23 councils where children's tooth decay is significantly worse than England's and a smaller share of children see an NHS dentist
NHSBSA's 2025/26 dental statistics, published on 27 August 2026, show 7.17 million children seen by an NHS dentist in the year to March 2026, 60% of all children and the highest number in the seven years the series covers. Here is who is still missing. Set council by council against the national survey of 5-year-olds, NHS dental contact for children does not rise where decay is highest. In 23 councils, home to about 1.6 million children, decay in the 2023/24 survey is significantly worse than England's and the share of children seen in the year to March 2026 is below England's 58.9%.
Key findings
- 35.1% of 5-year-olds in England's most deprived tenth of neighbourhoods have decay experience, 2.7 times the 12.8% in the least deprived (OHID, 2023/24).
- 49.4% of children in the most deprived tenth saw an NHS dentist in the year to March 2024, against 60.4% in the least deprived. By March 2026 the gap had narrowed, to 54.6% against 62.0% (NHSBSA).
- 23 councils, home to about 1.6 million children, have decay significantly worse than England's 22.4% (2023/24 survey) and a smaller share of children seen than England's 58.9% in the year to March 2026.
- 47.5% of 1 to 5-year-olds in England saw an NHS dentist in the year to March 2026. More than half did not.
- -0.14 is the correlation between decay and children seen across 229 councils. Deprivation's is 0.70.
- London combines worse-than-England decay (27.4%) with the lowest NHS contact for 1 to 5-year-olds of any region (38.5%).
The NHS Business Services Authority published its dental statistics for 2025/26 on 27 August 2026. They show 7.17 million children seen by an NHS dentist in the year to March 2026, 60% of all children in England and the highest number in the seven years the series covers. The recovery is real. The question for practices is who is still missing. We set NHSBSA's count of children seen, council by council, against the national survey of 5-year-olds' teeth.
It lands alongside prevention policy too. In March 2025 the Department of Health and Social Care and the Department for Education announced an £11 million supervised toothbrushing programme for 3 to 5-year-olds in nurseries and schools in England's most deprived areas, funded from April 2025, on the basis that up to a third of 5-year-olds there have decay. Toothbrushing is prevention. This is about the other half: whether children in those areas are getting into a dental chair.
Two measures are used throughout. Decay experience is the share of 5-year-olds, examined at school for the National Dental Epidemiology Programme survey in 2023/24, with at least one tooth that is visibly decayed into the dentine, missing because of decay, or filled. A child who has been treated still counts, so this measures how much decay children have had, not how much is untreated. Children seen is the share of all under-18s living in a council who had at least one NHS dental course of treatment in the previous 12 months, from the NHS's own claims data.
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1. Children in the most deprived areas have the most decay and are the least likely to be seen
Split England into ten equal slices by how deprived each neighbourhood is. In the most deprived slice, 35.1% of 5-year-olds have decay experience. In the least deprived, 12.8%. Decay climbs at every step on the way down.
NHS dental contact goes the other way. NHSBSA maps every child's claim to the deprivation of their home postcode. In the year to March 2024, 49.4% of children in the most deprived tenth had seen an NHS dentist, against 60.4% in the least deprived. Children in the areas with 2.7 times the decay were less likely to have seen an NHS dentist in the year.
Decay rises with deprivation. NHS dental contact for children falls.
The gap has narrowed since. By March 2026 the most deprived tenth was at 54.6% and the least deprived at 62.0%. It has not reversed. NHSBSA's own figures show more children seen in the most deprived tenth (858,000) than in the least deprived (686,000), but only because far more children live there. As a share, fewer are seen.
"Children in the poorest areas have the most decay and are the least likely to see a dentist," said Jack Henty, co-owner of Bollington Dental Practice and founder of Practice Radar. "That's the wrong way round."
2. Where decay is high and NHS contact is low
Every one of the 229 councils with a survey result is plotted below, decay up the side, children seen along the bottom. If NHS contact were highest where decay is highest, the cloud would slope up to the right. It is almost flat. The correlation is -0.14, where 0 is no relationship and 1 is a perfect one.
In the year to March 2024, 27 councils had significantly more decay and a smaller share of children seen than England
On the year to March 2024, the year of the survey, 57 councils sit in the upper left: more decay than England and a smaller share of children seen. In 27 of them the decay figure is significantly worse than England's, so it is unlikely to be a small-sample fluke.
