Official Statistics

Detailed findings of year 6 oral health survey

Published 10 September 2024

Applies to England

1. Executive summary

This report presents the results of the National Dental Epidemiology Programme oral health survey of schoolchildren in year 6 in England, 2023. The data was collected during the 2022 to 2023 school year. This is the first time this population group has been surveyed.

Estimates at national, regional, local authority and NHS levels are reported for the prevalence and severity of experience of dental decay in permanent (adult) teeth. Experience of dental decay refers to teeth with visually obvious dentinal decay, and teeth that are missing, or that have been filled due to decay. Severity of dental decay refers to the number of teeth with decay experience.

The average age of the schoolchildren who participated in the survey was 11.1 years. The median and interquartile range (IQR) of number of permanent teeth in the children in the survey was 20 (IQR 16 to 25).

Overall, 16.2% of year 6 schoolchildren in England in this survey had experienced dental decay in their permanent dentition. In this subset, each child had on average 1.8 teeth with decay experience.

There was wide variation in both prevalence and severity of experience of dental decay by geographical area. At a regional level, year 6 schoolchildren living in Yorkshire and The Humber were most likely to have experienced dental decay (23.3%). At upper tier local authority level Wolverhampton had the highest experience of dental decay (42.7%).

Children living in the most deprived areas of the country were more than twice as likely to have experienced dental decay (23.3%) as those living in the least deprived areas (10.4%). There were also disparities in the percentage of those who had experienced dental decay by ethnic group, which was significantly higher in the other ethnic group (22.2%) and the Asian or Asian British ethnic group (17.8%).

Two point nine per cent of year 6 schoolchildren reported having pain in their teeth or mouths often or very often in the previous 3 months and 2.1% reported having difficulty biting or chewing firm foods often or very often over that time period.

Poor oral health impacts on children and families. It affects children’s ability to eat, smile and socialise and causes pain and infection with days missed at school, and parents’ work, to attend a dental service to receive care. Dental decay is largely a preventable disease.

The cause of dental decay is well understood and is related to eating and drinking sugary food and drinks. Hence the majority of dental decay is preventable.

Local authorities are responsible for improving the oral health of their populations as set out in the Health and Social Care Act 2012. This report provides data that may be used in joint strategic needs assessments and oral health needs assessments to plan, commission and evaluate oral health improvement interventions and dental services. The Office for Health Improvement and Disparities (OHID) and the National Institute for Health and Care Excellence (NICE) have published documents to support local authorities in these activities:

• Improving oral health: an evidence-informed toolkit for local authorities

• Improving oral health: supervised tooth brushing programme toolkit

• Improving the oral health of children: cost effective commissioning

• Oral health: local authorities and partners, NICE 2014

Full tables of results from the survey are available from the oral health survey of year 6 data tables. The survey results are official statistics and are compliant with the Code of Practice for Statistics.

2. Introduction

This report presents the results of the National Dental Epidemiology Programme oral health survey of year 6 schoolchildren attending mainstream, state-funded schools. The fieldwork was undertaken during the 2022 to 2023 school year. The National Dental Epidemiology Programme is a programme of annual oral health surveys. The surveys are coordinated by the Office for Health Improvement and Disparities in the Department of Health and Social Care. Responsibility for commissioning the surveys lies with upper tier local authorities, as set out in Statutory Instrument 3094 (2012)^{[footnote 1]}. Information from the surveys is vital to inform oral health needs assessments at a local level. NHS and local authority commissioners use the information as part of the commissioning cycle when planning and evaluating local health services and health improvement interventions.

This is the first national survey of the oral health of children in year 6 in England. It was conducted to standards set by the British Association for the Study of Community Dentistry (BASCD) ^{[footnote 2] [footnote 3] [footnote 4]}. These standards help to ensure the quality and generalisability of the findings of the surveys. The local authorities that participated in this survey commissioned dental providers to undertake the fieldwork according to a national protocol.

