Healthwatch Essex has published a new report on Children’s Oral Health Experiences in West Essex, capturing the voices of parents, families and carers.
Every child deserves a healthy smile. But for many families, oral health goes beyond brushing twice a day. While NHS dental access is under growing strain and health inequalities persist, we must understand the real-world barriers children and parents face and how to address them.
Tooth decay remains the most common reason for hospital admissions in children aged between 5 and 9 years old. Between April 2023 and March 2024, hospital tooth extractions for young people are estimated to have cost the NHS £74.8 million (Department of Health and Social Care, 2025).
In January 2025, Healthwatch Essex was approached by the Hertfordshire and West Essex NHS Integrated Care Board to launch a project on children’s oral health experiences. Through surveys and interviews with parents, carers, and healthcare professionals, we gathered insights from 34 participants and created four case studies to form our key findings.
Exploring why children’s oral health remains a public health issue and how it impacts the local community, we have developed a series of recommendations on how we can improve oral healthcare experiences and NHS dental service provision.
Understanding the Scale
Between April 2023 and March 2024, NHS hospitals in England carried out 49,112 tooth extractions on children and young people. More than 60% of these were due to preventable tooth decay (Department of Health and Social Care, 2025). In the same year, 1 in 5 five-year-olds in England experienced advanced dental decay, averaging 3.5 decayed teeth each. Children in the most deprived areas were more than twice as likely to suffer from decay (National Dental Epidemiology Programme, 2025).
Poor oral health can cause pain, infections, difficulty eating, sleeping or socialising, time off school, and long-term dental problems. In March, the government announced an £11.4 million investment in a national supervised toothbrushing scheme for 3 to 5-year-olds in deprived areas to reduce disease, hospital admissions, and treatment costs. It’s a promising step – but more support is needed.
Access and Availability
More than a third of our participants struggled to find a local NHS dentist accepting new patients. Many had to travel long distances or pay privately, if they could afford to. Nearly 30% faced time-related barriers. Without flexible options like weekend, after-school, or school holiday appointments, limited availability disrupts care and delays early intervention.
Fear, Anxiety and the Dental Experience
Dental anxiety is common, but when not addressed sensitively, it can lead to long-term avoidance. Parents shared that while many dentists are kind and patient, others rushed appointments or lacked sensitivity. One traumatic case involved a tooth extraction without warning, which caused significant distress. Appointments need to make patients feel emotionally and physically safe and comfortable and practices should foster a non-judgmental, trauma-informed approach with specialised training to ensure this. Simple steps like child-focused explanations, stickers, and distraction techniques can help create a less stress-inducing dental visit.
Cost of Living and Oral Health
As the cost-of-living rises, choices around oral health and nutrition are affected. More than 40% of participants said this impacted their ability to purchase healthy foods. Misleading packaging means making healthy choices becomes even more difficult. Some participants expressed concern over unexpected dental costs and a lack of clarity around free NHS dental services and care entitlements. Programmes like Healthy Start Vouchers could provide vital support, but many families remain unaware of these schemes.
Parenting Under Pressure
Beyond the dental chair, parents face daily challenges making oral hygiene a non-negotiable part of the home routine. Overloaded schedules mean dental health slips down the list of priorities. Too often, families only seek dental services when there’s a problem — pain, infection, or visible decay. Whilst most parents feel informed, many want clearer, more consistent preventative guidance. This includes practical tools such as brushing videos, visual aids, and advice on reducing sugar intake.
Education and Community
More than 80% of participants supported oral health initiatives in schools, including fluoride varnish, supervised brushing, and nutrition education. Parents recognise schools as one of the key components to facilitating the shift from reactive to preventative care. Peer-led approaches like tooth brushing clubs or dental health ambassadors could be effective engagement tools. However, access to educational programmes varies, with children in under-resourced areas needing the most support. Community resources can help fill these gaps. Information in everyday spaces, like libraries and community centres, could help reach families with limited access to health services.
Child-Friendly Environments
A child-friendly environment goes beyond the dentist. Waiting rooms, booking systems, and follow-up communication all shape the experience. For many children, sterile, quiet, clinical spaces can increase anxiety. Simple improvements like toys, books, colourful décor, and friendly reception staff can improve their visit. Investing in these changes can help dental practices build trust, reduce fear, encourage regular attendance and lifelong dental engagement.
Support for All Families
Families with children with sensory or neurodivergent conditions may need tailored, sensitive care. Practices should offer individualised plans, sensory-friendly environments, and be prepared to refer patients to services which can provide appropriate care. Proactive communication, clear advice, and informed support can foster trust and promote long-term dental health.
Holistic Vision
Families want more than better appointments – they want a better system. One that recognises oral health as interconnected with nutrition, education, cost of living, and emotional wellbeing. One that prioritises prevention and supports integrated care. A child-focused system which is inclusive and accessible to all families.
Moving Forward
A child-friendly, prevention-focussed dental system is the key to supporting children’s emotional and developmental needs. Investing in early intervention and education can help reduce emergency care and build lifelong healthy habits. Achieving this vision requires collaboration between policymakers, practitioners, and public services. Because when children feel safe and supported at the dentist, they’re more likely to care for their health—and pass those habits on to the next generation.
Next Steps
Since the report was written, the Hertfordshire and West Essex NHS Integrated Care Board (ICB) has merged with two new ICBs to become Central East ICB and Essex ICB. The findings and recommendations in this report will be shared with both these ICBs with the aim of strengthening local NHS dental services.
This project was led by former Project Officer Lily Boag.
You can find our report here.