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 findings also 
highlight growing impacts on quality of life, persistent inequalities and clear challenges 
in accessing dental services.

The survey was commissioned by the Office for Health Improvement and Disparities 
(OHID) within the Department of Health and Social Care (DHSC). It 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. The AOHS 2023 provides the first clinical 
picture of adult oral health in England for more than a decade.

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.

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.”