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State of Child Health 2026: Oral health

Health Policy team
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This indicator examines the rate of tooth decay by reporting the proportion of children aged 5 years with obvious tooth decay across England, Scotland and Wales. Data for Northern Ireland were last collected in 2018 and are not included.
Last updated
Post date
14 July 2026
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This is one of 12 indicators in our State of Child Health resource.

What is the problem?

Tooth decay in children is entirely preventable, yet it remains highly prevalent. Approximately 1 in 4 of 5-year-olds had obvious tooth decay in 2024, with prevalence reaching 27% in Scotland, 22% in England and 27% in Wales (2024-25).1 While the overall prevalence of tooth decay has declined in all four UK nations, rates have remained largely stable between 2020 and 2024, suggesting that progress in reducing tooth decay has stalled since this was last examined in the 2020 State of Child Health report.

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These trends are reflected in the percentage of hospital tooth extractions that were due to tooth decay in under 10-year-olds in England. In 2021-22, the rate was 83.1%, rising to 88.5% in 2022-23 before falling slightly to 86.5% in 2024-25. In Wales, 3,572 children and young people aged 17 and under underwent tooth extractions under general anaesthesia in 2023-24, an increase from 3,362 in 2022-23.2

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There are marked health inequalities in oral health outcomes. Children living in the most deprived areas are significantly more likely to experience tooth decay. In England, 1 in 3 children (32%) in the most deprived communities had tooth decay in 2024, compared to roughly 1 in 10 (14%) in the least deprived communities.

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Similarly, in Wales, children living in the most deprived areas were nearly twice as likely to have tooth decay (37.6%) compared to children in the least deprived areas (19.8%) in 2024-25.

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In Scotland, 84% of children in the least deprived areas had no obvious tooth decay, compared with 60% of children in the most deprived areas in 2024. Data from England also evidences significant ethnic inequalities, with children from Asian or Asian British ethnic (37.7%) and Other ethnic (45.4%) groups being more likely to have tooth decay compared to other ethnic groups.

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Why does it matter?

Children with tooth decay can experience pain and infection, leading to difficulties with eating, sleeping, speaking, playing, and socialising, as well as increased school absences. If left untreated, it can lead to dental abscesses and systemic infections such as sepsis. Despite poor oral health being largely preventable, tooth decay remains the leading cause of hospital admissions in 5-9-year-olds in England.3 Similarly, in Scotland, dental extractions under general anaesthesia remain the most common reason for elective hospital admissions in 2023 among children and young people.4

Tooth decay also follows a strong social gradient, with children from more deprived backgrounds experiencing significantly higher levels of disease, reflecting wider social and economic inequalities in exposure to risk factors and access to preventive care.5 As with other conditions shaped by these underlying determinants, action to reduce such inequalities is likely to contribute to improvements beyond oral health alone.

Drivers of poor outcomes

Establishing positive oral habits and consuming low-sugar diets in the early years provides the foundation for lifelong good oral health. However, this can be hindered by the limited availability of NHS preventative dentistry services, which would support good oral hygiene, particularly in more deprived areas, where access is more limited.6

The risk of tooth decay is additionally increased by exposure to and consumption of excess sugar in diets. which children in low-income households are more likely to consume. Alongside this, the sugar content of commercially available infant foods and drinks often exceed the limits recommended by WHO Europe.7 This is despite there being no nutritional requirements for added sugar intakes in infants and children, which can lead to the development of sweet taste preferences.8

There is also evidence to show that children living in water fluoridated areas are less likely to experience tooth decay and require hospital admission for tooth extraction.9

Why we need to act now

Untreated poor oral heath in childhood increases the risk of dental problems in adulthood, including tooth loss and chronic gum disease, which are associated with an increased risk of cardiovascular disease, lung disease and poor diabetic control.10

Tooth decay is widely recognised as preventable, and investment in early intervention could help deliver substantial savings for the NHS. It is estimated that the cost of all tooth extractions in children aged 0-19 years in England was £74.8 million in 2024.11

A paediatrician's insight

From Dr Fiona Hogg, Honorary Consultant in Paediatric Dentistry  

Your experience of supporting and/or treating children and young people with poor oral health - has anything changed over time?

