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​Child tooth decay 'gap' persisting: latest survey

15 May 2018


The British Dental Association (BDA) has said local and national government in England can no longer ignore the tooth decay crisis, as the latest Child Oral Health Survey from Public Health England reveals deep inequalities show little sign of narrowing.

While there have been welcome improvements in overall decay levels, data shows almost a twenty-fold difference in severity between the local authorities with the best and worst outcomes – with 5-year-olds in Pendle having on average 2.3 decayed, missing or filled teeth, compared to just 0.1 for those in Waverley, home to Health Secretary Jeremy Hunt. 5.1% of young children in Waverley have decay, compared to 49.4% in Pendle.


Dentist leaders have expressed concern that authorities in England have failed to follow the lead set by devolved governments to bring supervised brushing to schools and nurseries – when elements of these programmes have been borrowed by governments from Chile to Israel. The Childsmile (Scotland) and Designed to Smile (Wales) programmes contain a range of universal and targeted interventions, have been huge successes, and have shaved millions off NHS treatment costs.


Tooth decay is a wholly preventable condition, but remains the number one reason for child hospital admissions in England. The BDA advocates a coherent and appropriately funded strategy to bridge the inequalities gap and urges greater effort from both local and national government.  


The report illustrates the difference early interventions can make. Leicester's pioneering Healthy Teeth, Happy Smiles, has not received any dedicated investment from central government but has secured significant reductions in decay rates. It offers supervised tooth-brushing sessions in nurseries, free oral health packs for pre-schoolers, education programmes and tooth-friendly bottle swaps.

The Conservatives pledged to act on child oral health inequalities in their 2017 manifesto. The BDA has dubbed the recently launched programme in England 'Starting Well' as 'second-rate', as it has no new funding attached and activities are limited to a handful of wards in 13 English local authorities. Nearly two years after it was conceived the government has confirmed in recent parliamentary questions that no children have yet benefited from it.


170 children and teenagers in England are undergoing tooth extractions under general anaesthesia in hospitals in England every day. This costs £36 million a year – and the number of operations have increased by 17% since 2012.


BDA Chair Mick Armstrong said: 


"It's a tragedy that a child's oral health is still determined by their postcode and their parents' incomes.

"We should not accept that a child raised in Pendle will enter primary school with twenty times the levels of decay as one born in the Surrey home of the Health Secretary. Sadly while cavities are almost wholly preventable, official indifference means this inequality gap shows little sign of narrowing. 


"To date England has seen little more than token efforts from Ministers, and not put in a penny of new money. In the face of austerity some farsighted councils have made big strides, but their successes are not being bottled or shared.


"The NHS will keep spending millions extracting baby teeth in overstretched hospitals until policymakers step up and grasp the nettle. When programmes and policies designed in Britain have become the envy of the world, it's perverse that children in England are not benefiting from them."


Top 10 worst child tooth decay rates

 % children with decayed, missing or filled teeth
Blackburn with Darwen42.6

Top 10 best child tooth decay rates

 % children with decayed, missing or filled teeth
Basingstoke and Deane5.7
Test Valley7.9
Mole Valley8.0
South Cambridgeshire8.1