Oral Health Briefing Report (November 2023)

Key issues and challenges
    • Access to NHS dentistry is a significant challenge [8]. In the British Social Attitudes Survey in 2022, satisfaction with NHS dentistry fell to a low of 27% and dissatisfaction increased to a high of 42%. 24% of respondents said they were ‘very dissatisfied’ with NHS dentistry – a higher proportion than for other health and care services asked about in the survey

    • Healthwatch England reports that patients frequently raise issues around access to dentistry. This was replicated locally in Healthwatch Wirral data [7]

    • 7 of 42 of England’s ICBs reported that they had no dental practices taking new adult NHS patients. While people can theoretically be treated by any dentist with an NHS contract,

      data from 2022 found that people who had been to a particular practice before were much more successful in getting an NHS dental appointment than those who were not previously

      known to the practice (82% compared with 32%) [8]

    • A report by BBC News and the British Dental Association in August 2022 found 9 in 10 NHS dental practices across the UK were not accepting new adult patients for NHS treatment [8]

    • As well as difficulties in securing an appointment, there are wide  disparities in the availability of dental practices providing NHS services.  There is also a  significant geographical variation in the supply of dentists, with dentists concentrated in cities and around dental hospitals and schools. In addition, the number of dentists willing to provide NHS services is falling [8]

    • Particular groups of the population continue to be at risk of poorer dental health and worsening health inequalities (see above section ‘Groups Most at Risk’); Younger adults and people from minority ethnic groups were reported to have the lowest levels of success in accessing appointments.

    • The majority of the information on oral health in older people relates to the minority of older people who live in residential and nursing care homes; little is known about the much larger and increasing proportion of older people who are living independently at home or being cared for by friends, family or formal carers [6]; more information is required on the oral and general health of the household resident older population [6]

    • Older people are more likely to have general health complications that make treatment planning more difficult and may require modification of services [6]; in addition, household resident older people may not be able to easily access routine dental services due to functional limitations, transport difficulties and multiple long-term conditions [6]

    • As more people are keeping their teeth for longer, the range of dental treatment required will be more complex than in the past and is more likely to demand the facilities of a dental surgery; this changing demographic picture makes identifying and accessing those who need preventive services and treatment more complex, and a whole-systems approach is required [6].

    • Consequently, dental services for older people must be more integrated within the wider health and social care landscape. Developments in training, information sharing, and referral pathways are necessary to achieve this [6]

    • Also, according to PHE (now OHID), in order to develop holistic patient-centred services, varying levels of prevention and care need to be available as part of the same care pathway; this may mean a service providing domiciliary care for routine prevention and simple treatments, plus access to mobile dental  surgeries, transport and multi-specialist centres for more complex treatments [6]

    • The COVID-19 pandemic has had a significant impact on primary care dentistry as routine dentistry was completely suspended for several months in 2020. In January 2022, the government announced the investment of £50 million to provide an additional 35,000 urgent dental care appointments to help to drive services back to pre-pandemic levels [9]

Previous local reports
  • Dental Health Needs Assessment and Dental Health Needs Assessment for Cheshire (includes Wirral) (April 2015)
    Undertaken by Liverpool Public Health Observatory, for local Directors of Public Health, to determine the current health needs of the population, to investigate the current service provision for dental health in children and adults, highlighting gaps and inequalities. They also developed a set of evidence based recommendations for local commissioners on oral health promotion and prevention and for NHS England on the provision of dental health services for the local population; from Cheshire and Merseyside, through to local authority level.

  • Dental Health Profile for Wirral for 5 year olds for 2015 (published July 2017)
    This report provides detail about the oral health of five-year-old children in the area covered by Wirral local authority.

  • Child Dental Health Survey 2013, England, Wales and Northern Ireland (March 2015)
    The 2013 Children’s Dental Health (CDH) Survey, commissioned by the Health and Social Care Information Centre, is the fifth in a series of national children’s dental health surveys that have been carried out every ten years since 1973. The 2013 survey provides statistical estimates on the dental health of 5, 8, 12 and 15 year old children in England, Wales and Northern Ireland, using data collected during dental examinations conducted in schools on a random sample of children by NHS dentists and nurses. The survey measures changes in oral health since the last survey in 2003, and provides information on the distribution and severity of oral diseases and conditions in 2013.

    • Oral health: approaches for local authorities and their partners to improve the oral health of their communities (2014)
      This NICE guideline makes recommendations on undertaking oral health needs assessments, developing a local strategy on oral health and delivering community-based interventions and activities. 

Topic information
  • Root causes: quality and inequality in dental care (November 2023)
    This Nuffield Trust paper uses publicly available data to provide a snapshot view of quality in specific areas of health and social care. This briefing uses a variety of routine data to provide evidence that NHS dental care has been improving steadily in recent times, but that regional and socioeconomic variations in quality remain that need to be addressed.

  • The impact of COVID-19 on access to dental care: a report from the 2021 Adult Oral Health Survey (December 2022)
    On 25 March 2020 access to general dental services was paused across the UK and dental care hubs were established to deliver urgent care as part of the government’s response to the COVID-19 pandemic. Personal protective equipment (PPE), infection prevention and control, and patient prioritisation guidance were issued to dental care providers as services began to reopen in England from June 2020. This guidance further changed as the nation continued to navigate the pandemic and as wider restrictions were amended.

    Although some access to dental services was maintained throughout subsequent lockdowns and changes in restrictions, there were longer-term impacts on access to dental services. These included the time needed to clear appointment backlogs, staff availability, physical distancing and PPE requirements, some of which still applied in February and March 2021, when the Adult Oral Health Survey (AOHS) was carried out. This survey gives an indication as to the impacts of COVID-19 on access to dental care.

  • Improving the oral health of children: cost effective commissioning (October 2016)
    Resources to support local authorities investing in the local commissioning of oral health improvement programmes for pre-school children. Local authorities can use the Return on Investment (ROI) tool to inform their commissioning decisions, providing an estimate of the return on investment of these programmes using the oral health profile for Wirral's population