Pediatric Tooth Decay Declining in England

Dentistry Today


The levels of tooth decay in 5-year-old children are continuing on a steady decline, according to Public Health England (PHE). Figures reveal that 23.3% of 5-year-olds in England had decayed, missing, or filled teeth in 2017, down from 30.9% in 2008. However, children in England miss more than 60,000 days of school each year due to hospital extractions alone. Also, disparities persist among children in low-income areas.

“It’s encouraging to see dental decay declining across England. However, almost a quarter of 5-year-olds are still suffering from this preventable condition. Children in our most deprived communities continue to be hit the hardest. We need more local authorities using targeted interventions to reduce these inequalities,” said Dr. Sandra White, dental lead for PHE.

PHE recommends a number of proven interventions to help local authorities improve dental health in their communities, such as supervised brushing, free toothbrushes and toothpaste, community fluoride varnish programs, and public water fluoridation. According to PHE, 80% of local authorities have an oral health needs assessment in place, with 73% commissioning oral  health improvement programs for children age 5 and under.

Analysis of tooth decay levels over nine years has identified 30 local authorities in England with the highest levels of tooth decay, with 10 of them showing long-term improvements. The most commonly commissioned programs included: 

  • Training for the wider professional workforce (71%)
  • Healthy food and drink policies (56%)
  • Supervised toothbrushing in early years and school settings (51%)
  • Targeted provision of toothbrushes and toothpaste (46%)
  • Fluoride varnish programs (20%)
  • Community water fluoridation (14%)
  • Integration of targeted home visits by health and social care workers (53%)

PHE’s return on investment tool can help local authorities decide which interventions are most appropriate for their population. It also calculates the financial savings the local NHS and wider economy can expect and estimates how many days off of school and days off of work for parents could be saved locally.

The British Dental Association (BDA) agrees that more needs to be done to address the inequalities in oral healthcare. For example, the BDA notes that 5-year-olds in Pendle have an average of 2.3 decayed, missing, or filled teeth, compared to just 0.1 for those in Waverly. Also, 49.4% of children in Pendle and just 5.1% of children in Waverly have decay.

“We should not accept that a child raised in Pendle will enter primary school with 20 times the levels of decay as one born in the Surrey home of the Health Secretary,” said BDA chair Mick Armstrong. “Sadly, while cavities are almost wholly preventable, official indifference means this inequality gap shows little sign of narrowing.”

The BDA further says that Scotland’s Childsmile and Wales’ Designed to Smile programs offer a range of universal and targeted interventions that have been successful while saving millions in NHS treatment costs, yet England has failed to follow their lead in bringing supervised brushing to schools and nurseries.

“The NHS will keep spending millions extracting baby teeth in overstretched hospitals until policymakers step up and grasp the nettle,” Armstrong said. “When programs and policies designed in Britain have become the envy of the world, it’s perverse that children in England are not benefitting from them.” 

Tooth decay remains the number one reason for pediatric hospital admissions in England, the BDA says. There are 170 extractions each day—a 17% increase since 2012—at a £36 million a year cost. The BDA further advocates a coherent and appropriately funded strategy to bridge the gaps in equality and urges greater from both local and national government. 

For example, the BDA notes that Leicester’s Healthy Teeth, Happy Smiles program hasn’t received any funding from the central government but has secured significant reductions in decay rates. It offers supervised toothbrushing in nurseries, free oral health packs for pre-schoolers, education programs, and tooth-friendly bottle swaps. 

While England has launched the Starting Well program to improve the oral health of children, the BDA calls it “second rate,” since it has no new funding attached and limits activities to a handful of wards in 13 local English authorities. Nearly two years after it was conceived, the government concedes that no children have benefitted from it yet.

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

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