A new report involving Newcastle University academics makes a series of proposals to tackle the children’s oral health crisis in England which is seeing millions of children suffering from tooth decay. 

The report calls on the new Government to develop a national child oral health strategy and makes recommendations to reduce sugar consumption among children, optimise fluoride exposure, and increase access to dental care.

Titled “An evidence-based plan for improving children’s oral health with and through educational settings” the report is by Child of the North and Anne Longfield’s Centre for Young Lives think tank.

It is the eighth in a series of Child of the North/Centre for Young Lives reports published in 2024 focusing on how the new Government can put the life chances of young people at the heart of policy making and delivery.

Today’s report reveals the substantial and wide-ranging extent of tooth decay affecting millions of children and young people in England, and its impact on their quality of life. Untreated disease can cause toothache, sleepless nights, and altered eating habits, and may also impact negatively on the development of speech and language. Poor oral health can lower confidence and affected children may be less likely to reach their developmental potential. There is also evidence to suggest that even when accounting for the different levels of tooth decay, the burden of tooth decay on the lives of children living in deprived areas is more severe.

The scale of the crisis and recommendations

The report sets out the alarming scale of the children’s oral health crisis, particularly in the North of England:

• Overall, fewer than four out of ten children in England have good oral health.
• One in ten 3-year-olds in England already have tooth decay, rising to three in ten by the age of five.
• One in five Year 6 school children in North East England and Yorkshire have experience of tooth decay in their permanent teeth.
• Research involving Year 7 and Year 8 children from deprived areas in the North of England, Scotland and Wales has found that over one-third had tooth decay in their permanent teeth. Four in ten reported that their oral health had an impact on their daily lives.
• Families living in deprived areas are more than twice as likely to have tooth decay, and there are much higher levels of tooth decay in children in the North compared with elsewhere in England.
• Tooth decay is the most common reason for hospital admission in 5-to-9-year-olds.
• In 2023, only half of children had visited an NHS dentist within the recommended maximum period of 12 months. For under-fives it was less than a third.
• Last year, 27,000 children in England were on NHS waiting lists for dental care by specialists, with 12,226 children on waiting lists for dental procedures under general anaesthetic with average waiting times of up to 80 weeks.

The report recommends the new Government develops and implements a national child oral health improvement strategy to improve children’s oral health and reduce social inequalities, particularly those experienced by children and young people in the North of England. This would be overseen by a national board including representatives from government departments, local government, dental organisations and specialist societies, universities, citizen representatives, and charities. This strategy would include:

• Reducing sugar consumption through policy action such as expanding the Soft Drinks Industry Levy to include other sugar-sweetened beverages such as sugary milk drinks.
• Applying restrictions on food marketing, advertising and promotions.
• Banning the sale of caffeinated energy drinks to under 16-year-olds.
• Optimising exposure to fluoride through a combination of community water fluoridation and increasing the number of targeted programmes such as supervised toothbrushing.

It also sets out proposals to maximise the impact of early years and education-based interventions, co-designed by health visitors, nurseries, and schools.

Re-orientate dental services

The report also calls for dental services to be re-orientated towards prevention of dental diseases among children and young people. This would mean:

• Working with the dental profession, dental system reform, and innovative commissioning - led by integrated care boards (ICBs) - to provide opportunities to prioritise improving dental services for children, particularly for those with additional needs.
• Better mechanisms for allocation and distribution of funding based on need, and consideration of providing dental services with and through schools and nurseries.
• A renewed emphasis on clinical prevention, including better use of fluoride treatments, dental sealants and behaviour change interventions to support families’ and children’s oral health behaviour.

The report highlights innovative approaches which are already addressing children’s oral health problems. It sets out how local government has a key role to play in reducing sugar consumption and many local authorities have their own strategies to reduce consumption of foods and drinks high in fat, sugar, and salt.

Paula Waterhouse, President of the British Society of Paediatric Dentistry, who is also Professor of Paediatric Dentistry at Newcastle University said: “This report reveals how higher levels of deprivation and associated unmet dental need are more seriously impacting children and young people living in the North of England compared with their southern counterparts.

“It is time to establish an oral health strategy for children and young people across England. The evidence base garnered by existing oral health research should be used to inform Government strategy and implementation of both national and local policies. 

“We need to act now. Our children’s health depends on it and it’s everybody’s business – parents, dental and medical teams, health visitors, industry, education colleagues, and policy makers. We all have a part to play.”

Anne Longfield, Executive Chair of the Centre for Young Lives, said: “It is staggering that so many children, particularly in the North of England and those living in low income families, are now growing up with tooth decay and suffering from toothache and discomfort. This can affect their quality of life, sleep patterns, eating habits, and impact on school readiness and attendance, speech and language development, and overall confidence. In some areas it has sadly become the norm.

“Many children are not only missing out on NHS dental healthcare but are more likely to suffer tooth decay from a younger age.

“The Government’s proposals for a programme of supervised teeth-brushing in schools is a positive step forward, as is its overall focus on boosting children’s wellbeing.

“We urge Ministers to be radical, go much further, and ignore any accusations of a ‘nanny state’. We need to take evidence-based action and to develop a national plan to tackle a rotten teeth crisis affecting millions of our children.”

Mark Mon-Williams, Child of The North report series editor, said: “Toothache is caused primarily by decay and the rotten teeth of the next generation provide a stark reminder of the perilous state of the nation’s health.

“The pain of toothache is excruciating and the most brilliant teacher in the world will struggle to educate a child experiencing dental disease.

“The time has come for the UK to start taking its future seriously - and helping ensure that all children throughout the UK have a smile on their face seems a pretty good place to start.”

(Adapted with thanks to The Centre for Young Lives)