Teenagers, particularly in deprived areas, were twice as likely to have permanent damage as those elsewhere.
The report said teenagers in affluent areas were having braces fitted and aesthetic treatments.
The British Dental Association said a dental health strategy, published five years ago, must be implemented.
Poor diet, social deprivation and a non-fluoridated water supply all contribute to bad teeth.
As well as highlighting the standard of oral hygiene the report also found that teenagers in poorer areas were more likely to have extractions.
Peter Crooks from the BDA said the current dental contract did not pay dentists to deliver preventive treatments.
He has accused the Department of Health of dragging its feet on the dental health strategy.
"I think it is critical that it is implemented as soon as possible," he said.
"We have been talking with the Department of Health for the past five years and there seems to be very little progress in this and our young people throughout the country need to have better dental health.
"Prevention will do most to help that on its way."
The Department of Health, however, disagrees.
It said the regular care payment dentists received for each patient should be enough to cover everything and insisted prevention was spread across the health sector including in schools.
The Chief Dental Officer, Donnocha O'Carolan, said that there was already a lot of good work being done.
"We do have poor oral health levels in Northern Ireland but the department has been extremely pro-active in the last five or six years to reduce these decay levels," he said.
"There are three main things we need to do. One is to get fluoride onto the children's teeth.
"The second is to put fissure sealants on their adult teeth when they erupt to protect them and the third thing is to improve the diet.
"We have had fluoride toothpaste schemes throughout the most deprived areas in Northern Ireland running since 2005 and we have noticed a decline in the number of extractions and fillings."
Northern Ireland teenagers have some of the highest levels of tooth decay in Europe, a study funded by Queen's University has found.