When should a child first see a dentist?

You can register a child with an NHS dentist from birth, and NHS inform advises starting to brush as soon as the first tooth appears. Bringing a child along to a parent's appointment early, before anything needs doing, is often the easiest introduction. From age two, children should be offered fluoride varnish by their dentist at least twice a year.

Is NHS dental treatment free for children in Scotland?

Yes. NHS dental treatment is free for everyone under 26 in Scotland, so it is free for all children. NHS dental examinations are free for everyone in Scotland regardless of age.

Childsmile is Scotland's national children's oral health programme, introduced in 2006 and rolled out across all health boards by 2011. It provides free daily supervised toothbrushing in nurseries and priority primary schools, fluoride varnish in priority settings, free dental packs, and dietary and oral hygiene advice, alongside preventive care in dental practices.

How often should my child be seen?

That is set by the dentist according to your child's own risk of decay rather than by a fixed calendar. Some children are seen every six months, others more or less often. We will tell you the interval we recommend and why at the appointment.

Do you see children at City Dental Care?

Yes. We see children on the NHS, and our NHS list is open, so a child can be registered and seen without a waiting list. Appointments are available until 8pm Monday to Thursday (until 5pm on Friday), which for many families is easier than taking a child out of school.

A contributed City Dental Care analysis

Children's oral health in Scotland: why has improvement plateaued?

Hamza Al Haddad explains why the long improvement in Scottish children's oral health has levelled off since the pandemic, and what practices and policymakers could do to restart it.

Illustration of children's toothbrushes standing in cups on a nursery shelf — Illustration made using Google’s Nano Banana Pro, an AI image illustrator.

Dr Hamza Al Haddad

Director, City Dental Care, Edinburgh · GDC 310491

In brief

Scotland's long improvement in children's teeth has levelled off since the pandemic.
The pandemic interrupted nursery toothbrushing and dental visits, the two Childsmile measures most strongly linked with less decay.
Five changes could restart it: finish the recovery in schools, treat age six as a prevention window, start in the first year, count fluoride varnish, and look again at water fluoridation.

According to Public Health Scotland's National Dental Inspection Programme, the share of Primary 7 (P7) pupils with no obvious decay experience rose from 52.9% in 2005 to 80.0% in 2019. It has hardly moved since, and stood at 81.5% in 2025. Since the pandemic, PHS says, the long decline in decay 'appears to have plateaued'. P1 is similar: 73.2% in 2024, against 73.5% in 2020.

One measure underneath has moved the wrong way. The share of P7 children with untreated decay rose from 7.9% in 2019 to 10.5% in 2023, and was 10.2% in 2025. Some may be early decay deliberately managed without a filling, but in my view much of it is treatment the pandemic delayed. The children who worry me aren't the ones who come every six months. It's the child we haven't seen for two or three years, who comes back because a back tooth hurts, and by then it needs more than a small filling. My argument is that the pandemic interrupted prevention at the ages when it counts, and that the recovery is not finished.

81.5%

of P7 children with no obvious decay experience, 2025

80.0% in 2019

10.2%

of P7 children with untreated decay, 2025

7.9% in 2019

58.0%

of primary schools running supervised brushing, 2024/25

65.9% before the pandemic

42.1%

of children aged 0-2 registered with an NHS dentist, 2025

47.4% in 2019

The children who worry me aren’t the ones who come every six months.

Part 1

Why has improvement plateaued?

A 2020 BMJ Open study of more than 50,000 Scottish P1 children found two Childsmile measures most strongly linked with lower odds of decay: over three years of supervised brushing at nursery (around 40% lower) and six or more dental visits before P1 (around 45% lower). The authors caution that attendance may partly reflect which families attend, but both point the same way.

Both were interrupted. Childsmile's supervised brushing ran in 97.0% of nurseries and 65.9% of primary schools in 2018/19, and in 8.2% and 5.1% in 2020/21. Practices reopened for routine care in the summer of 2020, but between December 2021 and February 2022 children's NHS dental treatment was still running at about 45% of its pre-pandemic level.

