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​Mayor urged to step up to address London's child tooth decay crisis

14 March 2019


Speaking to an inquiry today at the London Assembly, the BDA will urge the Mayor of London Sadiq Khan to follow the example of other city leaders, and tackle deep seated oral health inequalities among the capital's children, that's seeing decades of improvements go into reverse in some Boroughs

The inquiry will hear survey evidence from dentists practising in every London Borough, revealing a strong desire for concerted action:


  • 97% of dentists believe Mayor Khan should follow the Mayor of Greater Manchester in introducing supervised tooth-brushing into all nurseries and other early years settings across Greater London. These schemes are core elements of national child oral health programmes in Wales and Scotland, and according to models from Public Health England would generate up to £3 return on investment for every pound spent through lower treatment costs.
  • 98% believe the Mayor of London should run a campaign to raise awareness of the importance of regular dental attendance from an early age and the fact that all dentistry is free for under-18s.

Over a quarter (26%) of 5-year-olds in London suffer from decay – making London the third worst area in England in terms of child tooth decay outcomes, after the North West and Yorkshire and Humber. This figure also hides massive inequalities between different London boroughs, with outcomes varying from 14% in Bexley to 40% in Harrow. In the best-performing local authorities in England only 5% of 5-year-olds suffer from decay.


While nationally there has been a slow but steady improvement in child oral health, 10 of the London boroughs have also seen a marked deterioration in children's outcomes over the last two years, with children in areas like Camden and Sutton up to a 25% more likely to suffer from tooth decay now than they were two years ago.


Tooth decay is almost entirely preventable but hospitals in London are spending around £7 million on child tooth extractions in hospitals every year – almost £30m over the past 4 years – on top of the significant cost of treating child tooth decay in primary care.


Dentists have expressed concern that London has among the lowest attendance rates of all regions, with 18 out of 20 councils with the lowest proportions of children attending NHS dental services being London boroughs. In Hackney, two thirds of children (68%) are missing out on free dental care.


According to figures released in February 2019, half of London children (50%) – one million children in total – have not been seen by a dentist in the past year, even though NHS dentistry is free for under-18s and NICE guidelines recommend children should be seen by a dentist at least once a year. Dentists now are urging the Mayor to run awareness campaigns to encourage uptake.


The BDA has also urged the Mayor to consider the specific oral health needs of various immigrant groups in London, and co-ordinate relevant, culturally sensitive and accessible awareness raising campaigns on the risks of smokeless tobacco use and products such as shishas, betel nut and paan. Respondents to the BDA survey have identified cases of paan chewing among children as young as 5 years old, developing precancerous conditions known as submucosal fibrosis by the age of 14.


The BDA's Len D'Cruz, an NHS dentist in the London Borough of Redbridge, who is giving oral evidence to the London Assembly said:

"Across London decades of improvements in children's dental health are heading into reverse.

"The Mayor must now lead where Ministers have failed to do so. When the capital's NHS is under huge pressure we do not accept it's inevitable to spend £7 million each year removing rotten teeth from children.


"London faces unique challenges, with a million kids missing out on free care, and teenagers in some communities risking oral cancer through betel nut and paan consumption. From public health campaigns to supervised brushing in nurseries – the Mayor can offer more than the radio silence we're getting from Westminster.

"Dentists back Mayor Khan's bid to make London the world's healthiest city. But that can only be achieved by tackling the deep and persistent oral health inequalities that blight the capital."


BDA online survey of 144 dentists working in each of the 32 London Boroughs (and the City of London)

Fieldwork March 2019. Respondents were asked to indicate their support for the following measures:

  • Stronger action and better coordination is needed to reduce inequalities and improve child oral health outcomes in London - 82.3% strongly agreed, 15.6% agreed.
  • The London Mayor should follow the Mayor of Greater Manchester in introducing supervised tooth-brushing into all early year's settings across Greater London - 83.1% strongly agreed, 14.1% agreed.
  • The Mayor of London should run a campaign to raise awareness of the importance of regular dental attendance from an early age and the fact that all dentistry is free for under-18s - 88% strongly agreed, 9.9% agreed.

Percentage of 5-year-olds in London with experience of tooth decay

Boroughs which have seen a deterioration since 2015 marked in bold:


Waltham Forest29.8%32.9%
Tower Hamlets35.5%31.1%
Barking and Dagenham31.4%28.6%
Kensington and Chelsea33.4%26.6%
Hammersmith and Fulham26.3%24.2%
Kingston upon Thames22.9%21.5%
Richmond upon Thames19.0%16.4%


Improving oral health

Prevention should be at the heart of any effective healthcare strategy. Tooth decay, an almost entirely preventable condition, remains the leading cause of hospital admissions among children in the UK. Successive governments have failed to provide dentists with the plans or priority to deliver on it – here's what we are calling for.


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