A quarter of children in England start school suffering from tooth decay, new figures show.
Despite a dip in the number of five-year-old children who suffer from tooth decay, almost 25% start school with the condition which is almost entirely preventable, according to data from Public Health England (PHE).
And one in 40 five-year-olds need to have rotten teeth removed.
The statistics, from more than 100,000 children across the country, show significant regional variation in the rates of tooth decay among youngsters.
In the South East, 80% of five-year-olds have a clean bill of oral health but in the North West the figure stands at just 67%.
But PHE said that nationally the number has dipped to its lowest level in almost a decade - in 2008 31% of five-year-olds suffered tooth decay.
Dr Sandra White, director of dental public health at PHE, said: "This is great news. However, one child with tooth decay is one too many and there is still much inequality in dental health around the country.
"Tooth decay is painful and too often results in teeth extraction, some under general anaesthetic.
"This is further evidence that we can stop tooth decay in its tracks. Limiting sugary food and drink, supporting children to brush their teeth twice a day with fluoride toothpaste and regular trips to the dentist, will help prevent a great many more children suffering at the hands of tooth decay."
The proportion of five-year-olds who have had teeth removed due to decay was 2.5% - which equates to one in 40 children this age. But this represents a fall from 2008 when the figure stood at 3.5%.
Regional variation shows that only 1.9% of five-year-olds in the East Midlands have had tooth extractions due to decay, compared with 3.9% of children in Yorkshire and the Humber.
Commenting on the figures, Professor Nigel Hunt, dean of faculty of dental surgery at the Royal College of Surgeons, said: "We should not be complacent, Public Health England's survey still shows that almost a quarter of children in this age group suffer from visible tooth decay which is almost entirely preventable.
"The results also show significant regional variation. For example in Blackburn and Darwen more than half of five-year-olds have tooth decay compared to around 10% in West Cheshire.
"We cannot overemphasise the importance of teaching children to brush twice a day with fluoride toothpaste and making sure they consume less sugary food and drinks. Parents also need to ensure their children visit a dentist at least once a year from the first year of age - 40% of children do not.
"Government has begun to make steps in the right direction by introducing a sugar levy. It now needs to put real effort into improving access to NHS dentists and laying out a coherent children's oral health strategy that takes into account the social inequalities in the prevalence of tooth decay this survey highlights. The Government's imminent obesity strategy offers an opportunity to do this."