the need to engage patients and dental teams to increase pressure on the government to implement ‘immediate changes to the NHS dental contract” via an online petition was also passed.

Dental leaders also expressed their frustration over being side-lined by the new integrated care systems (ICS) because they are not represented on either the Integrated Care Board or the Integrated Care Partnership. For this reason, a motion from Manchester LDC expressing no confidence that local dental problems would be solved by the ICS, was passed.

Several motions highlighting  a ‘recruitment and retention crisis’ of dental nurses, and calling for barriers to be removed, were also passed.  These include one from Wirral LDC, which called on the government to recognise that the dental team is ‘part of the NHS’ and therefore should be offered NHS benefits, including the NHS pension scheme.

The new chief dental officer for Wales, Andrew Dickenson, joined the conference online from Germany.  He discussed his priorities for the transformation of dental services in Wales and said these would focus on preventative care, and expanded team working. He said oral health evidence would drive improvement, taking into account population health and whole system change would be underpinned by contract reform. 

The Conference heard from dental consultant, Alan Suggett, UNW Chartered Accountants, on the financial realities dentists and practices are facing. This showed starkly how the national funding constraints have led to a real financial pressure for dentists.

Countering the growing frustrations with the NHS,  a panel of four dentists held forth on the optimism they felt about various opportunities to diversify their incomes and careers. This prompted lively discussions on a wide range of ways in which dentists can take control over their own working lives.

Agi Tarnowski from West Sussex LDC was voted as chair-elect for the Annual Conference of LDCs 2024.

Mark Robotham, from Gwent LDC, Peter Tatton from Hertfordshire LDC and John Sheldon from the South West London LDC were honoured with the Unsung Hero Award.

Further information about the event, including the full list of motions carried, will be available on the dedicated LDC Conference website shortly.

 If you require pictures, please contact LDCSupport@bda.org.

The British Dental Association has pressed Health Secretary Sajid Javid to correct the official record after he claimed the professional body was the co-author of the discredited NHS contract fuelling the current crisis in NHS dentistry. 

In response to questions from Duncan Baker MP on the urgent need for dental contract reform, Javid told the House “it is well known how the Labour Government came up with contracts with the British Dental Association that are leading to poor outcomes for millions of people across the country”.

The target-driven NHS contract was imposed on dentists in England and Wales in 2006, with the BDA refusing to sign up a model that placed government targets ahead of patient care. 

The perverse system funds care for little over half the population and sets perverse incentives to dentists, rewarding them the same for doing one filling as ten. The unsuitability of this model during the pandemic has accelerated the drift of dentists away from the NHS into a full-on exodus.

In an open letter to the Health Secretary, BDA Chair Eddie Crouch and General Dental Practice Committee Chair Shawn Charlwood said:

“The current discredited contract, which has limited access for the public and decimated the NHS workforce, was in fact imposed on this profession. The British Dental Association was never prepared to sign up to a system that puts government targets ahead of patient care.

“In 2008 the Health Committee rightly dubbed this contract ‘unfit for purpose’, but no government in the last 14 years has been ready and willing to turn the page.  

“We warned back in 2006 that “it is clear that even those dentists who are signing the contract are desperately concerned about the future.” Our profound concerns, then as now, have been utterly vindicated.  With 3,000 dentists having left the NHS in England since lockdown, COVID has accelerated an exodus that was already in motion, with millions of patients paying the price.
 
“We trust you will now make a short personal statement to the House correcting your statement which wrongly suggests the BDA played any role in designing the current dysfunctional system.   
 
“Clearly, we all want to see the best possible outcome achieved for our patients and urgent and meaningful reform of the dental contract – as well as appropriate funding – are necessary to achieving it. As we await the commencement of formal negotiations on a new contractual model, we trust you will ensure officials have the latitude and the resources needed to finally end this crisis and start a new chapter in the history of NHS dentistry.”

The British Dental Association has welcomed the aspirations set out in the Independent review into smokefree 2030 policies to reduce tobacco use, while stressing government must take a guarded approach to the promotion of vaping as an alternative, given current gaps in the science.  

Smoking is one the lead drivers for oral cancers, which claim more lives each year than car accidents.  

The review, led by Dr Javed Khan OBE, makes 4 ‘critical recommendations’ including promoting vaping. It stresses “the government must embrace the promotion of vaping as an effective tool to help people to quit smoking tobacco. We know vapes are not a ‘silver bullet’ nor are they totally risk-free, but the alternative is far worse.”

