National Dental Epidemiology Programme (NDEP) for England: oral health survey of 5 year old schoolchildren 2024

Question 1

Summary

Accepted Answer

This report presents the results of the seventh National Dental Epidemiology Programme oral health survey of 5 year old schoolchildren in England in 2024. The data was collected during the 2023 to 2024 school year. This data is the source for the dental indicator (percentage of 5 year olds with visually obvious dentinal decay) included in the Public Health Outcomes Framework.

For the second time in this series of surveys on 5 year olds, the prevalence of children with enamel decay is presented. This is an important threshold to highlight the proportion of children who are found to have early stage decay who would ordinarily be counted as being free of obvious decay. This is presented at national and regional levels. Estimates at national, government region, NHS region, integrated care board (ICB) and local authority levels are reported for the prevalence and severity of experience of dentinal decay in primary (baby) teeth. Experience of dentinal decay refers to teeth with visually obvious dentinal decay, and teeth that are missing, or that have been filled due to decay. Severity of dentinal decay refers to the number of teeth with decay experience.

The average age of the schoolchildren who participated in the survey was 5.5 years.

In this survey of 5 year olds in England, the national prevalence of children with enamel and/or dentinal decay was 26.9%. Regionally, this ranged from 23.3% in the East of England to 36.8% in the North West.

Overall, 22.4% of 5 year old schoolchildren in England in this survey had experienced dentinal decay in their primary dentition. This was lower than the finding of the previous survey of 5 year old schoolchildren in 2022, where 23.7% of the surveyed children had experience of dentinal decay. Among the 22.4% of children with experience of dentinal decay, each child had on average 3.5 teeth with decay experience (at age 5 years, children normally have 20 primary teeth).

There was wide variation in both prevalence and severity of experience of dentinal decay by geographical area. At a regional level, 5 year old schoolchildren living in the North West were most likely to have experienced dentinal decay (28.7%). At upper tier local authority level Brent had the highest experience of dentinal decay (43.4%).

Children living in the most deprived areas of the country were more than twice as likely to have experienced dentinal decay (32.2%) as those living in the least deprived areas (13.6%). There were also disparities in the percentage of those who had experienced dentinal decay by ethnic group, which was significantly higher in the Other ethnic group (45.4%) and the Asian or Asian British ethnic group (37.7%).

There had been a decrease in the prevalence of experience of dentinal decay in 5 year old schoolchildren from 30.9% in 2008 to 23.3% in 2017, but there had been no continuation of this improvement in 2019 nor 2022. However, there has been a small decrease in this latest survey from 23.7% in 2022 to 22.4% in 2024. Inequalities in prevalence of experience of dentinal decay in 5 year old schoolchildren significantly reduced from 2008 to 2015 but there has been little change in inequalities since then.

Poor oral health impacts on children and families. It affects children’s ability to eat, smile and socialise and causes pain and infection with days missed at school, and parents’ work, to attend a dental service to receive care. Dental decay is largely a preventable disease.

The cause of dental decay is well understood and is related to eating and drinking sugary food and drinks. Hence the majority of dental decay is preventable.

Local authorities are responsible for improving the oral health of their populations as set out in the Health and Social Care Act 2012. This report provides data that may be used in joint strategic needs assessments and oral health needs assessments to plan, commission and evaluate oral health improvement interventions and dental services. The Office for Health Improvement and Disparities (OHID) and the National Institute for Health and Care Excellence (NICE) have published documents to support local authorities in these activities:

Full tables of results from the survey are available from the oral health survey of 5 year old schoolchildren data tables. The survey results are official statistics and are compliant with the Code of Practice for Statistics.

Question 2

Introduction

Accepted Answer

This report presents the results of the National Dental Epidemiology Programme oral health survey of 5 year old schoolchildren attending mainstream, state-funded schools. The fieldwork was undertaken during the 2023 to 2024 school year. The National Dental Epidemiology Programme is a programme of annual oral health surveys. The surveys are coordinated by the Office for Health Improvement and Disparities (OHID) in the Department of Health and Social Care (DHSC). Responsibility for commissioning the surveys lies with upper tier local authorities, as set out in The NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012 No. 3094.

Information from the surveys is vital to inform oral health needs assessments at a local level. Integrated care boards and local authority commissioners use the information as part of the commissioning cycle when planning and evaluating local health services and health improvement interventions.

