Child of the North and Anne Longfield’s Centre for Young Lives think tank have published a new report today which makes a series of proposals to tackle the children’s oral health crisis, which is seeing millions of children in England suffering from tooth decay.
Titled “An evidence-based plan for improving children’s oral health with and through educational settings”, the report calls on the new government to develop a national child oral health strategy and makes recommendations to reduce sugar consumption, optimise fluoride exposure, and increase access to dental care.
The report is the eighth in a series by Child of the North – led by the N8 Research Partnership and Health Equity North – and the Centre for Young Lives to be published in 2024. Each report focuses on how the new government can put the life chances of young people at the heart of policy making and delivery.
The wide-ranging extent of tooth decay, which is affecting millions of children and young people, and its impact on their quality of life is assessed in the report. Untreated disease can cause toothache, sleepless nights, altered eating habits, and may also negatively impact confidence and the development of speech and language. Evidence also suggests that the burden of tooth decay on the lives of children in deprived areas is more severe.
New analysis reveals that when school readiness was explored in Bradford, as part of the Born in Bradford project, children who were not considered school ready were more likely to have tooth decay compared to those who were.
The report sets out the alarming scale of the children’s oral health crisis, particularly in the North of England:
- Fewer than four out of ten children in England have good oral health.
- One in ten three-year-olds in England already have tooth decay, rising to three in ten by age 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 found that over one-third had tooth decay in their permanent teeth. Four in ten reported that their oral health impacted their daily lives.
- Families living in deprived areas are more than twice as likely to have tooth decay. 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.
To improve children’s oral health and reduce social inequalities, the report recommends the new government develops and implements a national child oral health improvement strategy. 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 policies to reduce sugar consumption, such as expanding the Soft Drinks Industry Levy to include other sugar-sweetened beverages. It would also apply restrictions on food marketing, advertising and promotions as well as ban the sale of caffeinated energy drinks to under 16-year-olds. Exposure to fluoride should also be optimised through community water fluoridation and with more targeted programmes.
The report sets out proposals to maximise the impact of early years and education-based interventions, co-designed by health visitors, nurseries, and schools, and it calls for dental services to be re-orientated towards prevention of dental diseases among children and young people. Achieving this reorientation will require 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. In addition, better mechanisms for allocation and distribution of funding based on need alongside a renewed emphasis on clinical prevention is important.
The key role local government must play in reducing sugar consumption is outlined in the report, with many local authorities having their own strategies to reduce consumption of foods and drinks high in fat, sugar, and salt.
The report showcases interventions like Sheffield’s Sweet Enough, a five-year initiative commissioned by Sheffield City Council, and HABIT, a public health intervention to support health visitors and their wider team to have effective oral health conversations with parents in Bradford. It also highlights projects like the BRIGHT trial, Liverpool’s Smile Squad Initiative, and RAISED In Yorkshire.
Read the full report – “An evidence-based plan for improving children’s oral health with and through educational settings”
Find out more about the A country that works for all children and young people series
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 suffering with tooth decay. 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.
“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.”
Paula Waterhouse, President of the British Society of Paediatric Dentistry, 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.
“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.”
Professor 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.”
Dr Camilla Kingdon, Immediate Past President of the Royal College of Paediatrics and Child Health, said:
“I am really thrilled with this report because the state of our children’s teeth should be a source of national embarrassment. The impact of poor oral health stretches way beyond childhood and so every one of us should see this as a key health promotion and disease prevention strategy that benefits the whole nation.”
Report co-author Zoe Marshman, Professor of Dental Public Health at the University of Sheffield, said:
“Treatment for tooth decay is the most common reason why young children – over 33,000 youngsters each year – are admitted to hospital, costing the NHS over £50 million every year.
“In deprived areas of the country up to 50 per cent of five-year-olds have tooth decay which causes pain and suffering, as well as affecting what children eat, their speech, sleep, quality of life and attendance at school.
“This report shines a spotlight on the impact of poor dental health on children’s lives and recommends a new national strategy to focus attention on providing much needed solutions.”
Dr Camilla Kingdon, Immediate Past President of the Royal College of Paediatrics and Child Health, said:
“I am really thrilled with this report because the state of our children’s teeth should be a source of national embarrassment. The impact of poor oral health stretches way beyond childhood and so every one of us should see this as a key health promotion and disease prevention strategy that benefits the whole nation.”
Report co-author Peter Day, Professor of Paediatric Dentistry, University of Leeds and Community Dental Service, Bradford District Care NHS Foundation Trust said:
“As a paediatric dentist, I see the impact of tooth decay on children every day in my clinic. There is still much to do. This report lays out strong evidence for what works. We need to reorient and coordinate national and local public services towards prevention and ‘turn the taps off.’ All children deserve the best start in life, and this includes having a healthy set of teeth.”
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