Supervised toothbrushing, before and after the pandemic

Share of nurseries and local authority primary schools taking part in Childsmile toothbrushing, Scotland.

2019/20 is not in either source. Drawn by City Dental Care from Childsmile National Headline Data (November 2019 and December 2025).

Different year groups lost different things. The P7 children inspected in 2025 had been through nursery before lockdown; what they missed was routine dental care, and in priority schools fluoride varnish, from the age of six or seven, just as their first permanent molars came through. At our practice in Edinburgh, we see the result in ten- and eleven-year-olds: first permanent molars that were never sealed, with decay starting in the grooves. That is exactly the decay prevention is meant to stop. The five-year-olds inspected in 2024 had their nursery years disrupted. The Scottish Government has said the slowdown is likely to be related to reduced access to nurseries and schools. For the youngest children I think that is right; for older ones, I think lost dental visits matter more. Neither link has yet been tested child by child.

The pandemic is not the whole explanation. Gains in the 2010s were smaller than in the 2000s, although both age groups were still improving up to 2020. At P7, PHS says recent improvement has continued only in the least deprived fifth of areas. P1 is more encouraging: in 2024 only the two most deprived fifths improved, which suggests to me that targeted Childsmile work held up while universal prevention slipped.

Part 2

What needs to change

Finish the recovery

Nursery brushing is back in 95.3% of nurseries, a credit to nursery staff and Childsmile teams, and a Scottish economic evaluation put the nursery programme's expected savings, by year eight, at over 2.5 times its cost. School brushing runs in 58.0% of primary schools, against 65.9% before the pandemic. The evidence for school brushing is thinner, but first permanent molars are newly through in P3 and P4, so BDA Scotland's proposal to extend brushing to those classes in high-need schools deserves a pilot with evaluation built in.

Treat age six as a prevention window

This sits with dental practices, including mine. Only 10.4% of P7 first permanent molars were sealed and sound in 2025 (11.4% in 2023, so not only a pandemic effect), and PHS has said in successive reports that the pattern of decay supports greater use of fissure sealants. SDCEP's 2025 guidance recommends varnish for every child from age two at least twice yearly, and four times a year at increased risk. As first molars erupt, we should check them closely, seal where the risk justifies it, and plan recalls so each child gets the varnish their risk calls for.

Start in the first year

In September 2025, 42.1% of children aged 0-2 were registered with an NHS dentist, against 47.4% in September 2019. We can register a baby from birth, but most families wait until something prompts them. Of 11,203 children referred to Childsmile's dental health support workers in 2024/25, 148 were recorded as referred by a dentist. Childsmile's guidance already asks practices to contact a support worker when a child is not brought more than once, and a family whose dental history is one of pain and emergencies is a referral we can make too.

Count the prevention

Where children get fluoride varnish is changing. NHS Greater Glasgow and Clyde says Childsmile's executive team told health boards in August 2025 that, because research suggests nursery varnish is less effective than other methods, no new consents would be taken and varnish would stop being applied in nurseries from August 2026. Children can still have it applied at their dental practice. In my view that is a reasonable reading of the evidence: nursery varnish was not independently linked with less decay in the 2020 cohort study, and a Scottish nursery trial, in children not already targeted for varnish, found only a modest benefit that was not statistically significant. But in 2024/25 nearly 19,000 three- and four-year-olds had varnish at nursery, including almost three in ten of that age group in the most deprived fifth of areas, and where nursery varnish ends, that work falls to practices. Nursery varnish is recorded application by application. In practices, since the November 2023 payment reform, varnish, brushing instruction and diet advice are claimed together under one preventive item, so national data cannot show whether varnish was given. PHS welcomed paying dentists for prevention, but told the Scottish Parliament's health committee in December 2024 that there is little detail on what the item delivers and that it would welcome more. I agree: as varnish moves into practices, we need to be able to count it.

