National statistics

Adult oral health survey 2021: health-related behaviours

Published 25 January 2024

Applies to England

Oral hygiene

Introduction

Current guidance recommends that teeth should be cleaned thoroughly with a toothbrush and fluoride-containing toothpaste at least twice a day (see chapter 8 of Delivering better oral health: an evidence-based toolkit for prevention). Additional cleaning aids are recommended to reach interproximal surfaces (the surfaces between teeth).

Frequency of brushing teeth

Participants who reported having any natural teeth were asked how often they clean their teeth.

The majority (77%) of adults (16 years and over) with natural teeth said that they cleaned their teeth at least twice a day and 20% said that they cleaned their teeth once a day. Only 2% said that they cleaned their teeth less often than once a day.

Sex

Women (82%) were more likely than men (72%) to clean their teeth at least twice a day.

Region

The proportion who brushed their teeth at least twice a day varied across regions from 74% in the North West and the North East and Yorkshire to 82% in the South East.

Household income

Seventy-two per cent of adults in households in the lowest income quintile reported that they brushed their teeth at least twice a day and this proportion increased with income to 82% in the second highest and highest income quintile.

Figure 1: frequency of brushing teeth at least twice a day, by household income

Base: all adults with natural teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 1 in the data tables.

Neighbourhood deprivation

The proportions who brushed their teeth at least twice a day varied with neighbourhood deprivation. Sixty-nine per cent of adults living in the most deprived quintile brushed their teeth at least twice a day. This proportion increased to 85% of adults in the least deprived quintile.

Figure 2: frequency of brushing teeth at least twice a day, by neighbourhood deprivation

Base: all adults with natural teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 1 in the data tables.

Usual pattern of dental attendance

Adults with natural teeth who said they attended a dentist for check-ups were more likely to brush their teeth twice a day: 82% of those who said they attended for a regular check-up and 76% of those who said they had occasional check-ups. In comparison, 64% of those who said they only saw a dentist when they had trouble and 62% who said they never went to the dentist brushed their teeth at least twice a day.

Figure 3: frequency of brushing teeth at least twice a day, by usual pattern of dental attendance

Base: all adults with natural teeth.

Age

The proportions of adults who cleaned their teeth at least twice a day did not vary significantly with age.

Error bars show the 95% confidence interval around the estimates.

Source: Table 2 in the data tables.

Use of fluoride toothpaste

Participants who reported cleaning their teeth were asked whether the toothpaste they used most often contained fluoride. (This excluded the handful of participants who reported that they never cleaned their teeth.)

Four in 5 adults (80%) said they used fluoride toothpaste. A small proportion (3%) reported they did not use fluoride toothpaste. The remaining 1 in 6 (17%) said they did not know if they used fluoride toothpaste.

Age

The proportions of adults who said they used fluoride toothpaste increased with age up to the age of 74 years from 69% among the youngest age group to 86% of those aged 45 to 64 years and 84% among those aged 65 to 74 years.

The proportion of those who did not know whether they used fluoride toothpaste decreased with age at a similar rate.

The proportion of adults who said they used non-fluoride toothpaste was slightly higher among the youngest (4% among those aged 16 to 34 years) and oldest age group (5% among those aged 75 years or over) compared with 2% to 3% for other age groups.

Figure 4: use of fluoride toothpaste, by age

Base: all adults who clean their teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 3 in the data tables.

Household income

Adults living the lowest income quintile were less likely to use fluoride toothpaste (78%) compared to adults living in the highest income quintile (85%).

Neighbourhood deprivation

The proportions of adults using fluoride toothpaste were lowest among adults living in the 2 most deprived quintiles (77% to 78%) and highest among adults living the least deprived quintile (85%).

Usual pattern of dental attendance

Adults who went to a dentist for a regular check-up were more likely to say that they used fluoride toothpaste (84%) compared to other adults (75% of those who went for an occasional check-up, 74% of those who only went when they had trouble and 71% of those who had never been to a dentist). Those who had regular check-ups were also less likely to say they did not know if they used fluoride toothpaste (13% compared with 21% to 23% in other groups).

Proportions of adults reporting using fluoride toothpaste did not differ statistically by sex or region.

High fluoride toothpaste

Seven per cent of adults who clean their teeth reported that they used a high fluoride toothpaste prescribed by a dentist.

The proportions of adults reporting that they used a high fluoride toothpaste prescribed by a dentist were similar across population groups.