The picture on the latest year is much the same. In the year to March 2026, 23 of those 27 were still below England's 58.9%, and no other council with significantly worse decay had fallen below it. Those 23 are home to about 1.6 million children. Preston, Hull, Nottingham and North Northamptonshire have moved above England.
Boston in Lincolnshire has the sharpest combination: 39.7% of 5-year-olds with decay experience and 50.8% of children seen in the year to March 2026. Among its 1 to 5-year-olds, 37.7% had seen an NHS dentist. Newham (40.1% decay, 51.5% seen) and Barking and Dagenham (34.4%, 49.3%) follow. Birmingham is the largest, with 286,474 children in NHSBSA's 2023/24 population: 30.2% decay, 53.5% seen.
| Council | 5-year-olds with decay experience, 2023/24 | Children seen, year to March 2026 | Aged 1 to 5 seen, year to March 2026 | Children seen, year to March 2024 |
|---|---|---|---|---|
| Brent | 43.4% | 55.5% | 41.0% | 53.0% |
| Newham | 40.1% | 51.5% | 35.8% | 47.2% |
| Boston | 39.7% | 50.8% | 37.7% | 44.1% |
| Haringey | 36.9% | 53.6% | 40.0% | 51.9% |
| Redbridge | 34.5% | 53.8% | 36.7% | 50.9% |
| Barking and Dagenham | 34.4% | 49.3% | 33.3% | 45.6% |
| Blackpool | 32.1% | 57.4% | 51.5% | 48.9% |
| Herefordshire | 31.3% | 54.0% | 42.6% | 41.4% |
| Birmingham | 30.2% | 53.5% | 39.8% | 49.6% |
| Tower Hamlets | 30.1% | 53.6% | 40.6% | 49.6% |
| Cornwall | 29.8% | 51.8% | 39.0% | 46.4% |
| Barnet | 29.2% | 50.7% | 37.5% | 48.7% |
| Enfield | 29.2% | 53.5% | 37.0% | 51.5% |
| Sandwell | 28.9% | 53.3% | 42.7% | 47.2% |
| Islington | 28.8% | 52.4% | 39.4% | 49.9% |
| Waltham Forest | 28.7% | 57.3% | 45.7% | 52.6% |
| Havering | 27.5% | 54.7% | 39.7% | 51.3% |
| Norwich | 27.4% | 57.1% | 44.3% | 47.8% |
| Bexley | 27.2% | 56.3% | 43.8% | 53.8% |
| West Northamptonshire | 27.2% | 56.6% | 42.9% | 52.5% |
| Sunderland | 27.2% | 58.6% | 55.2% | 53.5% |
| Newcastle upon Tyne | 25.6% | 57.0% | 48.6% | 52.1% |
| Walsall | 25.3% | 52.1% | 38.9% | 49.4% |
Three cautions. NHS contact depends on how much NHS dentistry the local integrated care board commissions, not only on what local practices do. These figures count NHS care only, so a council where many families pay privately will look under-served when it is not. That matters most in the better-off outer London boroughs on this list, such as Barnet, Havering and Bexley, and least in Boston, Newham, Barking and Dagenham, Blackpool, Sandwell and Birmingham, which are among the most deprived places in England. And 67 councils did not take part in the 2023/24 survey, so they cannot be placed at all. They are less deprived on average than those that did.
By NHS England region
London stands out. Its decay rate is worse than England's, and it has the lowest NHS contact for 1 to 5-year-olds of any region. The North West has the worst decay of all, but also the highest NHS contact, which is one reason the council picture matters more than the regional one.
| Region | 5-year-olds with decay experience, 2023/24 | Children seen, year to March 2024 | Children seen, year to March 2026 | Aged 1 to 5 seen, year to March 2026 |
|---|---|---|---|---|
| North West | 29.2% | 59.7% | 63.6% | 54.3% |
| London | 27.4% | 50.1% | 51.5% | 38.5% |
| North East and Yorkshire | 23.3% | 58.0% | 62.5% | 55.1% |
| Midlands | 21.7% | 54.3% | 58.9% | 47.6% |
| South East | 20.0% | 53.7% | 57.5% | 44.9% |
| South West | 19.7% | 50.2% | 53.6% | 41.4% |
| East of England | 17.5% | 53.4% | 58.4% | 45.5% |
| England | 22.4% | 55.1% | 58.9% | 47.5% |
3. Deprivation explains half of decay. Some councils beat it.
Deprivation here is the council's average score on the government's Index of Multiple Deprivation 2025, weighted by where people live. Plot decay against it and the points climb steeply. The correlation is 0.70. The most deprived fifth of councils have a median decay rate of 30.2%, the least deprived fifth 13.6%.