This is the seventh national survey of the oral health of 5 year old schoolchildren in England. It was conducted to standards set by the British Association for the Study of Community Dentistry (BASCD)^{[footnote 1]}^{[footnote 2]}^{[footnote 3]}. These standards help to ensure the quality and generalisability of the findings of the surveys. The local authorities that participated in this survey commissioned dental providers to undertake the fieldwork according to a national protocol.

Question 3

Method

Accepted Answer

The survey was undertaken during the 2023 to 2024 school year and according to a national protocol. The methods and standards used in this survey were the same as those used in previous national surveys of this series, facilitating comparison of results over time.

The survey population was schoolchildren who had reached the age of 5 years but not yet had their sixth birthday on the day of examination. The sampling frame was children attending mainstream, state-funded schools. The sampling unit was local authority boundaries at unitary, metropolitan or lower tier level. The minimum sample size was 250 children. Random samples of schools were drawn for each local authority in England according to the survey protocol. In some local authority areas larger samples were drawn at the request of commissioners to facilitate statistically robust analysis at smaller geographical levels below local authority areas, such as ward level.

Sampled schools were contacted to seek their co-operation and age-eligible children were selected and invited to participate in the survey. Written agreement from a person with parental responsibility was obtained before any child could participate in the survey.

Data was collected by trained and calibrated clinicians who were typically employed by NHS trusts providing community dental services. The clinicians were calibrated for dental decay and standardised for the proxy measure for oral hygiene. Calibration is an exercise that assesses whether individual dental examiners have reached an accepted level of comparability with others on the presence or absence of signs of oral disease. Standardisation is a process where groups of dental examiners are trained by experienced clinicians to reach a collective understanding and agreement on what constitutes the presence or absence of a condition as defined in the survey’s protocol.

A visual-only examination method was used. Visually obvious decay into dentine was the measurement threshold in line with BASCD criteria. Visually obvious decay is the widely accepted threshold in the literature for dental surveys. However, it provides an underestimate of the true prevalence and severity of disease as it does not capture earlier stages of decay. The presence of severely decayed teeth was measured in the primary teeth using the pufa index, which stands for:

presence of severely decayed teeth with visible pulpal involvement (p)
traumatic ulceration caused by tooth fragments (u)
fistula (f)
abscess (a)

The presence of dental plaque on the upper anterior (front) teeth was recorded to assess oral hygiene.

The ethnic groups used reflected those used in the 2021 national population census. Unlike in the 2021 national population census, clarification was not sought from those who identified as ‘Other’ ethnic group. Assumptions have been made that the ethnicity profile of those from ‘Other’ ethnic group are similar to those found in the response for the 2021 national population census.

Data was collected using a tailor-made data collection format in Microsoft Access. Electronic files of the raw, anonymised data were uploaded to a secure channel on a shared Microsoft Teams site by regional dental epidemiology coordinators. The data was collated, checked and cleaned by the national dental public health team in OHID. Record-level data was assigned to lower super output areas based on home postcode and Index of Multiple Deprivation 2019 (IMD 2019) scores and ranks were added.

The data was weighted by deprivation quintiles. Deprivation quintiles divide the population into fifths according to levels of deprivation. The weighted data was then analysed using simple descriptive statistics. The sampling method used for this survey was school based and therefore not truly representative of the population of 5 year old children by IMD quintile. Thus, the sample was treated as a stratified random sample, but the sampling probability varied between IMD quintiles. For this reason, IMD-weighted estimates were produced to provide more robust estimates of overall prevalence.

For the main findings, 95% confidence intervals (CI) have been reported. This is the range of measures in which we can be 95% confident that the true value lies. Confidence intervals for percentages have been calculated using the Wilson Score method. Error bars indicating 95% confidence intervals have been included on charts where appropriate.

Median values together with the interquartile range (IQR) have been presented where appropriate.

Data is not reported where there were fewer than 30 participants in a geographical area.

In this report, the term dentinal decay indicates the presence of visually obvious tooth decay into dentine and excludes enamel decay. The term experience of dentinal decay includes teeth with visually obvious decay into dentine and teeth that are missing, or that have been filled, due to decay. Severity of dentinal decay refers to the number of teeth with decay experience. In previous publications in this survey series, the term ‘dental decay’ was used to indicate dentinal decay.

Question 4

Results

Accepted Answer

Results from the survey at national, regional and upper tier local authority level are presented below. Full data tables of results are available at national, government region, NHS region, ICB and local authority levels and are published in this report.

