Twelve-year-old children in Leicester have the highest rate of tooth decay in England, according to an NHS report.
The latest figures found 45.3% of 12-year-old children in the city have experienced tooth decay, compared to an England average of 17.5% in 2008/09.
NHS Leicester City Primary Care Trust (PCT) said it needed to try harder to get the basic dental hygiene message across to people.
In total, 140 PCTs of 152 took part in the national dental health survey.
There are many causes of poor dental health, which include diet, poor oral hygiene and not visiting a dentist, the British Dental Association (BDA) said.
Ivan Browne, a consultant in public health for NHS Leicester City, said there was also a responsibility with "people looking after their own teeth" if the city was to improve tooth decay in children.
"Yes we can increase provision, improve information and get the information out there, but the fundamental thing is making sure children are not having all those sugary snacks and brushing their teeth properly," he said.
Jancy Pope, a specialist paediatric dentist at Leicester's Westcotes Clinic, said a few years ago removing all 20 baby teeth on a toddler was "not a unique occurrence at all".
She added: "Scotland runs a programme were fluoride is applied to children's teeth at pre-school, nurseries and schools and the results show significant improvement in oral health".
Ms Pope suggested "water fluoridation and better education" would reduce the number of children in Leicester with decaying teeth.
Christopher Allen, who chairs the Dental Public Health Working Group for the BDA, said: "Despite an overall improvement in recent years, unacceptable inequalities between those with the best and worst oral health persist.
"Vital to tackling these inequalities is the input of consultants in dental public health. Worryingly, around one-third of primary care trusts, including Leicester City, do not have access to such expertise. This must be rectified as the Government's NHS reorganisation continues."
The survey, called NHS Dental Epidemiology Programme (NHS DEP) for England, was undertaken by North West Public Health Observatory and The Dental Observatory.