Latest research on England’s oral health reports increasing tooth decay and widening inequalities

New Official Statistics from the Adult Oral Health Survey (AOHS) 2023 show that tooth decay has risen sharply since the last survey in 2009, reversing earlier improvements and taking levels back towards those last seen in the late 1990s.

The survey was commissioned by the Office for Health Improvement and Disparities (OHID), within the Department of Health and Social Care (DHSC), providing the first clinical picture of adult oral health in England for more than a decade.

The AOHS 2023 was delivered by a consortium, led by the National Centre for Social Research (NatCen) and includes dental academics with experience of oral epidemiology from the Department of Dentistry at the University of Birmingham, the Faculty of Dentistry, Oral & Craniofacial Sciences at King’s College London, the School of Dental Sciences at Newcastle University, and the Dental Public Health Group at the Department of Epidemiology and Public Health at University College London.

Key findings:

• Four in ten adults with natural teeth had obvious tooth decay when examined (41%). This compares with 28% in 2009 and is similar to levels seen in 1998.
  
  
• Under a broader measure that includes enamel decay, nearly two thirds of adults (64%) had signs of decay.
  
  
• Impacts on daily life have increased. Four in ten adults (43%) reported that their oral health had negatively impacted on their daily life, a rise since 2009 when this was 33%.
  
  
• Almost one in five adults (19%) had at least one potentially urgent oral health condition, including dental pain, deep decay involving the pulp or one or more PUFA* sign.
  
  
• Very few adults now have no natural teeth. Only 2.5% reported having none, down from 6% in 2009.
  
  
• Regular dental attendance has fallen. Just over half (52%) of dentate adults said their usual reason for attending was a check-up (this was 61% in 2009), while 35% only go when having trouble with their teeth, mouth or dentures.
  
  
• Barriers to care were common among those attending infrequently, including being unable to find a dentist (40%), being unable to afford charges (31%) and not perceiving a need to go (27%).

• Stark inequalities persist. Adults in more deprived areas had higher levels of disease, more pain, worse quality of life and were less likely to attend a dentist regularly than those in more affluent areas.

Dr Vahid Ravaghi, Assistant Professor in Dental Public Health at The University of Birmingham, said:

“These findings are particularly disappointing given that most dental conditions can be prevented. There are stark differences in dental health related to relative wealth. Those from more deprived backgrounds suffer a ‘double whammy’ of greater risk of disease coupled with greater difficulty in accessing dental care.

“Tooth decay remains a real problem for adults and, as well as improving access to basic dental care, we need to find public health approaches that reduce the burden of this disease such as further extension of water fluoridation across England.”

Franziska Marcheselli, Research Director at the National Centre for Social Research said: “Adults in England are keeping more of their natural teeth for longer, but today’s findings show that tooth decay has risen again and is now more common than it was in 2009. The findings underline the importance of prevention and better access to dental care, particularly for those facing the greatest disadvantage.”

George Tsakos, Professor in Dental Public Health at UCL, said: “These findings are deeply alarming. Earlier oral health gains have been reversed, and we are now back to the levels of untreated tooth decay last seen in 1998. More adults are reporting that the poor state of their teeth and mouth is affecting their quality of life, such as causing difficulty eating, than in previous surveys."

The survey also shows that adults in more deprived areas are suffering disproportionately higher levels of oral disease, reporting levels of pain up to three times higher and worse quality of life due to their oral health. At the same time, they are also finding it harder to get a dental appointment than those in more affluent areas.

This presents a considerable public health challenge and is an area that we need to look at as a priority. Decay is caused by sugar, and we need prevention strategies which address that such as the recent planned extension of the sugar levy to high-sugar drinks including milk-based drinks.

Since 1968, the UK national decennial dental surveys have been an important source of information for national and local policymakers. Academics from the University of Birmingham School of Dentistry have played a key role in developing, planning, and implementing these surveys since. The AOHS 2023 was supported by Dr Alexander John Morris, a Senior Lecturer in Dental Public Health, and Dr Vahid Ravaghi, Assistant Professor in Dental Public Health.