England values are represented in the charts by an orange bar. All charts are derived from the published data tables. Data pertaining to specific charts can be sent on request to dentalphintelligence@dhsc.gov.uk

Participation in the survey

In total, 130 out of 153 upper tier local authorities commissioned the survey. Reasons for not commissioning the survey included a lack of providers to undertake the fieldwork.

Map 1 below shows estimates are available for 128 upper tier and 229 out of 296 lower tier local authorities. Eighty-four per cent of responding upper tier and 66% of responding lower tier local authorities achieved the target sample size of 250 children.

In the South East only 3 out of 19 upper tier local authorities participated and in Yorkshire and The Humber 9 out of 15 upper tier local authorities participated. Hence regional level estimates for these areas should be interpreted with this in mind. The results for the South East region have not been included in regional comparisons in the text of this report. However, they have been included in regional maps and charts.

Map 1: participation in the survey in England by lower tier local authority, 2024.

Data from 81,905 5 year old schoolchildren was linked to geographical area level deprivation data and included in the final analysis. This represented 13% of the England population for this age cohort. This was an increase from the sample size in the previous survey in 2022, when 62,649 children (9% of the population) were examined.

In the areas where there was at least one examination, the overall proportion of children sampled and who were examined (participation rate) was 60%, ranging from 55% in the West Midlands to 66% in the North West. It is likely that non-response bias applies and should be considered when drawing conclusions.

Approximately 1% of children with parental agreement to participate refused to take part on the day of examination. Absenteeism accounted for a loss of approximately 4% of children with parental agreement to participate.

The average age of the schoolchildren who participated in the survey was 5.5 years. A similar proportion of boys and girls were examined.

Of the children examined, 70% were from the White ethnic group, 12% were from the Asian or Asian British ethnic group, 5% were from the Black, Black British, Caribbean or African ethnic group, 5% were from the Mixed ethnic group, 2% were from the Other ethnic group and for 5% the ethnic group was unknown. These proportions were similar to those of the general population of 5 year old schoolchildren in England.

The deprivation profile of the survey participants was also similar to the general population of 5 year old schoolchildren in England.

Prevalence of enamel and dentinal decay

The prevalence of enamel decay is being reported for the second time in the National Dental Epidemiology Programme. It is important to look at enamel decay as it is possible to implement preventive measures to help halt the progression of enamel decay to dentinal decay and prevent these children from needing invasive dentistry to restore loss of tooth structure in the future. It is especially important to determine the proportion of children with enamel decay who do not yet have dentinal decay, as in the past, children were often regarded as ‘free of decay’.

Taking into account children with any visually obvious decay (enamel or dentinal), almost a third of children were found to have experience of decay (26.9%) in England and this varied by region. The East of England (23.3%) had the lowest prevalence and the North West had the highest prevalence (36.8%) (figure 1 and table 5 in the data tables). At upper tier local authority level, prevalence of experience of dental decay (enamel or dentinal) ranged from 12.1% in Wiltshire to 60.8% in Manchester (table 7 in the data tables).

Figure 1: children with any obvious decay: prevalence of enamel decay and/or dentinal decay experience in 5 year old schoolchildren in England by region, 2024.

Note: regional estimates include 3 of 19 local authority areas in the South East and 9 of 15 local authority areas in Yorkshire and The Humber. Error bars represent 95% confidence intervals.

In surveys prior to 2022, only data for dentinal decay was presented. Children without obvious dentinal decay experience were considered to be free of decay at this threshold. The recording of obvious enamel decay allows for a consideration of what proportion of 5 year old schoolchildren have obvious decay restricted to an earlier stage where preventive management is indicated. When considering such children with no obvious signs of dentinal decay experience, the prevalence of enamel decay only was 4.6% in England. There was variation across the regions. London had the lowest prevalence (2.6%) and the North West had the highest prevalence (8.1%) (figure 2 and table 5 in the data tables). At upper tier local authority level, prevalence of experience of obvious enamel decay only ranged from 0.0% in several local authorities to 22.6% in Manchester (table 7 in the data tables).

Figure 2: prevalence of enamel decay in 5 year old schoolchildren with no dentinal decay experience in England by region, 2024.

Note: regional estimates include 3 of 19 local authority areas in the South East and 9 of 15 local authority areas in Yorkshire and The Humber. Error bars represent 95% confidence intervals.

Prevalence of experience of dentinal decay

In England, 22.4% of 5 year old schoolchildren surveyed had experienced dentinal decay. The prevalence was similar in girls (22.0%) and boys (23.4%). Prevalence varied regionally from 17.5% in the East of England to 28.7% in the North West (figure 3; map 2 and table 5 in the data tables).

