There is a wide variation at both regional and local authority level for both prevalence and severity of dental decay.

That's according to the latest Child Oral Health Survey from Public Health England, which reveals deep inequalities show little sign of narrowing.

Now the British Dental Association (BDA) says local and national government in England can no longer ignore the tooth decay crisis,

While there have been welcome improvements in overall decay levels, data shows almost a 20-fold difference in severity between the local authorities with the best and worst outcomes – with five-year-olds in Pendle having on average 2.3 decayed, missing or filled teeth, compared to just 0.1 for those in Waverley, 5.1% of young children in Waverley have decay, compared to 49.4% in Pendle.

Dentist leaders have expressed concern that authorities in England have failed to follow the lead set by devolved governments to bring supervised brushing to schools and nurseries – when elements of these programmes have been borrowed by governments from Chile to Israel.

The Childsmile (Scotland) and Designed to Smile (Wales) programmes contain a range of universal and targeted interventions, have been huge successes, and have shaved millions off NHS treatment costs.

The BDA advocates a coherent and appropriately funded strategy to bridge the inequalities gap and urges greater effort from both local and national government.

The report illustrates the difference early interventions can make. Leicester's pioneering Healthy Teeth, Happy Smiles, has not received any dedicated investment from central government but has secured significant reductions in decay rates. It offers supervised tooth-brushing sessions in nurseries, free oral health packs for pre-schoolers, education programmes and tooth-friendly bottle swaps.

The Conservatives pledged to act on child oral health inequalities in their 2017 manifesto. The BDA has dubbed the recently launched programme in England 'Starting Well' as 'second-rate', as it has no new funding attached and activities are limited to a handful of wards in 13 English local authorities. Nearly two years after it was conceived the government says that no children have yet benefited from it.

170 children and teenagers in England are undergoing tooth extractions under general anaesthesia in hospitals in England every day. This costs £36 million a year – and the number of operations have increased by 17% since 2012.

BDA Chair Mick Armstrong said: 'It's a tragedy that a child's oral health is still determined by their postcode and their parents' incomes.

'We should not accept that a child raised in Pendle will enter primary school with 20 times the levels of decay as one born in the Surrey home of the Health Secretary. Sadly while cavities are almost wholly preventable, official indifference means this inequality gap shows little sign of narrowing.

'To date, England has seen little more than token efforts from Ministers, and not put in a penny of new money. In the face of austerity some farsighted councils have made big strides, but their successes are not being bottled or shared.

'The NHS will keep spending millions extracting baby teeth in overstretched hospitals until policymakers step up and grasp the nettle. When programmes and policies designed in Britain have become the envy of the world, it's perverse that children in England are not benefiting from them.'

Top 10 worst child tooth decay rates

	% children with decayed, missing or filled teeth
Pendle	49.4
Rochdale	47.1
Burnley	46.5
Hyndburn	45.8
Salford	44.6
Manchester	43.0
Blackburn with Darwen	42.6
Knowsley	42.3
Slough	41.5
Boston	41.0

Top 10 best child tooth decay rates

	% children with decayed, missing or filled teeth
Horsham	4.4
Waverley	5.1
Guildford	5.5
Basingstoke and Deane	5.7
Uttlesford	7.4
Test Valley	7.9
Mole Valley	8.0
South Cambridgeshire	8.1
Wealden	8.3
Eastleigh	8.7

Author: Julie Bissett