3. Method

The survey was undertaken during the 2022 to 2023 school year and according to a national protocol. The methods and standards used in this survey were adopted from those used in previous national surveys of child oral health.

The survey population was year 6 schoolchildren. The sampling frame was children attending mainstream, state-funded schools. The sampling unit was local authority boundaries at unitary, metropolitan or lower tier level. The minimum sample size was 250 children. Random samples of schools were drawn for each local authority in England according to the survey protocol. In some local authority areas larger samples were drawn at the request of commissioners to facilitate statistically robust analysis at smaller geographical levels below local authority areas, such as ward level.

Sampled schools were contacted to seek their co-operation and year 6 children were selected and invited to participate in the survey. Written agreement from a person with parental responsibility was obtained before any child could participate in the survey.

Data was collected by trained and calibrated clinicians who were typically employed by NHS trusts providing community dental services. The clinicians were calibrated for dental decay and standardised for the proxy measures for fluorosis and oral hygiene. Calibration is an exercise which assesses whether individual dental examiners have reached an accepted level of comparability with others on the presence or absence of signs of oral disease. Standardisation is a process where groups of dental examiners are trained by experienced clinicians to reach a collective understanding and agreement on what constitutes the presence or absence of a condition as defined in the survey’s protocol.

A visual-only examination method was used. Visually obvious decay into dentine was the measurement threshold in line with BASCD criteria. Visually obvious decay is the widely accepted threshold in the literature for dental surveys. However, it provides an underestimate of the true prevalence and severity of disease as it does not capture earlier stages of decay. The presence of severely decayed teeth was measured in both primary and permanent teeth using the PUFA index: presence of severely decayed teeth with visible pulpal involvement (P), traumatic ulceration caused by tooth fragments (U), fistula (F) and abscess (A).

The presence of dental plaque on the upper anterior (front) teeth was recorded to assess oral hygiene.

Increased exposure to fluoride during tooth formation can result in dental fluorosis. Dental fluorosis presents as symmetrical, diffuse white marks on tooth surfaces. In its most severe forms, fluorosis can be unsightly. The standard Dean’s index of Fluorosis could not be used in this survey of year 6 schoolchildren due to their variable tooth eruption status. An alternative approach was chosen after consultation with fluorosis experts and in line with the Fluoride and Caring for Children’s Teeth (FACCT) study. The presence of symmetrical diffuse white patches or strips on any of the erupted permanent anterior tooth surfaces was recorded as a proxy for the prevalence of dental fluorosis. Given that this was a proxy measure, examiners were standardised rather than calibrated.

To assess self-reported oral health status and oral health impacts on daily life, 4 questions were included in the survey. The questions were based on the child perception questionnaire ^{[footnote 5]}. Participating year 6 schoolchildren were asked how often in the past 3 months they had:

• pain in their teeth or mouth

• difficulty biting or chewing firm foods

• been upset because of their teeth or mouth

• not wanted to talk to other children because of their teeth or mouth.

The ethnic groups used reflected those used in the 2021 national population census.

Data was collected using a tailor-made data collection format in Microsoft Access. Electronic files of the raw, anonymised data were uploaded to a secure channel on a shared Microsoft Teams site by regional dental epidemiology coordinators. The data was collated, checked and cleaned by the national dental public health team in OHID. Record-level data was assigned to lower super output areas based on home postcode and Index of Multiple Deprivation 2019 (IMD 2019) scores and ranks were added.

The data was weighted by deprivation quintiles. Deprivation quintiles divide the population into fifths according to levels of deprivation. The weighted data was then analysed using simple descriptive statistics.

For the main findings, 95% confidence intervals (CI) have been reported. This is the range of measures in which we can be 95% confident that the true value lies. Confidence intervals for percentages have been calculated using the Wilson Score method. Error bars indicating 95% confidence intervals have been included on charts where appropriate. Confidence intervals were used to assess statistical significance.