Figure 3: prevalence of experience of dentinal decay in 5 year old schoolchildren by region, 2024.

Note: regional estimates include 3 of 19 local authority areas in the South East and 9 of 15 local authority areas in Yorkshire and The Humber. Error bars represent 95% confidence intervals.

Map 2: prevalence of experience of dentinal decay in 5 year old schoolchildren by region, 2024 (table 5 in the data tables).

At upper tier local authority level, prevalence of experience of dentinal decay ranged from 11.4% in Wiltshire to 43.4% in Brent (map 3 and table 7 in the data tables).

Map 3: prevalence of experience of dentinal decay in 5 year old schoolchildren by upper tier local authority, 2024.

Within regions, there was variation in the prevalence of experience of dentinal decay in 5 year old schoolchildren by upper tier local authority area (figure 4 and table 7 in the data tables). The greatest variation was in London, where the lowest prevalence was 16.6% and the highest was 43.4%.

Figure 4: range of experience of dentinal decay in upper tier local authority areas among 5 year old schoolchildren by region, 2024.

Note: regional estimates include 3 of 19 local authority areas in the South East and 9 of 15 local authority areas in Yorkshire and The Humber.

There was also variation in the prevalence of experience of dentinal decay at lower tier local authority level within each region (table 8 in the data tables).

Severity of experience of dentinal decay

The mean number of teeth per child with experience of dentinal decay in all children examined was 0.8 (95% CI 0.77 to 0.80). The median number of teeth with decay experience was 0 (interquartile range 0 to 0), which was to be expected, as 77.6% of children surveyed had not experienced dentinal decay. The severity of experience of dentinal decay was similar in girls 0.8 (95% CI 0.75 to 0.79) and boys 0.8 (95% CI 0.81 to 0.85).

There was little variation in the severity of experience of dentinal decay between the regions (table 1 below).

There was variation in the severity of experience of dentinal decay at upper tier local authority level, ranging from a mean of 0.3 teeth per child (95% CI 0.18 to 0.43) in Wiltshire to 1.8 teeth (95% CI 1.63 to 2.02) in Bradford (table 7 in the data tables).

There was also variation in the severity of experience of dentinal decay at lower tier local authority level (table 8 in the data tables).

In the children who had experienced dentinal decay, the mean number of teeth with decay experience was 3.5 (95% CI 3.47 to 3.55) and the median was 2 (interquartile range 1 to 5) (table 1 below).

At regional level there was little variation in severity of experience of dentinal decay among children with decay experience (table 1 below).

At upper tier local authority level the variation was greater, ranging from 2.5 (95% CI 1.75 to 3.21) teeth in Rutland to 5.1 (95% CI 3.70 to 6.56) in Southend-on-Sea (table 7 in the data tables).

There was also variation in the severity of experience of dentinal decay among 5 year old schoolchildren with any decay experience at lower tier local authority level (table 8 in the data tables).

Table 1: mean and median number of teeth with experience of dentinal decay in 5 year old schoolchildren, by region 2024.

Region name	Mean number of teeth with decay experience in all examined children (95% confidence intervals in brackets)	Mean number of teeth with decay experience in children with any decay experience (95% confidence intervals in brackets)	Median number of teeth with decay experience in children with any decay experience (interquartile range in brackets)
North East	0.8 (0.74-0.81)	3.4 (3.31-3.53)	2 (1-5)
North West	1.1 (1.07-1.15)	3.9 (3.76-3.97)	3 (1-5)
Yorkshire and The Humber	1.1 (0.99-1.14)	3.9 (3.70-4.06)	3 (2-6)
East Midlands	0.8 (0.72-0.79)	3.5 (3.39-3.63)	2 (1-5)
West Midlands	0.7 (0.68-0.75)	3.3 (3.17-3.37)	2 (1-4)
East of England	0.6 (0.56-0.62)	3.4 (3.23-3.49)	2 (1-4)
London	1.0 (0.97-1.06)	3.7 (3.58-3.82)	3 (1-5)
South East	0.7 (0.59-0.75)	3.5 (3.19-3.73)	2 (1-5)
South West	0.7 (0.63-0.73)	3.5 (3.29-3.63)	2 (1-5)
England	0.8 (0.77-0.80)	3.5 (3.47-3.55)	2 (1-5)

Note: regional estimates include 3 of 19 local authority areas in the South East and 9 of 15 local authority areas in Yorkshire and The Humber.

