National statistics

Adult oral health survey 2021: conclusions

Published 25 January 2024

Applies to England

Self-reported health of teeth and gums

In 2021, only a small proportion of adults said that they did not have any natural teeth and the majority said they had a functional dentition, that is 21 or more natural teeth. Restoration of teeth plays a part in adults keeping their natural teeth for longer. Most adults reported having had at least one filling, around a third had at least one crowned tooth and a third had a root canal filling, with the prevalence of each form of restoration increasing with age.

Adults from the most deprived neighbourhoods and in the lowest income quintile were less likely to have 21 teeth or more and less likely to have filled teeth and crowns. This may indicate that financial barriers or access issues were leading some adults to forego treatment that may have helped them preserve their natural teeth.

One in 10 adults reported experiencing pain from their teeth, fillings, crowns or fixed bridges, and a quarter reported damaged teeth, fillings, crowns or fixed bridges. Almost 1 in 5 adults said they had been told they had gum disease. The prevalence of dental pain, damaged teeth and gum disease was higher among those in more deprived neighbourhoods or in lower income quintiles.

It is important to keep in mind that these findings related to a time during COVID-19 lockdown when access to dental services was reduced and may thus suggest a higher level of current dental problems than may otherwise have been the case.

Health-related behaviours

More than 3 quarters of adults with natural teeth reported meeting the recommendation of brushing their teeth at least twice a day and most adults said they used fluoride toothpaste. Adults who visited a dentist for a regular or occasional check-up, women, those living in less deprived neighbourhoods and those in the higher income quintiles were more likely to report brushing their teeth twice a day. Two thirds of adults also reported receiving advice from a dentist or member of the dental team on cleaning their teeth and gums.

Adults engaging in behaviours such as smoking and vaping were more likely to have been told they had gum disease and to have experienced bleeding gums than those not engaging in these behaviours.

Nearly a quarter of the population reported not cleaning their teeth at least twice a day, as recommended by the current guidance. Previous evidence shows that these people will have an increased risk of developing tooth decay and gum disease. While dentists and other members of the dental team were reported to have raised this with two thirds of adults, this messaging is less likely to reach those who need it the most, as not cleaning teeth at least twice a day and not using fluoride toothpaste were also linked to going to a dentist less frequently.

Being asked about other health-related behaviours, such as smoking, drinking alcohol and what types of drinks and foods were consumed was much less common. While most adults were not current smokers and thus would not have needed to discuss it with their dentist, raising the question about alcohol consumption and food and drink consumption would have been relevant to a larger proportion of the population.

Service use and barriers to accessing care

Findings from this report show that around 8 in 10 adults reported meeting the recommendation of visiting a dentist at least once every 2 years. Nearly 1 in 10 adults only visited a dentist when having trouble with their teeth, with this being more common among adults in more deprived neighbourhoods or in lower income quintiles.

Half of adults who said they attended a dentist less frequently than once a year said this was because they did not need to go and a third said it was because they could not afford it. Younger adults were most likely not to attend because they did not need to, whereas adults in most deprived neighbourhoods and in lower income quintiles were more likely to cite affordability.

Free or paid for NHS care was the most likely form of care to be received with two thirds of adults reporting to have received this at their last visit. Nearly a quarter of adults reported to have received private care, with the main reasons for not receiving NHS care being a perception that private care was a better quality and not being able to find an NHS dentist.

A third of adults reported that the cost of dental care had affected the type of dental care or treatment they had received, with those in more deprived neighbourhoods and in lower household income quintiles more likely to report this. A further quarter of adults reported that cost had delayed their dental care or treatment. This was more frequently reported by women, those aged 25 to 44 years, adults living in London, as well as those in lower income quintiles and those living in the most deprived neighbourhoods.

Visiting a dentist for a check-up at least once every 2 years helps to detect dental problems earlier and prevent more serious issues down the line. While most of the population reported to follow this advice, some did not, mostly because they considered their teeth to be healthy (more common among younger age groups) or they could not afford the check-ups (more common among those in lower income quintiles). While all adults are entitled to check-ups and treatment at NHS rates and some groups to free NHS treatment, the cost of care still influenced the type and timing of care, which in turn may have led to worse oral health outcomes. However, at the same time some adults opted for (more expensive) private care, because they could not find an NHS dentist or perceived private care to be of better quality. This indicates that there are 2 distinct groups whose needs are not fully met by the current NHS offer.

Self-reported health and oral impacts

The findings from the survey indicate adults were likely to have a positive perception about their oral health with two thirds saying they had very good or good oral health. Adults in the youngest age group and those who visited a dentist regularly or occasionally were more likely to report very good or good oral health, as were those in higher income quintiles and those living in less deprived neighbourhoods.

Nearly half of adults reported to have experienced one or more impacts from their oral health on their life overall. However, only one fifth of adults felt their daily performances had been severely impacted by their oral health. Women, those in lower income quintiles, those living in most deprived neighbourhoods and those who only went to the dentist when having trouble were more likely to report having experienced one or more impacts from their oral health on their life overall and feel their daily performances had been severely impacted by their oral health.

The association of household income and neighbourhood deprivation with most of the results presented in this report highlights disparities in reported oral health behaviours, condition of teeth and gums, patterns of dental attendance and overall oral health. The intersectionality of these differences is complex, and the causality cannot be unentangled using only cross-sectional data.