The future of NHS dentistry

The NHS tries to offer a comprehensive dental service to provide “clinically necessary treatment to keep your mouth, teeth and gums healthy and free of pain”, but the NHS is failing to deliver this service for all patients in England:

“Plan to increase access to NHS dentists in England ‘a complete failure’, MPs say” (The Guardian).
“Pliers, abscesses and agonising pain: Britain’s dental crisis – as seen from A&E” (The Guardian).
“Tory bid to boost NHS dental appointments led to fewer patients, MPs say” (Financial Times).

These stories reflect the day-to-day reality patients already know: endless calls to find an NHS dentist, mile-long waiting lists, and more people being pushed to go private or simply go without.

Official NHS statistics claim 40-50% of the population has been “seen” by an NHS dentist in the past 24 months, but this figure is skewed by some patients attending for one-off urgent visits which don’t represent ongoing, comprehensive care. The British Dental Association estimates that around 13 million people in England now have unmet need for NHS dentistry – well over one in four adults.

Successive governments have responded with what many in the profession see as sticking plasters over a gaping wound: short-term incentives, tweaks to the discredited dental contract, or schemes designed to generate big headline numbers. These may ease immediate political pressure, but they don’t rebuild a sustainable service.

So what are the possible futures for NHS dentistry?

1. Continue with partial comprehensive care

Provide comprehensive care only to the 25% of the population lucky enough to have an NHS dentist.

Upside: government spending on NHS dentistry is capped.
Downside: nothing gets better, a de facto 2 tier system where many patients cannot register with NHS dentists and either pay privately or go without.

2. Emergency-only service

The NHS becomes a “dental A&E”: free antibiotics and extractions for everyone, but little else.

Upside: nobody left in pain.
Downside: prevention disappears, inequalities widen, and patients bounce back repeatedly for crisis management.

3. Safety-net dentistry

Cover only the basics: extractions, dentures, and fillings for front teeth for everyone, but all other restorative, complex and preventive care carries a higher fee.

Upside: more people could at least access urgent or functional care.
Downside: encourages tooth loss, undermines oral health, and entrenches a two-tier system.

4. Targeted core service

Limited access to free comprehensive NHS dentistry for children, low-income adults, and vulnerable groups; everyone else must fund their own dentistry privately.

Upside: resources directed where they achieve the most health gain.
Downside: politically difficult, and creates sharp divides at the eligibility line.

5. Higher patient charges or insurance

Fund comprehensive NHS dental care for all via higher patient charges and/or dental insurance.

Upside: raises revenue without use of public funds.
Downside: to restore even pre-pandemic spend, charges would need to rise by over 70% – Band 1 check-ups jumping from £27.40 to nearly £50. Many would be priced out, widening inequality.

6. Increase public funding

Collecting the funds to pay for NHS dentistry by taxation is the best way to reduce dental health inequality.

The BDA calculates that around £1.5 billion extra per year would stabilise NHS dentistry. HMRC’s Ready Reckoner suggests it would equate to just 0.22-0.25p on the basic rate of Income Tax.

For a basic-rate taxpayer on £35,000: about £50-£56 per year.
For a two-earner household: around £100-£110 per year.
That’s roughly £1-£2 per taxpayer per week – about the cost of a cup of coffee.

Conclusion

Every alternative path – partial comprehensive, emergency-only, safety-net, targeted core, or higher charges – either entrenches inequality, deters attendance, or undermines prevention.

The fairest, most efficient and most sustainable solution would be to fund NHS dentistry properly with public funds, but this would come at a cost to each taxpayer: the price of a coffee a week. If we’re not willing to pay the cost, the government and NHS England should be transparent about which parts of NHS dentistry we must cut.