Median values together with the interquartile range (IQR) have been presented where appropriate.

Data is not reported where there were fewer than 30 participants in a geographical area.

In this report, the term dental decay indicates the presence of visually obvious tooth decay into dentine and excludes enamel decay. The term experience of dental decay includes teeth with visually obvious decay into dentine and teeth that are missing, or that have been filled, due to decay. Severity of dental decay refers to the number of teeth with decay experience.

4. Results

Results from the survey at national, regional and upper tier local authority level are presented below. Full data tables of results are available at national, regional, local authority and NHS levels.

England values are represented in the charts by an orange bar. All charts are derived from the previously published full data tables. Data pertaining to specific charts can be sent on request to [email protected]

4.1 Participation in the survey

In total, 125 out of 153 upper tier local authorities commissioned the survey. Reasons for not commissioning the survey included a lack of providers to undertake the fieldwork. Estimates are available for 123 upper tier and 215 out of 296 lower tier local authorities (Map 1). Sixty-five per cent of responding upper tier and 43% of responding lower tier local authorities achieved the target sample size of 250 children.

In the South East only 3 out of 19 upper tier local authorities participated and in Yorkshire and The Humber 7 out of 15 upper tier local authorities participated. Hence regional level estimates for these areas should be interpreted with this in mind. The results for the South East region have not been included in regional comparisons in the text of this report. However, they have been included in regional maps and charts.

Map 1: Participation in the survey in England by lower tier local authority, 2023

Data from 53,073 year 6 schoolchildren were linked to area level deprivation data and included in the analysis. In the areas where there was at least one examination, the overall proportion of children sampled and who were examined was 50%, ranging from 44% in the East of England to 60% in the North West. It is likely that non-response bias applies and should be considered when drawing conclusions.

Less than 1% of children with parental agreement to participate refused to take part on the day of examination. Absenteeism accounted for a loss of approximately 4% of children with parental agreement to participate. 

The average age of the schoolchildren who participated in the survey was 11.1 years. A similar proportion of boys and girls were examined. 

Of the children examined, 73% were from the white ethnic group, 12% were from the Asian or Asian British ethnic group, 5% were from the black, black British, Caribbean or African ethnic group, 5% were from the mixed ethnic group, 2% were from the other ethnic group and for 3% the ethnic group was unknown. These proportions were similar to those of the general population of year 6 schoolchildren in England.

The deprivation profile of the survey participants was also similar to the general population of year 6 schoolchildren in England.

4.2 Prevalence of experience of dental decay

In England, 16.2% of year 6 schoolchildren surveyed had experienced dental decay. The prevalence was similar in girls (16.9%) and boys (15.3%). Prevalence varied regionally from 12.1% in the South West to 23.3% in Yorkshire and The Humber (Figure 1; Map 2; Table 5 in the data tables).

Figure 1: Prevalence of experience of dental decay in year 6 schoolchildren by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals.

Map 2: Prevalence of experience of dental decay in year 6 schoolchildren by region, 2023 (Table 5 in the data tables).

At upper tier local authority level, prevalence of experience of dental decay ranged from 3.4% in Bath and North East Somerset to 42.7% in Wolverhampton (see Map 3 and Table 7 in the data tables).

Map 3: Prevalence of experience of dental decay in year 6 schoolchildren by upper tier local authority, 2023.

Within regions, there was variation in the prevalence of experience of dental decay in year 6 schoolchildren by upper tier local authority area (Figure 2 and Table 7 in the data tables). The greatest variation was in the West Midlands, where the lowest prevalence was 7.6% and the highest was 42.7%.

Figure 2: Range of experience of dental decay in upper tier local authority areas among year 6 schoolchildren by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber

There was also variation in the prevalence of experience of dental decay at lower tier local authority level within each region (Table 8 in the data tables).

