Tooth decay and deprivation: children from poorer areas of England far more likely to have rotten teeth

Children living in the poorest parts of England were 3.5 times more likely to have rotten teeth removed than those in more affluent areas last year, with dental experts warning the cost of living crisis is preventing some from accessing basic oral hygiene products like toothpaste and toothbrushes.

The British Dental Association (BDA) said the inequality between deprived children and dental care is set to widen due to the deepening crisis and that it was going “unchallenged”.

Tens of thousands of children had teeth removed in hospital last year because of decay, with deprived areas being the worst affected. In the 12 months to March 2022, more than 10,000 children and young adults (aged between 0 and 19) in the most deprived parts of the country had rotten teeth removed, representing a rate of 329 per 100,000 children, according to data published by the Office for Health Improvement & Disparities (OHID). In comparison more than 2,000 had similar extractions in the most affluent parts, representing a rate of 95 per 100,000 children. Over the course of the year nearly 27,000 children had decaying teeth removed.

The BDA recently reported that some school children were going without regular access to toothpaste and that teachers and schools had been providing students with toothbrushes and toothpaste. They said children were being socially excluded by their peers because of oral hygiene issues, with some even missing school. The Department of Health and Social Care (DHSC) said it was investing in NHS dentistry and was aware of the issue.

‘None of this is inevitable’

“Tooth decay is still going unchallenged as the number one reason for hospital admissions among young children,” Eddie Crouch, chair of the BDA said. "Decay and deprivation are going hand in hand, and this inequality is set to widen. None of this is inevitable. This government needs to be willing to take off the gloves when it comes to fighting a wholly preventable disease."

The total figures are an 83% increase on the previous year’s figures when almost 15,000 children had rotten teeth removed, however this was during the height of the coronavirus pandemic when access to health services was limited. The government said the increase is likely to reflect a partial recovery of hospital services following Covid.

Dental Nurse Karen Coates, spokesperson for The Oral Health Foundation added that the effects of fluoride could be “instrumental in closing the gap between affluent and more deprived areas and reducing dental inequalities”.

She said: “It is an unfortunate fact that social-economic status still currently affects the health of people’s teeth. The Oral Health Foundation recognises the safety and efficacy of fluoride for oral health benefits, it could really help to stop this great disparity. This can be utilised whether this is through water fluoridation schemes, dental products, fluoride added to salt or milk or naturally found in foods and drinks.”

Areas in England with highest rates of rotten teeth among children

The figures also show a stark geographical divide with regions in the north of the country having much higher rates than regions in the east and south.

Yorkshire and the Humber had the highest rate with 378 per 100,000 children, followed by the North East and North West with 369 and 312 per 100,000 respectively. The Midlands and East of England had some of the lowest rates in the country.

At a local level more children had rotting teeth removed in Sheffield than anywhere else in England. The local authority had 1,145 extractions, equating to 882 in every 100,000 children undergoing a tooth extraction for decay. The top nine authorities with the highest rates were all found in Yorkshire and the Humber and the North East and North West.

What has the government said?

A government spokesperson said it was aware tooth decay is linked to deprivation and that action was being taken to level up the country.

The spokesperson for the DHSC  said: “Good oral health is incredibly important and the number of children seen by NHS dentists increased by 44% in the last year. Likewise in hospitals we have seen an increase in hospital operations for tooth extraction for those aged 0-19 as oral healthcare services continue to recover from the pandemic.

“The number of dentists increased by over 500 last year and the government is investing more than £3 billion in NHS dentistry so people can access services when they need them.”