Inequalities in oral health and access to dental services in children and young people with learning disabilities

Oral Health | Last Updated: 29 Aug 25

Background

The dental health of children in Scotland has improved over the last decade. However, inequalities in child oral health remain. Some groups of children are particularly at risk, including those from economically disadvantaged communities and those with learning disabilities. To date, oral and dental health service access among children with educational additional support needs (ASN), including children with learning disabilities and/or autism has received less attention.

We investigated the oral and dental health service access among young children with ASN compared to the general child population in Scotland.

What we did

For the pre-pandemic school years 2016/17 to 2018/19, Scotland’s pupil census was linked (in a safe, secure, and confidential way) to four other routine administrative national databases (the National Dental Inspection Programme (NDIP) – school dental inspections in Primary 1; NHS dental practice activity; NHS hospital dental activity; and the Childsmile database).

Dental data on 166,781 children were included. Children were grouped according to their ASN status in Primary 1. Their oral health and dental service access were compared, accounting for socioeconomic circumstances and type of school attended.

What we found

Oral health - tooth decay

Experience of tooth decay in Primary 1 was highest among children with social educational ASN when compared to their peers with no ASN.
Children with learning disabilities were almost twice as likely to experience tooth extraction (due to tooth decay) under general anaesthesia than their peers with no ASN.

Access to school dental inspections

As part of the National Dental Inspection Programme - all children in local authority schools in Scotland in Primary 1 and Primary 7 should receive a dental inspection in school. The findings of this inspection are provided to parents and efforts are made to try and follow up children with dental abscesses or high levels of tooth decay.

Access to the National Dental Inspection Programme among P1 children with learning disabilities or autism improved markedly from 2016 onwards (when the NDIP programme was expanded to include special schools). However inspection levels are not yet in line with children with no ASN.
In participating schools, children with learning disabilities or autism have higher rates of refusal.
Children with learning disabilities or autism who attended special schools were less likely to get a dental inspection than their peers in mainstream schools.
Post 2016 children with learning disabilities or social ASNs were less likely to be inspected due to attending schools not participating in NDIP.

Access to dental services

Regular attendance at dental practices (in high street or in health centres) for children with any ASN was lower than for children with no ASN.
For children who did attend the dentist those with autism (and to a lesser extent those with learning disabilities) were less likely to receive “Childsmile” preventive care in practice (fluoride varnish, dietary advice or toothbrushing instruction).

Childsmile – the national oral health improvement programme for Scotland includes:

Children with intellectual disabilities or autism were more likely to receive support from Childsmile’s Dental Health Support Workers compared to those with no ASN.
Children with intellectual disabilities or autism had equal/similar access to Childsmile’s nursery supervised daily toothbrushing programme, compared to children with no ASN but those with a social ASN were less likely to participate in this programme.

Outcomes from this work to date

Findings from this study have been used to inform the development of the NHS Scotland Dental Payment Reform (November 2023), which included additional payments to General Dental Practitioners for treating children, young people and adults with additional support needs. This additional payment to the capitation fee allows for the extra time a dentist may require to spend with patients with additional support needs. This change could significantly improve oral health in people with learning disabilities.

We will continue with ongoing discussion, in collaboration with stakeholders, to develop a set of recommendations for policy and practice based on our analysis, while also continuing to monitor the outcome above.

Project lead: Andrea Sherriff

Research Team: Ryan Stewart, Lorna M. D. Macpherson, Jamie B. R. Kidd, Angela Henderson, Deborah Cairns, David I. Conway.

SLDO Group member(s) involved in this research

Professor Deborah Cairns

Deborah is the Director of the Scottish Learning Disabilities Observatory and Professor of Health and Neurodevelopmental Conditions, in the School of Health and Wellbeing, at the University of Glasgow. Deborah is passionate about her research which aims to improve the health of people with learning disabilities and their families. She has worked on many different projects about people with learning disabilities including: cancer incidence, cancer screening, multi-morbidity (having two or more health conditions), oral health and COVID-19, to name a few. She has also worked on projects about the physical and mental health of family members who support someone with a learning disability. Deborah is committed to conducting research that has impact and works closely with self-advocates with learning disabilities, family carers and third sector organisations who are pivotal in all of her work and who have a shared vision of ensuring the human rights of all people with learning disabilities are recognised, supported and upheld.

Angela Henderson

Angela was formerly the Director for Policy and Impact for the Scottish Learning Disabilities Observatory and remains an affiliate team member, having moved in 2024 to work with the Scottish Government leading the development of annual health checks and learning disabilities data. Angela is interested in how evidence is used in policy making and was involved in many projects at the Observatory. These included: Understanding the impact of Covid-19 on people with learning disabilities, The Research Voices Project, Helping to set up the SPIRE learning disabilities data project, Analysing information about drug prescribing for people with learning disabilities

Professor Anna Cooper

Anna set up the Scottish Learning Disabilities Observatory with funding from the Scottish Government. She wants the Observatory to make Scotland fairer and healthier for people with learning disabilities and their families, by: Finding out the health problems people have Finding out how good or bad health care is Telling people about health and health care problems Finding ways to make health and health care better Checking if health gets better or worse over time Helping the Scottish Government, and staff who provide health and social services, to get it right for people with learning disabilities Anna is a doctor. She has done a lot of studies on the health of people with learning disabilities. Anna’s full name is Professor Sally-Ann Cooper.