Is poor dental health in children equally common across England?

Poor oral health, in the form of tooth decay, can at best be unpleasant and at worst all-consuming. For children, its consequences include having difficulties with sleeping and eating, school absences and feeling embarrassed to smile and laugh, which affects their self-confidence and social development.

Last year, around a fifth of five-year old children in England had dental decay in at least one tooth. Tooth extractions – which are largely driven by tooth decay – remained the most common reason why children aged between five and nine were admitted to hospital in 2023/24. However, country-wide statistics hide a more nuanced picture on which groups of children are more likely to experience poorer oral health than others (as shown in the two different maps you can switch between below). 

These maps are based on oral health surveys conducted by clinicians in randomly sampled schools across the country. Last year, a higher proportion of five-year-old children in London and northern England experienced dental decay and tooth extractions than children in the South West and South East. As illustrated in the first map, this is estimated to be an average of 23.4% of children with dental decay across London and northern England, against 17.4% in the South West and South East. While higher levels of dental decay mostly correspond with higher proportions of tooth extractions, the Midlands remains an exception, for which there is not a clear explanation (there are not significantly fewer dental staff in the Midlands).

It is no coincidence that children in London and northern England experience poorer oral health. Differences by the indices of deprivation tell a similar story. In 2024, five-year-old children living in the most deprived areas of England were almost three times more likely to experience dental decay and four times as likely to have a tooth extraction. And areas of high deprivation are more common in London and in the north of England than elsewhere in the south.

In terms of ethnicity, at least 30% of South-East Asian and Arab children experienced dental decay last year, compared to 15% of White British children – indicating the intersection of deprivation with ethnicity.

The inverse care law – which states that those in most need of care are least likely to receive it – plays its part here as well. Data from 2013 revealed that children between five and 15 who were eligible for free school meals were more likely to have difficulty accessing a dentist and to not attend regular check-ups. Years after the release of this data, dental health inequalities remain persistent, even though dental care is principally offered equally and freely to all children. 

To improve child oral health, a supervised toothbrushing programme was announced in March this year for children between three and five years old. Based in nurseries and primary schools, the programme is meant to target children from the most deprived areas. This, along with public health policies like the strengthening of the levy on sugary drinks, may help to improve oral health in children, reduce hospital use and tackle inequalities. These preventative measures are especially important, given that access to NHS-funded dental treatment is in short supply.