Deprivation continues to shape children’s oral health across England
The Care Quality Commission’s latest State of Care 2025/26 assessment paints a familiar but still troubling picture: children in England are not sharing equally in improvements to oral health, and deprivation continues to track closely with disease. Five-year-olds living in the most deprived areas had a decay prevalence of 32%, more than double the 14% seen in the least deprived areas. The regulator’s review pulled together national data showing that the gap is visible not only in disease prevalence, but also in the need for hospital treatment and the ability to reach NHS dentistry in the first place.
The numbers are stark because they describe disease at the point where prevention should still be doing most of the work. By age five, primary teeth have already been exposed to years of dietary sugar, variable fluoride protection, delayed attendance, and uneven preventive advice. When decay is already affecting nearly a third of children in the poorest communities, the result is not just a clinical issue in the mouth; it becomes a marker of broader social exposure, missed prevention, and unequal access to routine care.
Across England, around 22% of five-year-olds had visible signs of decay. Advanced decay affected 3.7%, while 1.8% showed signs of severe dental infection. Across integrated care board areas, prevalence ranged from 12% to 33%, a spread that suggests geography still shapes oral health in ways that should not be tolerated in a national system built around universal access.
Hospital extractions remain concentrated in the poorest communities
The burden of preventable disease does not stop at diagnosis. Decay-related tooth extractions were reported at 403 per 100,000 children and young people in the most deprived areas, compared with 121 per 100,000 in the least deprived. This is the downstream expression of untreated caries: pain, infection, repeat visits, and eventual surgery when restorative pathways have failed or never become available in time.
Recorded extractions rose from 31,165 in 2022/23 to 33,976 in 2024/25, an increase of 9%. For paediatric services, those figures matter because dental extraction under hospital care is rarely a trivial event. It often means general anaesthesia, time away from school and work, and a family already navigating barriers that were present long before the child reached theatre. Preventable oral disease remains a major contributor to hospital activity among children and young people, and the pattern described in the CQC review suggests that the clinical pressure is being generated far from the operating room.
A one-sentence reality sits underneath those figures: the children most likely to need hospital extraction are also the children least likely to have had early, regular, preventive dentistry.
NHS dental recovery has not erased access gaps
NHS dental activity did recover across 2025/26, with 37.6 million courses of treatment delivered, up from 35.4 million the year before. Even so, activity remained below the 38.8 million recorded in 2019/20, indicating that the system has not yet returned to its pre-pandemic level of throughput.
Nearly 7.2 million children were seen within the previous 12 months, representing 60% of England’s child population. On its face, that sounds substantial. In practice, the remaining 40% is the population most exposed to drift in preventive care, delayed diagnosis, and reliance on urgent rather than routine appointments. Access also varied between integrated care board areas, reinforcing the point that national averages can conceal sharp local shortfalls.
The regulator also identified uneven provision of registered dental locations, with lower densities in several rural or mixed rural areas. Limited local provision can work through several mechanisms at once: fewer appointment slots, longer travel times, reduced continuity with a known practice, and a lower likelihood that families with competing demands will complete the journey to care. In paediatric dentistry, those barriers have a cumulative effect because small delays in primary teeth can allow disease to progress rapidly.
Why the disease gap persists despite service recovery
The CQC’s findings point to a structural problem rather than a single failure point. Deprivation is associated with higher caries risk through a cluster of linked factors: higher sugar exposure, less consistent fluoride use, lower uptake of routine care, and more difficulty securing timely appointments. When NHS activity increases but access remains uneven, the system can generate more treatment without necessarily reaching the children who need prevention earliest.
Baroness Julia Neuberger said improvements are not keeping pace with demand everywhere, and that the same people and places often carry the consequences when care falls short. Her comments fit the data closely. In oral health, inequalities are rarely subtle. They appear in the gradient between 32% and 14%, in the hospital extraction rates, and in the spread of prevalence between ICB areas that ranges from 12% to 33%.
The report also included examples of local attempts to widen access, including one practice that opened on Saturdays for a month so working parents could register children for NHS treatment, then extended the initiative after strong demand. Small operational changes like weekend access can matter because they reduce the practical barriers that keep families out of routine care. For parents balancing work, transport, and childcare, a weekday-only model can be enough to postpone registration until decay becomes symptomatic.
The CQC is describing a prevention failure as much as a service failure
Oral health in childhood is often treated as a narrow dental issue, but the data in this assessment show a broader pattern of inequality. A child who reaches age five with visible decay has already passed through several missed opportunities for prevention, and when that child comes from a deprived area, the chance of progression to infection or extraction is materially higher. The increase in hospital extractions suggests that the burden is still being transferred from community prevention to secondary care.
What remains unresolved is not the existence of the gap but how quickly the service model can narrow it. The CQC has assembled evidence of disease, hospital treatment, and access pressure in one assessment, and the pattern is coherent: prevalence is higher where deprivation is deeper, extractions are more common where decay is more advanced, and dental availability remains uneven where geography is less forgiving. Closing those gaps will require more than aggregate recovery in activity; it will depend on whether access, prevention, and local distribution of services finally align for the children most at risk of being left behind.