Decay tracks deprivation. The councils off the line are the interesting ones.
Of the 55 councils in the most deprived fifth (of 296) with a survey result, 12 come in clearly below the line, and 11 of those were below it in the previous survey too. Hartlepool is the standout. It is the 6th most deprived council in England, and 19.5% of its 5-year-olds have decay experience, against 33.1% expected and 22.4% for England as a whole. It was 21.0% in 2021/22. Wolverhampton (22.1% against 29.7% expected, with 1,731 children examined) and County Durham (20.6% against 27.1%) are the other large, steady cases. Tendring has the biggest gap, 10.3% against 29.4%, but on only 169 children examined. Blackpool, Sunderland and Walsall are among the 23 councils in section 2 and also beat their deprivation, so their decay is high for England but lower than their circumstances predict.
Seven of those twelve are in the North East. This data cannot say why. Water fluoridation is one possible reason: DHSC's consultation on expanding fluoridation in the North East (updated 7 March 2025) lists existing schemes covering Gateshead, Newcastle and parts of County Durham, and notes that areas in and around Hartlepool have naturally fluoridated water. Middlesbrough, Redcar and Cleveland, South Tyneside and Sunderland appear only in the proposed expansion, not among existing schemes. OHID's Water fluoridation: health monitoring report for England 2022 found 5-year-olds in areas with a scheme were less likely to have decay, and its 2026 report (updated 30 March 2026) found the dental benefits largest for children in more deprived areas. Local prevention programmes differ too, and neither is measured here.
On the same test, 45 councils sit clearly above the line, and 16 of those are London boroughs. The three widest gaps are all in London: Brent (43.4% against 28.0% expected), Ealing (38.8% against 25.1%) and Redbridge (34.5% against 20.9%). The widest outside London is Boston (39.7% against 26.9%). The survey itself finds decay experience in 37.7% of 5-year-olds of Asian heritage against 19.5% of White children. The councils well above the line have a median Asian population share of 9.9%, against 3.8% across all councils. Adding each council's ethnic make-up from the 2021 Census lifts the share of decay explained from 0.49 to 0.62.
Then add children seen to that model. It explains nothing further. Once you know how deprived a council is and who lives there, knowing its share of children seen does not help predict its decay rate. This compares councils, not children. It does not mean seeing a dentist makes no difference to a child's teeth, and a filled tooth still counts as decay in this survey.
4. It is improving, fastest in the most deprived areas, but not enough
Children's NHS dental contact has recovered from the pandemic. On the population in NHSBSA's council file, England was at 59.5% in the year to March 2020, fell to 45.9% in the year to March 2022, and reached 58.9% in the year to March 2026. 287 of 296 councils saw a rise between March 2024 and March 2026.
The rise was biggest where it was needed. The most deprived tenth of neighbourhoods gained 5.2 points between March 2024 and March 2026, the least deprived 1.6. Across councils, the size of the rise goes up with deprivation (correlation 0.29). The 27 high-decay, low-contact councils of March 2024 rose slightly faster than councils overall, a median of 4.3 points against 4.0. But 23 of the 27 are still below England's 58.9%.
The youngest are furthest behind: 40.9% of under-6s nationally were seen in the year to March 2026, and 47.5% of 1 to 5-year-olds. The NHS website advises parents to take a child to the dentist when their first milk teeth appear, or before they are 12 months old (nhs.uk, "Taking care of children's teeth", reviewed 30 June 2025).
What to do about it
Check your own council first. Find it in the council file. Two numbers matter: decay against England's 22.4%, and children seen against England's 58.9% in the year to March 2026. If your council is above the first and below the second, there are likely to be children near you with decay who have not seen an NHS dentist in the year.
If you hold an NHS contract there, make sure your NHS website profile says you are taking children if you are, since it lists children separately from adults. NHS dental care for children is free, so price is not the barrier. Capacity and being found are. The biggest gap is the 1 to 5 age band, so a short, regular slot for first visits is worth more than a general "accepting children" line.
"Children's NHS care is free, so price isn't what keeps a five-year-old away," said Jack Henty. "If a practice has room for children, the job is making sure parents can find it and know it will see their child."
If you are private, a family plan that brings a child in alongside a paying parent turns a need the NHS is not meeting into a household that stays with you. In the high-decay councils those children will need treatment as well as check-ups, so price the plan for that.
Either way, make it easy for families to find out that you see children, from what age, and whether on the NHS or privately.
