Alarming oral health crisis among youth in residential care

Dental Tribune International

Fri. 1 August 2025

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JÖNKÖPING, Sweden: When young people are placed in care, child welfare services, healthcare authorities and institutional care providers assume responsibility for their oral health—yet research shows that they are at a significantly higher risk of poor oral health. Because there is limited clinical data on those in secure residential care, a study at Jönköping University has objectively assessed the oral health status of young people detained in such care and found that they have severely compromised dental health. Corroborating studies in other countries, the results showed widespread caries and poor oral hygiene, drawing urgent calls for reform from the researchers regarding the failing of authorities to meet residents’ oral health needs.

The study involved clinical and radiographic examination of 107 residents and interviews with 23 young people from two institutions. A further survey on health, oral health and dental care included 77 respondents from these two institutions and an additional facility. The findings were striking: fewer than one in ten young people were free from any caries, and those affected had a high caries incidence, resulting in an average of more than four teeth with manifest caries per person and over nine when incipient lesions were included. Less than one in five of those surveyed required no fillings, and plaque, gingivitis, erosion and early periodontal problems were widespread.

Despite over 80% needing further care, fewer than half received this treatment. The research highlights fragmented coordination between regions, record-keeping failures and administrative delays worsening access. The interviews and surveys found that the young people in care acknowledged the importance of oral hygiene, but struggled to prioritise it amid mental health challenges. They also reported that security rules often restricted access to floss picks or dental appointments.

Th study found that intake interviews severely under-estimate dental needs: fewer than one-third of new arrivals report problems, despite clinical findings. The residents reported lack of support from residential care facilities and child welfare services to establish hygiene routines or receive timely treatment. The researchers thus argued that society must act as a better “parent”: dental needs must be assessed early and treated without delay. Their recommendations included better staff training, regular oral health monitoring, stronger collaboration across agencies and outreach by regional dental teams. Such changes could help address the systemic issues identified by the study.

Speaking in a university press release, co-researcher Dr Torbjörn Kalin, senior lecturer in social work at the School of Health and Welfare, stated: “It is alarming that children for whom society has taken over parental responsibility have such extensive dental needs. These are children who often have experiences of neglect and difficult childhood conditions. Society is supposed to provide security—but in this case we are letting them down.”

The Swedish findings mirror growing global recognition of poorer dental health among vulnerable young people. As shown in related studies in both England and Scotland, children in care show higher rates of untreated caries and emergency dental visits, as well as lower attendance of dental appointments, than their peers. Factors include poor service access, lack of coordination between care and health authorities, and carers’ limited knowledge of dental care pathways.

The report on the Swedish study, titled Hål i Samhällsvården: Behov av och Uppfattningar om Tandvård och Munhälsa hos Unga på Särskilda Ungdomshem, is available to download and has an English summary.