A City Dental Care analysis
Better than it was, and no longer improving
Scotland spent twenty years transforming children’s teeth. The latest inspection figures suggest that progress has levelled off, and that where a child lives still decides a great deal.
Every year Scotland inspects the teeth of schoolchildren and publishes what it finds. It is one of the better public health datasets in the country, and the long view it gives is genuinely encouraging: in 2005, barely half of Primary 7 children had no obvious decay. In 2025 the figure is 81.5%.
The recent view is less comfortable. Public Health Scotland put it plainly in the 2025 report: obvious decay experience has declined since 2005, “although this downward trend appears to have plateaued since the COVID-19 pandemic”.
Primary 7 children with no obvious decay experience
Scotland, Detailed Inspection, 2005 to 2025. No programme ran in 2021.
Weighted to represent all P7 children in Scotland. 2025: 81.5% (95% confidence interval 80.9 to 82.1), from 13,129 children inspected. The 2023 figure was 81.9%.
Two decades of gains, then a flat line. The same pattern shows in the younger cohort: among Primary 1 children, 73.2% had no obvious decay experience in 2024, which the report describes as similar to the 73.5% recorded in 2020. The average amount of decay in that age group is the lowest ever reported, so the picture is not one of decline. It is one of a country that has stopped getting better.
The part that has not been solved
Averages hide the thing that matters most here. Sort the same children by the deprivation of the area they live in and the national figure comes apart.
The same year, sorted by deprivation
P7 children with no obvious decay experience, 2025, by SIMD quintile.
These deprivation figures are unweighted: they describe the children actually inspected rather than being scaled to the whole P7 population, so they are not directly comparable with the 81.5% headline above.
Eighteen percentage points separate the most and least deprived quintiles. Public Health Scotland notes that progress “has stalled across most quintiles, with continued improvement only among children in SIMD5” — the least deprived. In the younger group the same gradient runs from 60.1% in the most deprived quintile to 83.6% in the least, though there the long-run gap has narrowed, from 32.2 percentage points in 2010 to 23.6 in 2024.
It is worth being clear about what this measures. It is not a claim about parenting. Decay in childhood tracks the things deprivation brings with it, and a national programme that lifts everyone still leaves that gradient largely intact.
Children do attend. Adults are the problem.
One figure in this area surprises most people, including dentists. Scotland’s children are not the ones avoiding the dentist.
Seen within the last two years
Share of registered NHS patients who participated, Scotland, quarter ending 31 March 2026.
Across all ages the figure is 62.1%. Among children it is 83.2%, and among children in the most deprived areas 77.4%, against 87.7% in the least deprived.
Five in six registered children are being seen. Barely more than half of registered adults are. Whatever is going wrong with dental attendance in Scotland, it is mostly going wrong after people stop being children — which is the subject of our analysis of the national access figures.
What it costs in school days
The most striking recent Scottish research on this is not about teeth at all. A population-wide data linkage study published in the Journal of Epidemiology and Community Health in 2025 followed 263,597 children and matched their dental records to school attendance. Children with decay experience missed, on average, five more part-days of school than those without. For children who had needed a general anaesthetic for dental treatment, the difference was 6.5 days. The authors found that children in the 10% most deprived areas carried nearly twice the burden of oral-health-related absence of those in the least deprived.
On the treatment end, the British Dental Association reported in November 2025 that in the quarter ending March 2025 around one in four patients waiting for dental treatment under general anaesthetic in Scotland had been waiting over a year, with the longest waits exceeding three years. Tooth decay remains the leading reason young children are admitted to hospital in Scotland.
Does Childsmile work?
Childsmile is the national programme behind most of the improvement above. Introduced in 2006 and running across all health boards by 2011, it provides free supervised toothbrushing in nurseries and priority primary schools, fluoride varnish in priority settings, free dental packs, and preventive care through dental practices. In the 2024/25 academic year it reached 95.3% of Scotland’s nurseries and 58.0% of local authority primary schools.
The evidence is good but specific. A study in BMJ Open in 2020 found substantially lower odds of decay among children with more than three years of nursery toothbrushing, and among those who attended the dentist frequently. The same study found that targeted nursery fluoride varnish was not independently associated with caries experience. Both halves of that matter: the daily brushing habit and regular attendance are doing the work. The Scottish Government, restating the economic evaluation in June 2025, reported that by the eighth year of the toothbrushing programme the expected savings were more than two and a half times its costs.
Edinburgh, specifically
Children in this part of the country do comparatively well. In 2025, 88.5% of P7 children in NHS Lothian had no obvious decay experience against 81.5% for Scotland, placing Lothian third of the fourteen health boards. Within Lothian, the City of Edinburgh figure was 85.5% — above the national figure, but the lowest of the four Lothian partnerships, behind East Lothian, Midlothian and West Lothian. Health and social care partnership results are weighted using board-specific deprivation categories rather than the national ones, so they should be read alongside the Scotland figure rather than directly against it.
Doing better than the national average is not the same as doing well, and a city average conceals the same gradient the national figures show.
What this means for a parent
Very little of the above requires anything unusual of a family. The interventions with the best evidence behind them are brushing every day from the first tooth, and turning up regularly before anything hurts.
- Register early. A child can be registered with an NHS dentist from birth, and coming along to a parent’s appointment is an easy first visit.
- It costs nothing. NHS dental treatment is free for everyone under 26 in Scotland, and examinations are free for everyone at any age.
- Fluoride varnish from two. From age two, children should be offered fluoride varnish by their dentist at least twice a year.
- Keep going when nothing is wrong. The attendance effect in the research is about routine visits, not emergencies.
Registering a child with us
Our NHS list is open, so a child can be registered and seen without a waiting list. We are open until 8pm Monday to Thursday, which is often easier than a school day.
Sources: Public Health Scotland, National Dental Inspection Programme 2025, published 21 October 2025 (P7 Detailed Inspection, and NHS board and partnership tables); NDIP 2024, published 29 October 2024 (P1 Detailed Inspection); Public Health Scotland, NHS dental data monitoring report for the quarter ending 31 March 2026, published 26 May 2026, with child figures from the accompanying dashboard; Childsmile National Headline Data, Childsmile Evaluation and Research Team, University of Glasgow, December 2025 (2024/25 academic year); Kidd JB and others, BMJ Open 2020;10(11):e038116; Goulart M de A and others, Journal of Epidemiology and Community Health 2025;79(11):882–888; British Dental Association Scotland, November 2025; Scottish Government, Learning from 25 years of preventative interventions in Scotland, 19 June 2025; NHS inform, Receiving NHS dental treatment in Scotland, updated 27 July 2026. Written by Dr Hamza Al Haddad, Director, City Dental Care, Edinburgh.
