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Diet and health advice with metabolic bone conditions

How can teeth be affected?

Osteogenesis imperfecta

Sometimes teeth can be brittle and chip easily (dentinogenesis imperfecta or ‘DI’). Teeth with DI are more prone to have decay and tooth wear. Very often children may need dental treatment.

As bones are softer there is a higher risk of breaking the jaws when removing teeth. Braces treatment may take longer and be more difficult to glue train track braces to teeth.

Hypophosphathaemic rickets

Teeth may develop spontaneous abscesses. Often teeth are not decayed and they may not hurt, so we may only find out by doing a dental check up and taking X-rays. If they are not treated they may cause large cysts in the jaws.


Teeth may fall out (exfoliate) earlier than normal. Good brushing is essential!

Teeth which have worn away

Vitamin D deficiency or rickets

Teeth may have enamel defects, and so they may be rough, have grooves or be softer. It can make them more sensitive, difficult to brush and prone to have decay.

Muscular dystrophy

Children may find it hard to brush and dental treatment may be difficult, especially as they get older.

Effects of bisphosphonates medication

Some medications that are used to treat metabolic bone disease (bisphosphonates) can delay jaw healing after tooth removal. This does not affect children, but may be an issue in adulthood.

How to look after your teeth

Brush twice a day

Brush last thing at night and on one other occasion during the day.

Parents should help children until at least they are 7-years-old.

If they are able to tie their own shoe laces, they should be able to brush by themselves.

Use a toothpaste with fluoride

Use fluoridated toothpaste with 1350 to 1500ppm of fluoride.

We recomennd using a small headed toothbrush with soft  to medium bristles.

An electric toothbrush can be helpful if your child finds it difficult to hold the brush and thoroughly clean their teeth.

Brush after supplements

Your child should have their teeth brushed following a supplement drink. If that is not possible, at least drink water, rinse with water or wipe their teeth with a wet cloth to remove the milkshake from the teeth and prevent decay.

Dental check ups

Your child should attend the dentist by their 1st birthday and have dental check ups every 3 to 6 months.

The dentist may do simple procedures to prevent decay, such as fluoride varnish or do fissure sealants

If teeth are decayed or have abscesses, it is important to treat it early and the general dentist or paediatric dental team can provide this treatment.


You should register your child with a family dentist even if they are seen by the dental team at Sheffield Children’s

Extra protection for older children

From 8 year olds use fluoride mouthwash to rinse at different times from brushing, for example, when children come home from school or after a snack.

From 10 year olds your dentist or GP can prescribe a stronger toothpaste with 2800ppm of fluoride.

Specialist toothpaste containing extra fluoride

Sugar content of common drinks

Drink Sugar content (spoonfuls)
Nutritional supplements from a variety of brands 1 to 5 🥄🥄🥄🥄🥄
Glass of squash 3 🥄🥄🥄
Can of coke 9 🥄🥄🥄🥄🥄🥄🥄🥄🥄
Cup of chocolate milkshake 5 🥄🥄🥄🥄🥄

Try to work towards reducing and stopping overnight milk feeds as soon as your baby is capable, from when their teeth start to come through.

Your metabolic bone dietitian can help you with this if needed.

Water is the best drink

Water or milk during the day and water only at night are best for teeth.


Your dietitian may advise nutritional supplement drinks as well as fortifying the diet with extra calories and protein.

The milkshake supplements are very high in nutrients including sugars. Avoid giving them in baby bottles. Ideally add them to meals, use them instead of milk on cereal for example. Avoid sipping on supplements as this can quickly cause dental decay.

Diet for babies and toddlers

Weaning onto a varied diet that relies heavily on savoury foods and vegetables will help your baby to develop a liking for the more bitter foods and this will help protect the teeth as they grow up.

Avoid giving any juice – as even non-added sugar drinks contain natural sugars that can cause decay.

Fortified diet

Try to use savoury foods to fortify your child’s diet instead of sweet treats. Try to use oils, cheese, milk, cream, margarine, and eggs, for example.

Foods such as custard, milk, ice cream, and peanut butter can provide a good amount of calories and proteins but may contain sugar. Try where possible to go for full fat but no added sugar versions.

Contact us

Metabolic bone team: 0114 226 7890

Dental team at Charles Clifford Dental Hospital: 0114 271 7990

Is something missing from this resource that you think should be included? Please let us know

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Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: MBD23

Resource Type: Article

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