Untreated dentinal decay

The majority of experience of dentinal decay in this age group was untreated. On average, children with any experience of dentinal decay had 2.9 (95% CI 2.82 to 2.90) primary teeth with obvious untreated decay. At regional level the average number of primary teeth with obvious untreated decay ranged from 2.5 (95% CI 2.41 to 2.61) in the North East to 3.3 (95% CI 3.16 to 3.36) in the North West (figure 5 and table 5 in the data tables). The number of teeth with untreated dentinal decay ranged from 1 to 20 and the median was 2 (interquartile range 1 to 4).

Figure 5: mean number of teeth with experience of dentinal decay among 5 year old schoolchildren with any decay experience by region, 2024.

Note: regional estimates include 3 of 19 local authority areas in the South East and 9 of 15 local authority areas in Yorkshire and The Humber. Error bars represent 95% confidence intervals for the whole bar.

The care index

The care index is the proportion of teeth with experience of dentinal decay that have been treated by filling.

The care index in England was 10.5%. There was regional variation from 7.3% in the West Midlands to 15.9% in London (figure 6 and table 5 in the data tables).

Caution should be taken in making any assumptions about the extent or the quality of clinical care available when using the care index.

Figure 6: care index in the teeth of 5 year old schoolchildren by region, 2024.

Note: regional estimates include 3 of 19 local authority areas in the South East and 9 of 15 local authority areas in Yorkshire and The Humber. Error bars represent 95% confidence intervals.

Teeth extracted due to decay

In England, 1.8% of 5 year old schoolchildren had a decayed tooth extracted. Extraction of teeth in young children usually involves admission to hospital and a general anaesthetic. The majority (81.4%) of 5 year old children’s decayed teeth across England were untreated, however, 8.1% of the decayed teeth had been extracted because of decay. At a regional level this ranged from 4.3% in East of England to 17.1% in the North East (figure 7 and table 5 in the data tables).

Figure 7: proportion of teeth with experience of dentinal decay that have been extracted in 5 year old schoolchildren by region, 2024.

Note: regional estimates include 3 of 19 local authority areas in the South East and 9 of 15 local authority areas in Yorkshire and The Humber. Error bars represent 95% confidence intervals.

Experience of dentinal decay by level of deprivation

Inequalities in oral health in England have previously been highlighted as a public health problem. In 2023 to 2024 5 year old schoolchildren living in areas categorised as the most deprived fifth of the country were more than twice as likely to have experienced dentinal decay (32.2%) as those in the least deprived fifth of the country (13.6%) (figure 8 and table 10 in the data tables). Of those children with experience of decay living in the least deprived areas, they had a mean number of teeth with experience of dentinal decay of 2.8 (95% CI 2.70 to 2.92). This was compared to 3.9 (95% CI 3.84 to 3.99) for those living in the most deprived areas.

Figure 8: prevalence of experience of dentinal decay in 5 year old schoolchildren, 2024 by national IMD 2019 quintiles.

Note: error bars represent 95% confidence intervals.

Area deprivation explained 46.5% of the variation in prevalence of experience of dentinal decay in 5 year old schoolchildren (figure 9 and table 10 in the data tables). To explain this further, the direction of the slope in figure 9 illustrates that there is a positive association between decay experience and deprivation. As deprivation increases, so does decay experience. However, the scatter of points above and below the line in figure 9 show that decay experience is not perfectly correlated with (or explained by) deprivation alone.

Figure 9: correlation between prevalence of experience of dentinal decay in 5 year old schoolchildren and IMD 2019 score by lower tier local authority areas, 2024.

The slope index of inequality (SII) measures the difference in a health outcome between people living in the most deprived and the least deprived areas of the country and is a measure of absolute inequalities. Where there is no inequality, the slope index will be zero. In 2024 the slope index of inequality for the prevalence of experience of dentinal decay in 5 year old schoolchildren was 24.9% (figure 10 and table 10 in the data tables). This was lower when compared to the previous survey in 2022, when the slope index was 27.7%.

The relative inequalities index (RII) is based on a ratio and is a relative measure of inequality. In 2024 the RII was 3.4 indicating that 5 year old children living in the most deprived areas were 3.4 times more likely to experience dentinal decay than those living in the least deprived areas (figure 10 and table 11 in the data tables).