Aids used for dental hygiene

Survey participants who cleaned their teeth were asked what they used to clean their teeth and mouth with. Participants could select more than one answer to this question.

Half (51%) of adults who cleaned their teeth reported that they used an ordinary manual toothbrush. A greater proportion (59%) of adults reported using an electric toothbrush. This means that some adults used both an ordinary manual and an electric toothbrush.

Of the other hygiene aids asked about, the most commonly used were:

• mouthwash (37%)
• dental floss (30%)
• interspace brushes (21%)
• interdens, toothpicks or woodsticks (11%)
• sugar-free chewing gum (8%)

Figure 5: frequency of use of dental hygiene aids

Base: all adults who cleaned their teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 7 in the data tables.

Sex

Women were more likely than men to have reported using an electric toothbrush (62% of women compared with 57% of men).

Age

The proportion of adults who reported using an electric toothbrush increased with age up to the age of 65 years, from 55% of those aged 16 to 24 years to 67% of those aged 55 to 64 years.

The oldest and youngest adults were more likely to report using a manual toothbrush (59% of those aged 75 years and over, 57% of those aged 16 to 24 years). This was least common among adults aged between 55 and 64 years (44%).

Figure 6: use of electric and manual toothbrush, by age

Base: all adults who cleaned their teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 7 in the data tables.

Region

The proportion of adults who used a manual or electric toothbrush varied between regions. The proportion of adults who used an electric toothbrush was lowest in the North East and Yorkshire and the North West (51%) and highest in the South East (64%).

The proportion of adults who used a manual toothbrush was highest in the North East and Yorkshire (60%) and lowest in the South East (45%).

Household income

The proportion of adults who used an electric toothbrush increased from 47% in the lowest income quintile to 76% in the highest income quintile.

The proportion of adults who used a manual toothbrush decreased from 62% in the lowest income quintile to 36% in the highest income quintile.

Figure 7: use of electric and manual toothbrush, by household income

Base: all adults who cleaned their teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 7 in the data tables.

Neighbourhood deprivation

The proportion of adults who used an electric toothbrush increased from 46% in the most deprived quintile to 68% in the least deprived quintile.

The proportions of adults who used a manual toothbrush was highest in the 2 most deprived quintiles (63% and 56%) and lowest in the 2 least deprived quintiles (43% and 46%).

Figure 8: use of electric and manual toothbrush, by neighbourhood deprivation

Base: all adults who cleaned their teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 7 in the data tables.

Usual pattern of dental attendance

Adults who reported going to the dentist for regular check-ups (67%) were twice as likely to report using an electric toothbrush than those who had never been to the dentist (32%). Those who said they only attended the dentist when having trouble were also less likely to report using an electric toothbrush (39%) than those reporting going to the dentist for regular check-ups. 

Adults who reported going to the dentist for regular check-ups were less likely to use a manual toothbrush (45%) than those who said they went for an occasional check-up (53%), those who said they only visited the dentist when they were having trouble (69%) or those who said they had never been to the dentist (74%).

Figure 9: use of electric and manual toothbrush, by usual pattern of dental attendance

Base: all adults who cleaned their teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 8 in the data tables.

The proportion of adults using a manual toothbrush did not statistically differ by sex.

Health-related behaviours

Introduction

Participants were asked about tobacco use, vaping and alcohol consumption.

Tobacco use, including smoking cigarettes and other tobacco products, poses a major risk to oral health, particularly through oral cancers and on periodontal (gum) health (source: chapter 11 of ‘Delivering better oral health: an evidence-based toolkit for prevention’). 

Evidence linking the use of e-cigarettes and other vaping devices to poor oral health outcomes is still developing (source: chapter 11 of ‘Delivering better oral health: an evidence-based toolkit for prevention’).  

An increased risk of developing oral cancer is also associated with alcohol consumption and this risk increases synergistically when alcohol is used in conjunction with tobacco. There is also emerging evidence of alcohol consumption being associated with periodontal disease (source: chapter 12 of ‘Delivering better oral health: an evidence-based toolkit for prevention’).

Tobacco use

Prevalence of tobacco use

The questionnaire included questions on smoking and non-smoked tobacco use.