"Poor oral health in children and young people continues to result in significant pain, infection and impairment to sleep and play.  Although overall levels of dental caries have improved slightly over time, oral health inequalities have remained largely unchanged and, in some cases, worsened. Children from deprived backgrounds, certain ethnic minority groups and those with disabilities or additional healthcare needs experience disproportionately higher levels of oral disease, placing increasing demand on healthcare services.

"I have observed an increasing lack of consistency in parent-led toothbrushing routines at home. Parents sometimes report not brushing their child’s teeth because their child struggles to accept their intervention.  In terms of diet, energy drinks are an increasing problem, and young children report bringing large bottles of squash to school, which are consumed throughout the day, alongside snacks which exceed the recommended daily sugar intake. The single most common reason for hospital admission in children is for removal of decayed teeth under General Anaesthetics. We have long waiting lists for this and community dentists in my team are frequently removing more than 10 teeth on each child on our operating lists, often extracting 60-80 teeth in one day."

What have been challenges to supporting children and young people with poor oral health - what contributes to this or keeps them returning to NHS for support?

"Access to care remains a major challenge, particularly affecting vulnerable and minority groups.  Waiting times for dental general anaesthetic are the longest I have known in twenty years of practice. Despite being a preventable disease, dental caries is now the leading cause of hospital admission for young children.  In my own health board, children are waiting two years to have painful teeth extracted under general anaesthetic.

"Children with additional or complex health needs face further barriers, often being expected to navigate standard care pathways that do not adequately meet their needs. In both health boards in which I work, children with additional needs are expected to be seen by a local general dental practitioner and are not eligible for community dental care unless there is a need for treatment under anaesthetic. Parents often express frustration that their own dentist cannot meet their child’s needs."

Any examples of good practice to tackle the growing number of children and young people with poor oral health?

"Evidence‑based initiatives such as community water fluoridation and national supervised toothbrushing schemes show clear benefits in reducing disease and narrowing inequalities. There are some areas of England which have benefitted from water fluoridation, however, where I work (Scotland) there are no such schemes. I would advocate this as a highly cost-effective and sustainable health measure to reduce dental caries. The “Dental Check by One” campaign and the “Making Every Contact Count” approach should be supported by all health professionals.  

"A child‑centred, rights‑based approach, grounded in the UN Convention on the Rights of the Child, is essential to ensuring equitable access to oral health care and preventing avoidable pain and disease.  A toolkit from the British Society for Paediatric Dentistry (BSPD) with support from RCPCH signposts paediatricians (and wider professional groups) to the key means of supporting patient oral health."

Advice for paediatricians

" Key messages for oral health can be found in the Department of Health Toolkit. In summary:

  • Routinely ask if the child has seen a dentist in the last year, if not support them to access local services  
  • Recommend tooth brushing twice daily with fluoride toothpaste (parent-led until age 8)
  • Restrict sugar intake to 3 times per day and encourage plain water and plain milk as main drinks."

Recommendations

England
  • Increase the capacity of dental services to establish strong early oral health habits, ensuring that all children have a dental appointment by age one to support optimal oral health development.
  • Expand and accelerate the implementation of community water fluoridation schemes across England.
  • Introduce fiscal levers to mandate reformulation of commercial baby food and drinks high in sugar to help reduce intake in the early years. 
Scotland
  • Increase the capacity of dental services to establish strong early oral health habits, ensuring that all children have a dental appointment by age one to support optimal oral health development.
  • Expand the Childsmile programme to ensure all nurseries and primary schools deliver supervised toothbrushing schemes, supporting the development of lifelong oral health habits and reducing inequalities. 
Wales
  • Increase the capacity of dental services to establish strong early oral health habits, ensuring that all children have a dental appointment by age one to support optimal oral health development.  
  • Work with partners to ensure oral health promotion and education are embedded within local early years health teams and social services.
  • Continue funding the Designed to Smile programme, ensuring optimal local delivery in nurseries and schools, and promoting and delivering low-sugar diets and sugar-free snacks within these settings. 
Northern Ireland
  • Fund and fully implement the Children’s Oral Health Improvement Plan.
  • Improve access to early years oral health information through investment in and expansion of programmes such as pre-school oral health education, as well as integrating early years services with routine oral health guidance and referrals for families at risk of poor oral health outcomes.
  • Ensure the timely publication of Northern Ireland‑wide paediatric oral‑health indicators, including dental‑extraction rates and inequalities monitoring, to guide future service planning. 

This is one of 12 indicators in our State of Child Health resource.