Figure 10: slope index of inequality in the prevalence of experience of dentinal decay in 5 year old schoolchildren, 2024.

Note: 1 = most deprived, 10 = least deprived. Error bars represent 95% confidence intervals.

The SII can also be used to describe changes in the inequalities gap over time. Using this measure, there was a significant decrease in absolute inequalities in the prevalence of experience of dentinal decay in 5 year old schoolchildren from 2012 to 2015 (29.8% in 2012 and 25.9% in 2015), after which there was little change until the current survey in comparison to 2022 (27.7% in 2022 and 24.9% in 2024) (figure 11). However, significant inequalities still exist.

Figure 11: trend in slope index of inequality in the prevalence of experience of dentinal decay in 5 year old schoolchildren in England, 2008 to 2024.

In 2024, those living in the most deprived areas had 2.7 times greater prevalence of experience of dentinal decay compared to those living in the least deprived areas. This highlights the persistent and consistent social inequalities that have existed between 2008 and 2024 (figure 12).

Figure 12: inequality in the prevalence of experience of dentinal decay in 5 year old schoolchildren in England, 2008 to 2024.

Prevalence and severity of experience of dentinal decay by ethnic group

The prevalence of experience of dentinal decay in 5 year old schoolchildren varied by ethnic group and was significantly higher in the Other ethnic group (45.4%) and the Asian or Asian British ethnic group (37.7%) than for other ethnic groups (figure 13 and table 12 in the data tables).

Figure 13: prevalence of experience of dentinal decay in 5 year old schoolchildren by ethnic group, 2024.

Note: error bars represent 95% confidence intervals.

Among children with any experience of dentinal decay, children from the Other ethnic group (4.4 teeth 95% Cl 4.12 to 4.60) and the Asian or Asian British ethnic group (4.3 teeth 95% Cl 4.22 to 4.44) had on average more teeth with decay experience than children from any of the other ethnic groups (figure 14 and table 12 in the data tables).

Figure 14: mean number of teeth with experience of dentinal decay among 5 year old schoolchildren with any experience of dentinal decay in England by ethnic group, 2024.

Within the White ethnic group, children from the Gypsy and Irish Traveller ethnic group (58.9%), Roma ethnic group (46.8%) and Other White background (36.2%) had a greater prevalence of experience of dentinal decay than children from the White Irish ethnic group (11.8%) and White British ethnic group (17.7%) (figure 15 and table 13 in the data tables).

Figure 15: prevalence of experience of dentinal decay in 5 year old schoolchildren within the White ethnic group, 2024.

Note: error bars represent 95% confidence intervals.

Within the Asian or Asian British ethnic group, children from the Pakistani ethnic group (43.2%) and Other Asian background (41.4%) had a greater prevalence of experience of dentinal decay than children from the Chinese ethnic group (24.6%) (figure 16 and table 13 in the data tables).

Figure 16: prevalence of experience of dentinal decay in 5 year old schoolchildren within the Asian or Asian British ethnic group, 2024.

Note: error bars represent 95% confidence intervals.

There were no significant variations in prevalence of experience of dentinal decay within the Black, Black British, Caribbean or African ethnic group, the Mixed ethnic group and the Other ethnic group.

The severity of dentinal decay was similar in all ethnic sub-groups apart from in the White sub-group. Within the White ethnic group, children from the Gypsy and Irish Traveller ethnic group (2.6 teeth 95% CI 1.73 to 3.47) had an 80.8% greater severity of dentinal decay than children from the White British ethnic group (0.5 tooth 95% CI 0.51 to 0.53) (table 13 in the data tables).

Children from Asian or Asian ethnic groups and Other ethnic groups had higher prevalence of experience of dentinal decay compared to other ethnicity groups in both the most and least deprived quintiles in England (figure 17). This shows ethnic inequalities that exist can not be explained by deprivation alone.

Figure 17: prevalence of experience of dentinal decay in 5 year old schoolchildren by ethnic group within the most and least deprived quintiles, 2024.

Prevalence of experience of dentinal decay of incisor teeth

Decay affecting one or more incisor (front) teeth is usually associated with long term bottle use with sugar-sweetened drinks, especially when these are given overnight or for long periods during the day.

The prevalence of experience of dentinal decay of incisor teeth was 6.0% in England and varied by region. The East of England (4.8%) had the lowest and London had the highest (9.7%) (figure 18 and table 5 in the data tables).

Figure 18: prevalence of experience of dentinal decay affecting incisor teeth in 5 year old schoolchildren in England by region, 2024.