4.3 Severity of experience of dental decay

The mean number of teeth per child with experience of dental decay in all children examined was 0.3 (95% CI 0.29 to 0.30). The median number of teeth with decay experience was 0 (interquartile range 0 to 0), which was to be expected, as 83.9% of children surveyed had not experienced dental decay. The severity of experience of dental decay was similar in girls (0.32) and boys (0.27).

There was little variation in the severity of experience of dental decay between the regions (Table 1).

Table 1: Mean and median number of teeth with experience of dental decay in year 6 schoolchildren, by region 2023.

Region name	Mean number of teeth with decay experience in all examined children (95% confidence intervals in brackets)	Mean number of teeth with decay experience in children with any decay experience (95% confidence intervals in brackets)	Median number of teeth with decay experience in children with any decay experience (interquartile range in brackets)
North East	0.3 (0.26-0.31)	1.8 (1.67-1.85)	1 (1-2)
North West	0.4 (0.35-0.38)	1.8 (1.77-1.87)	1 (1-2)
Yorkshire and The Humber	0.4 (0.40-0.49)	1.9 (1.78-2.02)	1.5 (1-2)
East Midlands	0.3 (0.25-0.28)	1.8 (1.74-1.88)	1 (1-2)
West Midlands	0.5 (0.44-0.49)	2.1 (2.00-2.14)	2 (1-3)
East of England	0.2 (0.21-0.24)	1.7 (1.65-1.78)	1 (1-2)
London	0.2 (0.22-0.25)	1.8 (1.71-1.83)	1 (1-2)
South East	0.2 (0.16-0.22)	1.8 (1.60-1.92)	1 (1-2)
South West	0.2 (0.20-0.24)	1.8 (1.71-1.91)	1 (1-2)
England	0.3 (0.29-0.30)	1.8 (1.81-1.86)	1 (1-2)

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber.

There was variation in the severity of experience of dental decay at upper tier local authority level, ranging from a mean of 0.1 tooth per child (95% CI 0.00 to 0.15) in Bath and North East Somerset to 1.0 tooth (95% CI 0.94 to 1.10) in Wolverhampton (Table 7 in the data tables).

There was also variation in the severity of experience of dental decay at lower tier local authority level (Table 8 in the data tables).

In the children who had experienced dental decay, the mean number of teeth with decay experience was 1.8 (95% CI 1.81 to 1.86) and the median was 1 (interquartile range 1 to 2) (Table 1).

At regional level there was little variation in severity of experience of dental decay among children with decay experience (Table 1).

At upper tier local authority level the variation was greater, ranging from 1.3 (95% CI 1.05 to 1.51) teeth in Barking and Dagenham to 2.4 (95% CI 2.28 to 2.50) in Wolverhampton (Table 7 in the data tables). 

There was also variation in the severity of experience of dental decay among year 6 schoolchildren with any decay experience at lower tier local authority level (Table 8 in the data tables).

4.4 Untreated dental decay

The majority of experience of dental decay in this age group was untreated. On average, children with any experience of dental decay had 1.1 (95% CI 1.11 to 1.16) adult teeth with obvious untreated decay. At regional level the average number of adult teeth with obvious untreated decay ranged from 0.9 (95% CI 0.80 to 0.92) in London to 1.7 (95% CI 1.58 to 1.72) in the West Midlands (Figure 3 and Table 5 in the data tables).

Figure 3: Mean number of teeth with experience of dental decay among year 6 schoolchildren with any decay experience by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals for the whole bar.

4.5 The care index

The care index is the proportion of teeth with experience of dental decay that have been treated by filling.

The care index in England was 30.1%. There was regional variation from 15.3% in the West Midlands to 41.7% in London (Figure 4 and Table 5 in the data tables).

Caution should be taken in making any assumptions about the extent or the quality of clinical care available when using the care index.

Figure 4: Care index in year 6 schoolchildren by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals.