This analysis focuses on smoking and categorises adults into one of 3 groups:

• current smokers were those who answered yes to the question: “Do you smoke cigarettes or other tobacco products at all nowadays?”
• previous smokers were those who answered no to the question: “Do you smoke cigarettes or other tobacco products at all nowadays?” and yes to the question “Have you ever smoked a cigarette or another tobacco product, for example a cigar, pipe or shisha? Don’t count e-cigarettes or other vaping products.”
• those who had never smoked answered no to the question: “Have you ever smoked a cigarette or another tobacco product, for example a cigar, pipe or shisha? Don’t count e-cigarettes or other vaping products”

Twelve per cent of adults said that they currently smoked. A further 30% had previously smoked and 58% of adults had never smoked.

The use of non-smoked tobacco was relatively uncommon, with 3% of adults reporting that they had previously used it and 1% reporting current use.

Sex

Men were more likely than women to report they currently smoked cigarettes or other tobacco products (14% and 10% respectively).

Age

The proportion of adults who currently smoked varied with age. The proportions were highest among those aged 25 to 34 years (20%) and lowest among those aged 75 years and over (3%).

Smoking and oral health

Smoking was associated with poorer periodontal health.

Twenty-four per cent of current smokers and 23% of previous smokers reported that they had been told by a dental health professional that they had gum disease, compared with 16% of those who had never smoked.

Current smokers were more likely to report that their gums bled than were previous smokers and those who had never smoked:

• 34% of current smokers reported that their gums bled, including 7% whose gums bled when they ate some foods and 30% who reported that their gums bled when they cleaned their teeth
• 27% of previous smokers reported that their gums bled, including 4% whose gums bled when they ate some foods and 25% who reported that their gums bled when they cleaned their teeth
• 25% of those who had never smoked reported that their gums bled, including 3% whose gums bled when they ate some foods and 24% who reported that their gums bled when they cleaned their teeth

Figure 10: whether gums bleed, by smoking status

Base: all adults with natural teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 15 in the data tables.

E-cigarettes and other vaping devices

Prevalence of vaping

All adults were asked if they had ever used e-cigarettes or vaping devices. If they reported ever having used e-cigarettes or vaping devices, they were asked if they were currently using them. 

Fifteen per cent of adults reported having used e-cigarettes or vaping devices, with 6% currently using them.

Sex

Seven per cent of men currently used e-cigarettes or vaping devises compared with 4% of women.

Men were less likely than women to have reported never having used e-cigarettes or vaping devises (83% and 87% respectively).

Age

E-cigarette and vaping device use varied with age, with those aged 25 to 34 years most likely to currently be using e-cigarettes or vaping devices (9%) and having used them in the past (18%).

The proportion who had never used e-cigarettes or vaping devices increased with age, from 73% of those aged 25 to 34 years to 99% of those aged 75 years and over.

Vaping and oral health

Given the high overlap between vaping and past or current smoking (source: Health Survey for England, 2021 part 1) it is likely that any relationship between vaping and oral health status may be wholly or partly due to the tobacco use. Also, as vaping products have been available for a shorter period of time, their longer-term effect on oral health is still unclear.

The prevalence of ever having been told by a dental professional that they had gum disease was higher among adults who reported current (27%) or previous (23%) use of e-cigarettes or vaping devices compared to adults who reported they had never used e-cigarettes or vaping devices (18%).

Figure 11: prevalence of ever having been diagnosed with gum disease, by vaping status

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 14 in the data tables.

Those who reported current or past vaping were more likely to report that their gums bled than were those who had never used e-cigarettes or other vaping products:

• 35% of current vapers reported that their gums bled
• 40% of previous vapers reported that their gums bled
• 25% of those who had never vaped reported that their gums bled

Drinking alcohol

Prevalence of drinking alcohol

Participants were asked how often they drank alcohol in the last 12 months: never, monthly, 2 to 4 times a month, 2 to 3 times a week or 4 or more times a week.

Thirty-four per cent drank alcohol twice or more a week, including 12% who drank 4 or more times a week; 40% drank less often. Twenty-six per cent of adults reported that they never drank alcohol.

Sex

Fourteen per cent of men reported drinking 4 or more times a week compared to 9% of women.

Women (28%) were more likely than men (23%) to report that they never drank alcohol.

Age

Younger adults were least likely to report drinking 4 or more times a week. Just 2% of those aged 16 to 24 years said they drank 4 or more times a week; this proportion increased to 23% of those aged 65 to 74 years.

The proportion of adults who never drank alcohol decreased with age, from 43% of those aged 16 to 24 years to 18% of those aged between 55 and 64 years. It increased in older adults to 31% of those aged 75 years and over.