Look again at water fluoridation

Almost every measure above depends on a child being in a nursery, a classroom or a dental chair, and the pandemic showed how quickly those can close. Water fluoridation does not, and in 2021 the UK's four chief medical officers, Scotland's included, said its greatest effect is in children who do not get fluoride through regular brushing or dental care. No public water supply in Scotland is fluoridated. The initiative lies with NHS boards, which must consult the public before asking Scottish Water to fluoridate, and in 2022 the Scottish Government said it would support a board that had local backing. Modern studies show smaller effects than older ones, and the 2024 Cochrane review rated that evidence low certainty, so I would start where BDA Scotland does: fund boards to carry out feasibility studies, as a complement to Childsmile rather than a replacement for it.

Part 3

What to watch

27 October 2026

Next P1 figures, scheduled by Public Health Scotland

2027

P7 inspection of the children who started P1 in August 2020

Childsmile turned 20 this year, and in my view it still works. What the pandemic took was around two years of it, at ages that matter. The next P1 figures, which PHS has scheduled for 27 October 2026, cover the first P1 cohort since the pandemic whose nursery years ran close to normal. If nursery brushing is the main lever, P1 should start improving; if it stays flat, disruption in infancy may be the reason. The P7 cohort inspected in 2027 started P1 in August 2020, and their first molars came through while practices were still below normal capacity. If the pandemic explanation is right, it should show most clearly there; if not, we should look harder for other causes.

Key figures

The figures in more detail

Primary 7 children with no obvious decay experience

Scotland, Detailed Inspection, 2005 to 2025. No programme ran in 2021.

52.9

2005

59.1

2007

63.6

2009

69.4

2011

72.8

2013

75.3

2015

77.1

2017

2019

81.9

2023

81.5

2025

Weighted to represent all P7 children in Scotland. 2025: 81.5% (95% confidence interval 80.9 to 82.1), from 13,129 children inspected.

Younger children

Among P1 children in 2024, the average amount of decay was the lowest Public Health Scotland has ever reported, even though the share with none has not moved since 2020.

The same P7 children, by deprivation

No obvious decay experience, 2025, by SIMD quintile.

SIMD 1 · most deprived71.4%

SIMD 279.1%

SIMD 383.1%

SIMD 485%

SIMD 5 · least deprived89.6%

Unweighted: these describe the children actually inspected, so they are not directly comparable with the 81.5% headline. Among P1 children in 2024 the gap ran from 60.1% to 83.6%, and it has narrowed since 2010.

Children do attend

83.2% of registered children were seen in the two years to March 2026, against 57.7% of adults. The attendance problem is mostly an adult one, as our analysis of the national access figures shows.

Edinburgh

88.5% of P7 children in NHS Lothian had no obvious decay experience in 2025, third of 14 boards. The City of Edinburgh figure, 85.5%, was the lowest of the four Lothian partnerships.

What it costs in school days

A 2025 Scottish study linked the records of 263,597 children in their first year of primary school: those with decay missed about five more part-days of school, and 6.5 more if they had had teeth extracted under general anaesthetic. Having teeth taken out under general anaesthetic remains the most common reason for a child in Scotland to have a planned hospital admission.

What this means for a parent

The measures with the best evidence ask nothing unusual of a family: brushing every day from the first tooth, and regular visits before anything hurts.

Register earlyA 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 nothingNHS dental treatment is free for everyone under 26 in Scotland, and examinations are free for everyone at any age.
Fluoride varnish from twoFrom age two, children should be offered fluoride varnish by their dentist at least twice a year.
Keep going when nothing is wrongThe attendance effect in the research is about routine visits, not emergencies.

Children at City Dental Care

Our NHS list is open, and a child can be registered with us from birth. NHS dental treatment is free for everyone under 26 in Scotland.

Book online Children’s dentist in Edinburgh

Sources (26)

Written by Dr Hamza Al Haddad, Director, City Dental Care, Edinburgh. A contributed City Dental Care analysis. Figures are the latest published at 30 September 2026.

Back to all guides