4.6 Teeth extracted due to decay

In England, 1.3% of year 6 schoolchildren had a decayed tooth extracted. While most (61.6%) of the year 6 children’s decayed teeth were untreated, 8.3% had been extracted because of decay. At regional level this ranged from 4.7% in the West Midlands to 12.5% in the North East (Figure 5 and Table 5 in the data tables).

Figure 5: Proportion of teeth with decay experience that have been extracted in year 6 schoolchildren by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals.

4.7 Experience of dental decay by level of deprivation

Inequalities in oral health in England have previously been highlighted as a public health problem. In 2022 to 2023 year 6 schoolchildren living in the most deprived 20% of areas of the country were twice as likely to have experienced dental decay (23.3%) as those in the least deprived 20% of areas (10.4%) (Figure 6 and Table 10 in the data tables).

Figure 6: Prevalence of experience of dental decay in year 6 schoolchildren, 2023 by national IMD 2019 quintiles.

Note: error bars represent 95% confidence intervals.

Deprivation explained 25.1% of the variation in prevalence of experience of dental decay in year 6 schoolchildren (Figure 7 and Table 10 in the data tables).

Figure 7: Correlation between prevalence of experience of dental decay in year 6 schoolchildren and IMD 2019 score by lower tier local authority areas, 2023.

The range of a disease or condition across people living in the most deprived and the least deprived areas of the country is called the slope index of inequality (SII). It is a measure of absolute inequalities. Where there is no inequality, the slope index will be zero. In 2023 the slope index of inequality for the prevalence of experience of dental decay in year 6 schoolchildren was 16.1% (Figure 8 and Table 10 in the data tables).

Figure 8: Slope index of inequality in the prevalence of experience of dental decay in year 6 schoolchildren, 2023.

Note: 1 = most deprived, 10 = least deprived. Error bars represent 95% confidence intervals.

4.8 Prevalence and severity of experience of dental decay by ethnic group

The prevalence of experience of dental decay in year 6 schoolchildren varied by ethnic group and was significantly higher in the other ethnic group (22.2%) and the Asian or Asian British ethnic group (17.8%) than for other ethnic groups (Figure 9 and Table 12 in the data tables).

Figure 9: Prevalence of experience of dental decay in year 6 schoolchildren by ethnic group, 2023.

Note: error bars represent 95% confidence intervals.

The severity of dental decay was similar in all ethnic groups (Table 12 in the data tables).

Within the white ethnic group, children from the Gypsy and Irish traveller ethnic group (34.7%), Roma ethnic group (24.1%) and any other white background (22.6%) had a greater prevalence of experience of dental decay than children from the white British ethnic group (15.3%) (Figure 10 and Table 13 in the data tables).

Figure 10: Prevalence of experience of dental decay in year 6 schoolchildren within the white ethnic group, 2023.

Note: error bars represent 95% confidence intervals.

Within the Asian or Asian British ethnic group, children from the Pakistani ethnic group (21.6%) and any other Asian background (18.8%) had a greater prevalence of experience of dental decay than children from the Chinese ethnic group (12.8%) (Figure 11 and Table 13 in the data tables).

Figure 11: Prevalence of experience of dental decay in year 6 schoolchildren within the Asian or Asian British ethnic group, 2023.

Note: error bars represent 95% confidence intervals.

There were no significant variations in prevalence of experience of dental decay within the black, black British, Caribbean or African ethnic group, the mixed ethnic group and the other ethnic group.

The severity of dental decay was similar in all ethnic sub-groups (Table 13 in the data tables).

4.9 Advanced dental decay: prevalence of PUFA signs

The PUFA index reports on the clinical consequences of advanced dental decay. In this survey 1.6% of year 6 schoolchildren had one or more PUFA signs relating to their primary or permanent teeth. At regional level this ranged from 0.8% in the North East to 3.1% in Yorkshire and The Humber (Figure 12 and Table 5 in the data tables).