The BDA accepts the harms from vaping are less than from smoking. However there have has been recent suggestions linking disposable vapes to gum disease, and epidemiological studies highlight concerns over oral dryness, irritation, and gum diseases.

Mick Armstrong, Chair of the British Dental Association’s Health and Science Committee, said: “With oral cancers on the rise, dentists will only welcome aspirations for Britain to go smoke-free. This review is right not to view vaping as a silver bullet solution, and Ministers must approach ‘promotion’ carefully, not simply roll out the red carpet. The risks of long-term oral and general health problems from e-cigarettes are frankly an unknown. With products that are so new, officials must keep an eye on emerging evidence, particularly given high uptake among young people.”  

The British Dental Association has said Ministers must wake up to the crisis facing NHS dentistry, as new research from The Times finds nearly 9 in 10 practices in England are not accepting new adult patients.

Analysis of the NHS.uk website found 86% of practices currently providing information are not accepting new adult patients, or only accepting them on referral from another dentist. The paper found more than half of council areas in England, home to 9.4 million people, have no dentists that are taking on new adult patients. Just under a third have no dentists accepting children.

The professional body for dentists warns that without radical action from government the future of NHS dentistry is at risk. Around 3000 dentists have left the NHS since the onset of the pandemic, an exodus fuelled by the discredited contract NHS dentists work to. The system puts government targets ahead of patient need, effectively setting a limit on the number of NHS treatments a dentist can do in a year. Dubbed ‘unfit for purpose’ by the Health Select Committee in 2008, the system funds care for little over half the population and sets perverse incentives to dentists, rewarding them the same for doing one filling as ten. Every vacancy translates into thousands of patients unable to access care.

Dentist leaders have now accused government of hiding behind slogans to “level up” dentistry, given the seeming lack of urgency and ambition to meaningfully address these problems.  The BDA stressed that there remains no timeline for when the dysfunctional system will end, nor any indication the Treasury is willing to put needed funds in place to underpin the rebuild of the service. After a decade of cuts NHS dentistry would require an additional £880m per year simply to restore resources to 2010 levels.  

Patient champions Healthwatch England have also pressed government to pick up pace on reform, urging them to roll out new contractual arrangements no later than April 2023 when formal responsibility for dental services passes to the new Integrated Care Systems. They have warned current access crisis is fuelling widening inequality, with polling showing the shortage of appointments is hitting those on low incomes the hardest. 

Freedom of Information data indicates over 40 million fewer courses of treatment have been delivered by NHS dentists in England since March 2020, when compared to pre-COVID levels – amounting more than a year’s worth of dentistry lost as a result of the pandemic.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, said: “Demoralised dentists are calling it quits as millions go without the care they need, and this government seems asleep at the wheel. Pledges to ‘level up NHS dentistry’ are coming thick and fast, but with no commitments to deliver adequate funding or needed reform. Patients across England need urgent action now, not empty slogans.”

With the reported exodus of dentists from NHS dentistry accelerating, the British Dental Association have been called to give evidence direct to Parliament’s Health and Social Care Committee as part of their ongoing inquiry into recruitment, training and retention across health and social care.

To ensure the Committee, chaired by former Health Secretary Jeremy Hunt MP, has sight of the very latest intelligence, the BDA has now launched a new survey, inviting all General Dental Practitioners in England to take part. https://www.smartsurvey.co.uk/s/aserviceincrisis/ 

Around 3,000 dentists in England have left the NHS since the start of the pandemic, and both private and NHS providers continue to report severe workforce problems. While the pandemic has exacerbated these issues, the union has been highlighting the chronic problems the service has faced with burnout, recruitment and retention long before Covid struck. As it prepares to give evidence in Parliament, feedback from members will help paint a detailed picture of the morale and intentions of the profession, and make compelling arguments about the drivers of – and potential solutions to – the workforce crisis dentistry is facing.

Based on the evidence it receives, the Committee is set to offer recommendations to government on the main steps needed to ensure the country has the dentists it needs, short, medium and long-term.   

“Every vacancy that remains unfilled translates into thousands of patients unable to access care” says Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, who will be addressing the Committee in Westminster on 24 May. 

“It is vital that Jeremy Hunt and his committee colleagues hear the facts on what dentists are facing on the frontline.”