How we did this
Councils. Everything is at lower-tier council level: districts, unitary authorities, metropolitan boroughs and London boroughs, 296 in all. It is the one level all the sources publish. NHSBSA codes Barnsley and Sheffield on their 2024 boundary codes, and these were matched to the older codes the other sources use. The councils are the same.
Children seen. NHSBSA, NHS Dental Statistics for England 2025/26, published 27 August 2026: the "patients seen by patient location" files. NHSBSA's headline for the year to March 2026 is 60%, on the mid-2025 population. We use the population in its council file, which gives 58.9%, so that councils and England are measured the same way. Children are counted in the council they live in, not where their dentist is, so a child who crosses a boundary for treatment still counts at home. We used the 12-month windows ending 31 March 2020 to 2026, and the part-year 2026/27 file was not used. Cells for fewer than five patients are blank in the source and were counted as zero, a difference of 9 children nationally in 2023/24. 96,803 children seen that year had no usable home postcode and are left out of council rates, but kept in England's. The deprivation-tenth figures use NHSBSA's separate file that maps each child's postcode to its IMD 2025 tenth, with population.
Decay. OHID Fingertips indicator 93563, "percentage of 5 year olds with experience of visually obvious dental decay", 2023/24, from the National Dental Epidemiology Programme survey. A child counts if any tooth is decayed into the dentine, missing because of decay, or filled. It is a sample, a median of 279 children per council, so every council figure has a confidence interval, and we used it. The quadrant uses OHID's own significance test against England. The beat-the-line and above-the-line lists require the whole interval to clear the fitted line, and were checked against the 2021/22 survey. 67 councils have no 2023/24 result because they did not take part.
Hospital admissions. OHID also publishes hospital admissions for tooth decay among 0 to 5-year-olds by council, but that indicator is licensed for non-commercial use only, so it is not shown here.
Regions. NHS England regions. NHSBSA and Fingertips carry different codes for the North West and the East of England, so the two sources were matched by region name. Regional rates exclude the children NHSBSA could not place.
Deprivation and population. English Indices of Deprivation 2025, File 7: each council's score is the population-weighted average of its neighbourhood scores. Weighting by children rather than all residents gave the same result. Ethnic make-up is Census 2021 table TS021, via Nomis.
Controls we ran. Excluding London, decay follows deprivation slightly more closely (0.73) and children seen still barely matters (-0.09). In the 96 councils where 300 or more children were examined, decay against children seen is 0.03, which is nothing. Districts and unitary councils show the same deprivation link (0.61 each). Using children seen in the year to March 2026 instead of 2024 makes no difference (-0.10). Using only 1 to 5-year-olds seen makes no difference (-0.07).
What this is not. It is not a measure of private dentistry, which none of these sources count. It compares councils and neighbourhoods, not children, so it cannot say whether a particular child who was seen has less decay. And the decay survey is a sample of 5-year-olds, so a single council figure is an estimate with a margin, shown in the file.
Questions we get asked about this data
What share of children in England see an NHS dentist?
NHSBSA reports 60% of children, 7.17 million, seen in the 12 months to March 2026, on the mid-2025 population. On the population in its council file it is 58.9%. For 1 to 5-year-olds it was 47.5%.
How many 5-year-olds in England have tooth decay?
22.4% had decay experience (decayed, missing or filled teeth) in the 2023/24 national survey, which examined 81,905 children. Across councils with a result it ranges from 7.5% in Braintree to 43.4% in Brent, counting councils where at least 200 children were examined.
Do areas where more children see a dentist have less decay?
Not measurably, at council level. The correlation between the two is -0.14, and once deprivation and ethnic make-up are allowed for, it is effectively zero. That compares areas, not children, and a filled tooth still counts as decay in the survey. What it does show is that NHS contact for children is not highest where decay is highest.
For editors
The data is free to reuse with attribution to Practice Radar, under Creative Commons BY 4.0. Sources: NHSBSA NHS Dental Statistics for England 2025/26 (children seen, years to March 2024 and March 2026), OHID National Dental Epidemiology Programme 2023/24 via Fingertips, and the English Indices of Deprivation 2025. The council file, childrens-tooth-decay-nhs-dentistry-by-council.csv, has one row per council with its code, and a column glossary is in the README.
Jack Henty, who compiled this analysis, co-owns Bollington Dental Practice in Cheshire and founded Practice Radar, which measures local dental markets for practices. He is available for interview.
Contact: hello@practiceradar.co.uk
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