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Fewer Children Needed Teeth Extracted After Soft Drinks Levy

The soft drinks levy introduced in the UK in 2018 was followed by a fall in the number of children needing hospital admission for dental extractions, according to a new study led by the University of Cambridge. 

Tooth extraction due to caries is the main reason for elective admissions in children aged 5 to 9 years in England, and nearly 90% of extractions in young children are due to decay. More than 42,000 extractions in patients aged 18 years or under occurred in NHS hospitals in England last year, according to the British Dental Association (BDA).

The researchers explained that sugar-sweetened drinks account for around 30% of added sugars in children's diets at age 1-3 years old. By late adolescence, the proportion is over 50%. 

The soft drinks industry levy, widely dubbed the 'sugar tax', was introduced to reduce childhood obesity by removing added sugar from soft drinks.

While it is well-known that sugar-sweetened drinks contribute to tooth decay, no previous studies had examined the effects of the levy on dental health. 

To address this issue, the researchers analysed real-world data on hospital admissions for tooth extractions due to a primary diagnosis of dental caries in children aged 0 to 18 years old in England from January 2012 to February 2020, covering periods before and after the levy was implemented in April 2018. 

Overall 12% Reduction in Admissions

Changes in rates from monthly NHS Hospital Episode Statistics showed an overall absolute reduction in children's admissions of 3.7 per 100,000 population per month, compared with the projected scenario if the soft drinks levy had not been introduced. This equated to a relative reduction of 12%, which the team estimated avoided 5638 hospital admissions for dental extractions due to decay. 

The largest reductions were seen in the youngest children, with absolute reductions of 6.5 per 100,000 at age 0-4 years old, and 3.3 per 100,000 at age 5-9 years. No significant changes in admission rates were seen among older age groups. 

Even though higher extraction rates are associated with socioeconomic deprivation, reductions in hospital admissions after the levy's introduction were seen in children living in most areas regardless of deprivation. 

The researchers acknowledged that as an observational study, they were unable to establish causality. Moreover, other contemporaneous national interventions, including a sugar reduction programme between 2015 and 2020 – aiming for a 20% reduction in sugar in foods – and compulsory nutrition labels, "may have raised public awareness of sugar consumption and influenced buying habits". 

However, the authors of the study, published in BMJ Nutrition, Prevention & Health, concluded they had found "evidence of possible benefits to children's health from the UK soft drinks industry levy beyond obesity".

First author Dr Nina Rogers, a research associate at the Medical Research Council Epidemiology Unit at the University of Cambridge, said that reduced admissions among the youngest children represented "an important finding, given that children aged 5 to 9 are the most likely to be admitted to hospital for tooth extractions under general anaesthesia".

"Ambitious" Public Health Policies Can Improve Child Oral Health 

Co-author David Conway, professor of dental public health at the University of Glasgow, said: "This study shows that ambitious public health policies such as a tax on sugary drinks can impact on improving child oral health."

In a statement sent to Medscape News UK, the BDA said the sugar levy was "delivering the goods", adding that "the Government must remain willing to force the hand of the food industry on reformulation". 

The levy took out 47,000 tonnes of sugar from soft drinks in its first 4 years, as drinks manufacturers were "encouraged" to reduce sugar levels to avoid the tax, the BDA said. It stressed that this effectiveness was "in sharp contrast to voluntary appeals to the food industry". 

Dentists Advocate Extension of the Levy to Other Products

Expansion of the levy into other product ranges – including milk-based drinks, biscuits, cakes, sweets, yoghurts, and cereals – would "drive widespread reformulation of high sugar foods and need not raise costs for consumers", according to the Association. 

The study was funded by the Medical Research Council and the National Institute for Health and Care Research.