Figure 12: never drinks alcohol, by age

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 11 in the data tables.

Drinking alcohol and oral health

The mean number of natural teeth were lower for adults who never drank alcohol (24.0) compared to adults who drank alcohol; monthly (25.9), 2 to 4 times a month (26.1) or 2 to 3 times a week (26.0).

The mean number of fillings and crowns increased from 4.1 of those adults who never drank alcohol and drank alcohol monthly to 7.0 of those adults who drank alcohol 4 or more times a week.

Adults who never drank alcohol (16%) were least likely to report that they had been told by a dental professional that they had gum disease.

The proportion of those who reported to have previously been told by a dental health professional that they had gum disease increased with the frequency of alcohol consumption, from 17% of those drinking 2 or 4 times a month, to 25% of those drinking 4 or more times a week.

The mean number of crowned teeth did not significantly differ by frequency of drinking alcohol.

Figure 13: prevalence of ever having been diagnosed with gum disease, by frequency of drinking alcohol

Base: adults with natural teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 14 in the data tables.

The proportions who reported bleeding gums varied with alcohol consumption. Twenty-three per cent of those who drank at least twice a week reported that their gums bled, but this proportion was higher among those who drank alcohol less often or not at all (between 28% and 30%).

Figure 14: prevalence of bleeding gums, by frequency of drinking alcohol

Base: all adults with natural teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 15 in the data tables.

Advice on health-related behaviour received from a dentist or a member of the dental team

Introduction

Dental professionals are encouraged to engage with service users and advise as appropriate on behaviours that can affect the health of their teeth and gums (source: ‘Delivering better oral health: an evidence-based toolkit for prevention’).

All participants were asked if they had ever been asked about or received advice relating to their health-related behaviours by a dentist or member of the dental team. The health-related behaviours included smoking behaviours, alcohol consumption, food and drink consumption and advice on cleaning teeth and gums. The proportions given advice would be dependent both on whether a dental professional had asked about relevant behaviour and whether that behaviour was seen to need some change. For instance, if we observe a certain age group being more likely to receive advice on cutting down drinking, then this may be a result of: a) this age group being more likely to drink and therefore considered to be in need of advice or b) the age group being as likely to drink as others, but being more likely to go to a dentist frequently and thus having more opportunities to receive advice. The results below cannot disentangle these 2 scenarios. 

A relatively small proportion of adults (4%) reported that they had never been to a dentist. Some of these also reported having been asked about health-related behaviours or being given advice. They have been included in total estimates and shown in the data tables, but their responses are not discussed here.

Ever been asked about health-related behaviours

Less than half of adults reported that they had been asked about behaviours related to their oral health:

• 42% had been asked whether they smoked
• 33% had been asked about their alcohol consumption
• 30% had been asked about the food and drink they consumed

Figure 15: type of health-related behaviour asked about by a dentist or dental team member

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 16 in the data tables.

Age

The proportion of adults who had been asked about their smoking behaviours was lowest among those aged 16 to 24 years and those aged 75 years and over (28%) and highest among those aged 35 to 44 years (52%).

A similar pattern was seen for those asked about their alcohol consumption: 25% of adults aged 16 to 24 years and 21% of those aged 75 years or over had been asked about alcohol consumption compared with 40% of those aged 35 to 44 years.

Having been asked about food and drink consumption differed slightly by age, with those aged 16 to 24 years and 25 to 34 years being the most likely to have been asked (43% and 45% respectively).

Region

Adults living in London were most likely to have been asked about food and drink consumption (36%) compared to adults living in the South West who were least likely to have been asked (24%).

Household income

The proportion of adults asked about alcohol, as well as food and drink consumption varied across income quintiles with no clear pattern.

Usual pattern of dental attendance

Whether adults had been asked about their health-related behaviours varied according to their reported usual pattern of dental attendance:

• nearly half of those who said they attended a dentist for regular check-ups (45%) and those who said they went only with trouble (43%) had been asked about smoking, compared with 38% of those who said they went for occasional check-ups
• smaller proportions had been asked about drinking alcohol: 35% of those who said they went for regular check-ups compared with 31% of those who said they saw a dentist only when they had trouble and 29% of those who said they went for occasional check-ups
• there was less variation in the proportions who reported that they had been asked about what they ate and drank: 33% of those who said they went for occasional check-ups, 31% of those who said they saw a dentist only when they had trouble and 30% of those who said they went for regular check-ups

Figure 16: type of health-related behaviour asked about, by usual pattern of dental attendance  

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 17 in the data tables.

