Nearly one-in-three North-east schoolchildren in P1 already show signs of tooth decay, according to the latest health figures.
Although 70% of five-year-olds who had a check-up had healthy teeth, about 30% had evidence of tooth decay.
An NHS Grampian spokeswoman said the situation had improved over the last 20 years, when two-in-three five-year-olds had signs of tooth decay.
She said: “Children’s oral health in Grampian has been improving with the proportion of primary 1 children who are decay-free now at 70.2% in 2016 compared to 1996 when it was 44.3%.
“This improvement has been brought about through the implementation of the Childsmile programme which includes the nursery toothbrushing programme, the targeted fluoride varnish application scheme and the tailored programme of care that involves oral hygiene instruction, dietary advice and fluoride varnish application within primary care dental services.
“Decay is largely preventable but the burden of the disease is mainly borne by the disadvantaged in our society. The risk factors for tooth decay include diets high in sugary foods and fizzy drinks, poor oral hygiene, inappropriate infant feeding practices and inadequate exposure to fluoride.”
Health Secretary Shona Robison said there was more work to do.
She said: “Rates of decay in Grampian are lower than the national average. There have been some significant improvements to oral health in recent years, particularly for children, with 92% of children now registered with a dentist and the number of primary one children with no obvious decay experience rising from 54% in 2006 to 69% in 2016.”
Ms Robison said the Childsmile programme was behind the reduction in children’s tooth decay and said a new initiative was also on the way.
She said: “Our Childsmile programme, which offers every child attending nursery in Scotland free daily supervised tooth brushing, has contributed to this improvement. Clearly we want to these positive trends continue as tooth decay is almost always preventable so there is no reason for a child to have poor teeth.”