Advanced dental decay - prevalence of pufa signs

The pufa index reports on the clinical consequences of advanced dental decay. In this survey 1.8% of 5 year old schoolchildren had one or more pufa signs relating to their primary teeth. At regional level this ranged from 1.3% in the West Midlands to 3.3% in Yorkshire and The Humber (figure 19 and table 5 in the data tables).

Figure 19: prevalence of one or more pufa signs in 5 year old schoolchildren by region, 2024.

Note: regional estimates include 3 of 19 local authority areas in the South East and 9 of 15 local authority areas in Yorkshire and The Humber. Error bars represent 95% confidence intervals.

Prevalence of dental plaque in 5 year old schoolchildren

The presence of dental plaque is a consequence of poor oral hygiene and provides a proxy measure of children whose teeth are brushed poorly or rarely. Plaque was recorded at 3 different levels:

plaque covering up to one-third of the exposed labial tooth surfaces of the upper anterior sextant
plaque covering more than one-third but not more than two-thirds of the exposed labial tooth surfaces of the upper anterior sextant
plaque covering more than two-thirds of the exposed labial tooth surfaces of the upper anterior sextant

Dental plaque was recorded in 22.1% of 5 year old schoolchildren. This was more likely in boys (23.5%) than girls (20.9%). There was variation across the regions from 16.8% in the South West to 28.1% of children in Yorkshire and The Humber (figure 20 and table 5 in the data tables). Substantial plaque, that is plaque covering more than one-third of the exposed labial tooth surfaces of the upper anterior sextant, was recorded for 3.3% of all children (table 5 in the data tables).

Figure 20: prevalence of any amounts of plaque in 5 year old schoolchildren by region, 2024.

Note: regional estimates include 3 of 19 local authority areas in the South East and 9 of 15 local authority areas in Yorkshire and The Humber. Error bars represent 95% confidence intervals.

Trends in experience of dentinal decay

The same methods for agreement to participate in the surveys and application of weighting to the data have been used in the surveys since 2008. Since then, there has been a decrease in reported response rates (which was 66.8% in 2008). The reported response rate for this survey (59.5%) was similar to the previous survey in 2022 (61.2%). It is likely that non-response bias applies to this survey and the previous 6 surveys. Reference should be made to the response levels when making comparisons, particularly when the sample sizes are small and response levels are low. At a national level the data was a large sample size and broadly representative in terms of deprivation and ethnicity.

Nationally there has been a reduction in the prevalence in experience of dentinal decay of 5 year old schoolchildren from 2022 to 2024 (23.7% and 22.4% respectively), but there was no significant change in the severity of experience of dentinal decay in all children (0.8 and 0.8) and severity of experience of dentinal decay in those children with any decay experience (3.5 and 3.5 teeth). The prevalence of experience of dentinal decay of incisor teeth was also similar across the 2 surveys (6.6% and 6.0%), as was the severity of untreated dentinal decay in those children with any decay experience (3.3 and 2.9 teeth). The slope index of inequality reduced between the 2022 and 2024 survey (from 27.7% to 24.9%). The care index had increased from 7.4% to 10.5%.

From 2008 to 2017 there was a clear trend of significant improvement in prevalence of experience of dentinal decay in 5 year old schoolchildren in England. The prevalence of experience of dentinal decay decreased from 30.9% in 2008 to 23.3% in 2017. Nationally 2024 is the first year there has been a further change in oral health since 2017. At regional level there was a slight improvement in the East of England, North West and West Midlands in 2024 compared to 2022 (figure 21).

Figure 21: prevalence of experience of dentinal decay in 5 year old schoolchildren in England by region, 2008 to 2024.

Note: error bars represent 95% confidence intervals.

Question 5

Implication of results

Accepted Answer

Inequalities in the levels of experience of dentinal decay were found in 5 year old schoolchildren living in different life circumstances and from different ethnic backgrounds. There was also geographical variation in dentinal decay experience with children living in the north of England more likely to have experienced dentinal decay.

Across England, experience of dentinal decay was apparent in the primary teeth of more than 1 in 4 schoolchildren aged 5, and almost 1 in 2 in some areas. Children with experience of decay had on average between 3 and 4 affected teeth. The majority of the decay was untreated. Five year old schoolchildren living in the most deprived areas of the country were more than twice as likely to have experienced decay as those living in the least deprived areas and also more likely to have more severe decay.

