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Oral health: the postcode lottery of childhood decay

Blog Author Mick Armstrong

Blog Date 16/05/2018




​First the good news.

We are continuing to see gradual improvements in decay rates for 5-year olds in England. However, that headline disguises some uncomfortable truths about oral health in England.

The one in five children with decay marks a slight improvement on earlier surveys. But look closer at the data and you'll see whole regions seem have moved backwards.  

The North West, Yorkshire and The Humber and the West Midlands see rising numbers buck the national trend since the last survey in 2014-2015.

The issue here is inequalities, and an oral health gap that isn't closing. And once again Health Secretary Jeremy Hunt's constituency offers us the clearest example. 

His prosperous Surrey seat is the place to be if you want your kids to grow up decay free. 

Kids in Waverley have twenty times less decay when they enter reception, as those in Pendle in the North West. 

Across England it's a familiar picture, and we've mapped the dividing lines. North or South, urban or rural it boils down to deprivation.


Top 5 worst child tooth decay rates


% Children with decayed missing and filled teeth


Top 5 best child tooth decay rates


% Children with decayed missing and filled teeth
Basingstoke and Deane​5.7

A child's postcode and their parents' incomes continues to dictate their oral health. 

We think all children deserve the best start in life, but they aren't getting it.

Instead 170 children and teenagers undergo tooth extractions under general anaesthesia in hospitals in England every day, with 60,000 school days lost to dental pain every year.

It adds up to unnecessary pain, distress and a huge drain on the wider health service. And it doesn't have to be this way.

But the survey shows 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.

It's the action we need to see in far more communities.

Parts of Scotland's transformative Childsmile programme have been exported worldwide from Chile to Israel.


Britain has much to teach the world on prevention, so it's bizarre that children in so much of England are missing out on tried and tested, cost-effective policies.

We now look to all local authorities and national government to step up.

Tooth decay is always preventable. We cannot let policymakers accept that these inequalities are inevitable.

Mick Armstrong, Chair

BDA Principal Executive Committee


Campaigning for better oral health

When it comes to oral health, we believe in prevention first: tooth decay is an avoidable disease and we are campaigning for Government's to take this problem seriously, to act now and invest in real prevention. Read our latest blogs on the topic of public health in dentistry.

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