Figure 12: Prevalence of one or more PUFA signs in year 6 schoolchildren by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals.

4.10 Prevalence of dental plaque in year 6 schoolchildren

The presence of dental plaque is a consequence of poor oral hygiene and provides a proxy measure of children whose teeth are brushed poorly or rarely. Plaque was recorded at 3 different levels:

• plaque covering up to one third of the exposed labial tooth surfaces of the upper anterior sextant

• plaque covering more than one third but not more than two-thirds of the exposed labial tooth surfaces of the upper anterior sextant

• plaque covering more than two-thirds of the exposed labial tooth surfaces of the upper anterior sextant

Dental plaque was recorded in 41.5% of year 6 schoolchildren. Substantial plaque, that is plaque covering more than one-third of the exposed labial tooth surfaces of the upper anterior sextant, was recorded for 11.9% of all children; this was more likely in boys (14.3%) than girls (9.4%). There was variation across the regions from 8.5% in the South West to 23.0% of children in Yorkshire and The Humber (Figure 13 and Table 5 in the data tables).

Figure 13: Prevalence of substantial amounts of plaque in year 6 schoolchildren by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals.

4.11 Prevalence of symmetrical diffuse white patches

In this survey 13.3% of year 6 schoolchildren had symmetrical diffuse white patches on their front teeth. At regional level this ranged from 9.9% in London to 18.0% in the East of England (Figure 14 and Table 5 in the data tables).

Figure 14: Prevalence of symmetrical diffuse white patches in year 6 schoolchildren by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals.

4.12 Self-reported oral health and impacts on daily life

Almost all children (99.7%) responded to the 4 questions on self-reported oral health and the impacts of oral health on daily life in the previous 3 months. Two point nine per cent of year 6 schoolchildren reported to have had pain in their teeth or mouth often or very often in the previous 3 months (Figure 15). Five per cent reported to have experienced one or more oral health impacts often or very often in the previous 3 months.

Children living in the West Midlands were least likely to report having experienced pain.

There was some regional variation in the percentage of children experiencing an oral health impact although the percentages overall were small at less than 4.0% (Figures 16 to 18 and Table 5 in the data tables).

Figure 15: Percentage of year 6 schoolchildren reporting to have had pain in their teeth or mouth often or very often in the previous three months by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals.

Figure 16: Percentage of year 6 schoolchildren reporting to have experienced difficulty biting or chewing firm foods often or very often in the previous 3 months by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals.

Figure 17: Percentage of year 6 schoolchildren reporting being upset because of their teeth or mouth often or very often in the previous 3 months by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals.

Figure 18: Percentage of year 6 schoolchildren reporting not wanting to talk often or very often because of their teeth or mouth in the previous 3 months by region, 2023.

Note: regional estimates include 3 of 19 local authority areas in the South East and 7 of 15 local authority areas in Yorkshire and The Humber; error bars represent 95% confidence intervals.

5. Implications of results

This is the first national oral health survey of this age of children in England. The survey focused on dental decay in permanent teeth in 10 to 11 year olds. Inequalities in the levels of experience of dental decay were found in year 6 schoolchildren living in different life circumstances and from different ethnic backgrounds. There was also geographical variation in dental decay experience with children living in the north of England more likely to have experienced dental decay.

Across England, experience of dental decay was apparent in the permanent teeth of 1 in 6 year 6 schoolchildren and more than 1 in 4 children in some areas. Children with experience of decay had on average between 1 and 2 affected teeth. The majority of the decay was untreated. As the survey measured dental decay in the permanent dentition, these teeth will need to be restored where possible and retained into adulthood and beyond and are likely to require ongoing intervention throughout life.

5.1 Putting this information to use

Good oral health is fundamental to good general health and wellbeing. Poor oral health in children can result in pain and infection and lead to difficulties with eating, sleeping, playing and socialising. There are also significant costs on society associated with preventing and treating oral diseases and their consequences.