This is the seventh survey of 5 year old schoolchildren across England since methodological changes were implemented in 2007 (to include the requirement to seek explicit parental agreement to participate in the survey). The first 3 surveys showed a clear trend for lowering levels of prevalence of experience of dentinal decay in this age group and a reduction in oral health inequalities from 2007 to 2015. The surveys in 2017, 2019 and 2022 did not demonstrate any further improvements in prevalence of experience of dentinal decay or inequalities, however this survey has shown a slight improvement in prevalence compared with 2022. Since 2015 there has been little change in inequalities.

Putting this information to use

Good oral health is fundamental to good general health and wellbeing. Poor oral health in children can result in pain and infection and lead to difficulties with eating, sleeping, playing and socialising. There are also significant costs on society associated with oral diseases, not least the costs of hospital admissions for tooth extractions. Dental decay is one of the most common causes of hospital admission in young children. These impacts and costs are mostly avoidable as dental decay is a preventable disease.

Of the 5 year old schoolchildren participating in the survey, 22.4% had experience of dentinal decay. Of these children 1.8% had one or more teeth extracted. Removal of decayed teeth, usually due to pain, will often require hospital admission and general anaesthesia. Longer term consequences are that children who have decay at an early age are likely to go onto develop decay in their permanent teeth and to enter a lifetime cycle of repair, which may lead to eventual tooth loss^{[footnote 4]}. A further study has shown that 40% of children with dentinal decay went on to experience toothache and infection^{[footnote 5]}. The strong link between dental decay and deprivation is well established.

Data from this survey will be used to update the dental indicator (percentage of 5 year olds with visually obvious dentinal decay) in the Public Health Outcomes Framework.

The cause of dental decay is well understood and is related to the frequent exposure of teeth to fermentable carbohydrates, most commonly through eating and drinking sugary snacks and drinks^{[footnote 6]}. Hence the majority of dental decay is preventable and the impacts and costs referred to above are mostly avoidable.

Local authorities, which have a responsibility to improve oral health, may use this information to inform needs assessments to plan and commission oral health improvement interventions to address the needs of their populations. OHID and NICE have published documents to support local authorities in these activities. As high frequency of consumption of sugar-containing food and drink is also a contributory factor to other issues of public health concern in children, for example, childhood obesity, interventions to tackle sugar consumption will benefit health beyond oral health.

ICBs, NHS England and commissioning organisations may use this information to inform the planning and commissioning of oral healthcare services.

Local authorities may also wish to seek dental public health advice about commissioning specific surveys or larger samples using this method to evaluate their interventions and gain more detailed information about the oral health of their populations.

Limitations of the survey

While the survey had almost 82,000 participants, 15% of upper tier local authorities did not commission the survey and 34% of lower tier local authority areas did not achieve the minimum sample size. As previously mentioned, more than three-quarters of the local authority areas in the South East and approximately a third of the local authority areas in Yorkshire and The Humber did not participate in the survey and regional estimates for these areas should be interpreted with this in mind. Nationally, the sample was largely reflective of the 5 year old schoolchildren population in terms of area deprivation and ethnicity.

A further limitation was that the survey did not recruit from the entire population of 5 year old schoolchildren. For example, children attending private schools were not included in the survey. The likelihood of bias from this is acknowledged but cannot be measured.

As with other National Dental Epidemiology Programme surveys, this survey required written parental agreement for children to participate. This has been shown to adversely affect participation rates, which may be lower for those children with higher levels of dental decay experience and those living in more deprived areas. Both factors could contribute to underestimation of the prevalence and severity of dentinal decay experience in this survey. It has been shown to be difficult to model the data to control for the effect of parental agreement to participation in the survey^{[footnote 7]}.

Accessing further data

Cleaned and verified copies of the raw, anonymised data will be available to local authority and NHS England staff, who can apply to become a super user and access the raw, anonymised data for specific purposes following the steps below.

Requestor to send an email to dentalphintelligence@dhsc.gov.uk providing the following information:

name of individual to be allocated as super user
geographical area for which data required
contact details

2. The nominated super user will be contacted by a member of the national dental public health team who will send a data sharing agreement for signing.

3. Once the signed agreement has been received and authorised, the super user will be sent their (anonymised) data along with a set of analysis guidance notes.

For any other data requests that are for national data or complex queries email dentalphintelligence@dhsc.gov.uk

Acknowledgements

We would like to thank all the children who participated in the survey and the school staff and fieldwork teams who made delivery of the survey possible.