Tooth decay is rising again in England — what the data actually shows

The first full clinical survey of adult teeth in England in over a decade shows real regression — here's what's behind it, and what still works.

A new survey gives the first full clinical picture of adult oral health in England in over a decade — and the picture isn't good. The Adult Oral Health Survey 2023, published in the British Dental Journal earlier this year, found that tooth decay has crept back to levels last seen in the late 1990s, undoing almost two decades of improvement.

What the survey found

• 41% of adults examined had obvious, visible signs of tooth decay — up from 28% in 2009, and close to the level recorded in 1998.
• Including earlier-stage enamel decay, that figure rises to almost two-thirds of adults (64%).
• 42% said their oral health affects their day-to-day life in some way, up from 33% in 2009.
• Nearly 1 in 5 (19%) had a potentially urgent condition at the time of examination, such as active pain or deep decay.

The British Dental Association described the results as 'almost a reversal of the previous improvement' and has called on government to back its planned NHS dental reforms with real investment, not policy alone.

Why the trend has reversed

There's no single cause, but a few pressures show up consistently in the reporting around this survey: harder access to routine NHS dental care in parts of the country, cost pressures pushing some people to delay check-ups until something hurts, and sugar and acid staying a fixture of most people's daily diet. None of those are dramatic on their own — decay builds slowly, which is exactly why it's easy to underestimate until a survey like this puts a number on it.

What still works, regardless of the headline

• Brush twice a day for two minutes with a fluoride toothpaste — spit, don't rinse, so the fluoride stays on your teeth longer.
• Keep to regular check-ups. Decay caught early is often reversible or a simple filling; decay caught late is a root canal or worse.
• See the hygienist. Professional cleaning removes what brushing alone can't, and it's a natural point to flag anything you've noticed.
• Cut back on how often sugary or acidic food and drink cross your teeth — frequency matters more than quantity.
• Don't wait out a niggle. Sensitivity, a dull ache, or a rough edge you can feel with your tongue are all worth a look before they become urgent.

None of this is new advice — but a survey like this is a reminder that the basics still do the heavy lifting, and that skipping check-ups has a real, measurable cost over time. If it's been a while since your last one, that's the easiest place to start.