Longer term consequences are that children who have decay in their permanent teeth enter a lifetime cycle of repair, which may lead to eventual tooth loss^{[footnote 6]}.

The cause of dental decay is well understood and is related to the frequent exposure of teeth to fermentable carbohydrates, most commonly through eating and drinking sugary snacks and drinks^{[footnote 7]}. Hence the majority of dental decay is preventable and the impacts and costs referred to above are mostly avoidable.

Local authorities, which have a responsibility to improve oral health, may use this information to inform needs assessments to plan and commission oral health improvement interventions to address the needs of their populations. OHID and NICE have published documents to support local authorities in these activities. As high frequency of consumption of sugar-containing food and drink is also a contributory factor to other issues of public health concern in children, for example, childhood obesity, interventions to tackle sugar consumption will benefit health beyond oral health.

NHS England and commissioning organisations may use this information to inform the planning and commissioning of oral healthcare services.

5.2 Limitations of the survey

This is the first survey of year 6 schoolchildren across England. While the survey had over 53,000 participants, 18% of upper tier local authorities opted not to commission the survey and 57% of lower tier local authority areas did not achieve the minimum sample size. As previously mentioned, approximately three quarters of the local authority areas in the South East and half of the local authority areas in Yorkshire and The Humber did not participate in the survey and regional estimates for these areas should be interpreted with this in mind. Nationally, the sample was largely reflective of the year 6 schoolchildren population in terms of deprivation and ethnicity.

A further limitation was that the survey did not recruit from the entire population of year 6 schoolchildren. For example, children attending private schools were not included in the survey. The likelihood of bias from this is acknowledged but cannot be measured.

As with other National Dental Epidemiology Programme surveys, this survey required written parental agreement for children to participate. This has been shown to adversely affect participation rates, which may be lower for those children with higher levels of dental decay experience and those living in more deprived areas. Both factors could contribute to underestimation of the prevalence and severity of dental decay experience in this survey. It has been shown to be difficult to model the data to control for the effect of parental agreement to participation in the survey^{[footnote 8]}.

5.3 Accessing further data

Cleaned and verified copies of the raw, anonymised data will be available to local authority and NHS England personnel, who can apply to become a super user and access the raw, anonymised data for specific purposes following the steps below.

1.  Requestor to send an email to [email protected] providing the following information:

• name of individual to be allocated as super user

• geographical area for which data required

• contact details

2.  The nominated super user will be contacted by a member of the national dental public health team who will send a data sharing agreement for signing.

3.  Once the signed agreement has been received and authorised, the super user will be sent their (anonymised) data along with a set of analysis guidance notes.

For any other data requests that are for national data or complex queries email [email protected]

5.4 Acknowledgements

We would like to thank all the children who participated in the survey and the school staff and fieldwork teams who made delivery of the survey possible.

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4. Pitts NB, Evans DJ and Pine CM (1997). British Association for the Study of Community Dentistry (BASCD) diagnostic criteria for caries prevalence surveys-1996/97. Community Dental Health 14 Suppl 1, 6 to 9 ↩

5. Ju X, Ribeiro Santiago PH, Do L, Jamieson L (2020): Validation of a 4-item child perception questionnaire in Australian children. PLoS ONE 15(9): e0239449. ↩

6. Hall-Scullin E, Whitehead H, Milsom K, Tickle M, Su T-L and Walsh T (2017). Longitudinal Study of Caries Development from Childhood to Adolescence. Journal of Dental Research 96 (7):762 to 767] ↩

7. Public Health England (2021). Delivering better oral health: an evidence-based toolkit for prevention ↩

8. Davies GM, Robinson M, Neville J and Burnside G (2014). Investigation of bias related to non-return of consent for a dental epidemiological survey of caries among five-year-olds. Community Dental Health 31 (1): 21 to 26 ↩