Upper front teeth of a two-year-old child. Photo: Dr Gabriella Gatt

Maltese children’s oral health has been described by dental leaders as “terrible” due to the over-consumption of sugary drinks and fruit juice.

Children – some as young as three – are having their baby teeth extracted due to decay caused by the drinks, according to dentists.

“Just this morning I had a three-year-old with 18 holes in his 15 teeth: that’s 15 out of his 20 milk teeth,” said paediatric dentist Audrey Camilleri, adding that it’s a common sight.

All dentists contacted by The Sunday Times of Malta said that they extract a rotting baby tooth “at the very least once a week” due to a bad diet based on sugar. A dentist said that “one in four children” he sees at his clinic needs to have a tooth extracted.

Just this morning I had a three-year-old with 18 holes in 15 of his 20 milk teeth

There are no national statistics; however, last year 181 children aged five to 11 were admitted to Mater Dei Hospital due to dental caries and 182 children underwent operations to surgically remove their primary teeth.

Most of the extractions seem to take place at age six, with 46 children having had tooth extractions in 2013.

The Health Ministry spokes­man pointed out that additional tooth extractions are performed in private hospitals and clinics that “are not captured in this database”.

According to Dr Camilleri, even though statistics are not available, dentists’ can tell that there is “an incredible amount” of child tooth decay on the island.

The culprit for rotten teeth over fives is sugary drinks. She said: “At that age they are very exposed to it and sugary drinks are worse than sweets.”

Under the age of four, the problem is twofold.

“Decay at that age is normally due to formula milk. Parents allow their children to sleep with the bottle in their mouth; the milk has lactose which settles on the teeth all night without being brushed away.”

This causes what is known as nursing-bottle caries.

“It’s very common for Maltese parents to keep on giving formula milk beyond one year,” she said, adding that it goes against the advice of top paediatricians in Malta.

“After the age of one you should be switching to cow’s milk: not full-fat, but semi-skimmed.”

The second problem is that parents add flavour to their children’s glass of milk.

“It’s very popular in Malta: they add chocolate powder thinking that it’s good for them, but really it’s full of sugar.”

Paediatric dentists try to treat decaying teeth, “but a lot of extractions still have to be done, and I feel very strongly about it”, Dr Camilleri said.

Dentist Kevin Briffa said that although he advocates preventive dentistry, one in four children who visit his clinic would need tooth extraction – at times even multiple ones – due to an unhealthy diet.

“This is very serious: baby teeth have an important function in the mouth: without teeth, children won’t be able to eat properly and that might lead to a lack of a varied nutrition,” said Dr Briffa.

He said that consumption of sugary drinks over the past years had increased drastically, with parents still unaware of the harmful effects.

“Although schools have no sugary-drinks policies, some parents give their children soft drinks in dark-glassed bottles,” he said, stressing the need to educate the parents.

Another problem is that some parents fail to regularly check their children’s teeth.

“Sometimes a child’s first visit to the dentist would be when they’re eight years old – they’d already have decaying permanent teeth and those are supposed to last them a lifetime. A three-year-old child cannot go for a check up by herself, so it’s the parents who have to be aware.”

Dentist Tonio Cachia believes the damage caused by soft drinks and sugary sweets over the past 35 years has been constant.

“We should have improved over the years but we haven’t: we haven’t regressed – God forbid – because the situation is already terrible as it is.”

It’s very popular in Malta: they add chocolate powder to milk thinking that it’s good for them, but really it’s full of sugar

He said that at his clinic he comes across children who never drink water. “Their parents tell me: ‘But what can you drink?’ As if there is no alternative: they find the concept of drinking water completely baffling.”

He said that sometimes teeth can be saved, but children do not always cooperate when it comes to longer term treatment.

Parents at times do not realise that their children are eating sweets behind their backs at their grandparents’ homes, said dentist Maria Borg.

“However, sugary drinks are an even bigger culprit than sweets... and it’s a problem when parents insist that their children are not able to drink anything but soft drinks.”

Tooth extraction should not be so high in Malta, she said.