The proportions of adults receiving advice about their smoking behaviours did not statistically differ by sex, region, household income or neighbourhood deprivation.

The proportions of adults receiving advice about their alcohol consumption did not vary by sex, region or neighbourhood deprivation.

The proportions of adult receiving advice about their food and drink consumption did not differ by sex or neighbourhood deprivation.

Advice about health-related behaviours

A minority of adults had received advice from a dentist or member of the dental team about giving up smoking (8%), cutting down or giving up drinking alcohol (3%) or the types of food and drink consumed (17%).

The proportion who had received advice about cleaning their teeth and gums was considerably higher (67%), however a third had never received advice about cleaning their teeth or gums.

Figure 17: proportion who had received advice about health-related behaviours from a dentist or a member of the dental team

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 18 in the data tables.

Sex

Women were less likely than men to have received advice on cutting down or giving up drinking (2% and 5% respectively) and were more likely than men to have received advice about cleaning their teeth or gums (68% and 65% respectively).

Age

Receiving advice about smoking, drinking and food and drink consumption was generally most likely among younger adults:

• adults aged 25 to 34 years were the most likely to have received advice for giving up smoking (14%)
• those aged 25 to 44 years were most likely to have received advice for cutting back or giving up drinking alcohol (5%)
• those aged 16 to 24 years were most likely to have received advice about the types of food and drink consumed (29%)

The proportion who had received advice about cleaning gums and teeth increased with age from 63% of those aged 16 to 24 years to 74% of those aged 55 to 64 years but was lower among older adults.

Figure 18: type of health-related behaviour advice received, by age

Base: all adults with natural teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 18 in the data tables.

Region

Receiving advice about food and drink consumption and cleaning teeth and gums varied by region.

Those living in London (20%) were most likely to report having received advice about the types of food and drink consumed; those living in the South West were least likely (13%).

The proportion who received advice about cleaning teeth and gums was highest for those in the South East (73%) and lowest for those in the North West (63%).

Figure 19: type of health-related behaviour advice received, by region

Base: all adults with natural teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 18 in the data tables.

Household income

Adults in the lowest income quintile were more likely to have received advice on giving up smoking. Receiving advice for giving up smoking was most likely among adults in the lowest household income quintile (11%) and least likely in the 2 highest quintiles (6% and 5%). This is likely because adults in the lowest household income quintile are more likely to be current smokers (see ‘Health Survey for England, 2021 part 1’).

The proportion who had received advice about the type of food and drink they consumed varied by income, but without a clear pattern.

Adults in the highest income quintile were more likely to have received advice on cleaning their teeth and gums. Receiving advice on cleaning teeth and gums increased by income from 60% in the lowest quintile to 74% in the highest quintile.

Figure 20: type of health-related behaviour advice received, by household income

Base: all adults with natural teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 18 in the data tables.

Neighbourhood deprivation

Adults in the most deprived quintiles were more likely to receive advice about giving up smoking. Thirteen per cent of adults in the most deprived quintile received advice about giving up smoking, compared with 4% and 6% of those in the 2 least deprived quintiles.

Adults in the least deprived quintile were more likely to receive advice about cleaning their teeth and gums. Receiving advice on cleaning teeth and gums increased with decreasing neighbourhood deprivation from 59% in the most deprived to 74% in the least deprived quintile.

Usual pattern of dental attendance

Adults who reported that they only went to the dentist when they had trouble with their mouth, teeth or dentures were most likely to have received advise on quitting smoking (14%). Whether adults had received advice on cleaning their teeth and gums varied by the pattern of dental attendance: 74% of those who said they went for regular check-ups, 64% who said they went for occasional check-ups and 57% of those who said they went to the dentist only when they had trouble had received this type of advice.

Figure 21: type of health-related behaviour advice received by usual pattern of dental attendance

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 19 in the data tables.

The proportions of adults who received advice on giving up smoking were not statistically different by sex or region.

Receiving advice on alcohol consumption did not vary by region, household income, neighbourhood deprivation or usual pattern of dental attendance.

The proportions of adults receiving advice on food and drink consumption did not differ by neighbourhood deprivation or usual pattern of dental attendance.

There were no significant differences between women and men in the proportions who received advice on cleaning their teeth and gums.