NHS dental statistics show that there are differences across England in how recently adults and children have been seen by a dentist.

A new NHS data release on the dental workforce, carried out in May 2024, gives further information that helps contextualise these differences. It shows that people in areas with fewer dentists, higher vacancies for dental staff, and lower rates of delivering commissioned NHS dental services are less likely to have been seen by a dentist recently and more likely to visit A&E with dental problems.

This Insight explains what we know about access to dentistry in England and what the new release can tell us.

Uneven access to dentistry?

There are inequalities in access to dental care across England. However, it is not straightforward to measure differences in access to dentistry using data published by the NHS.

For example, one indicator sometimes used to assess coverage of dental services across the country is the percentage of children and adults who have been seen by a dentist within a given period. However, while this may indicate differences in access to dentists, lower values here could also reflect behaviour: variation in the likelihood of people choosing to attend private dentists instead (not captured in NHS statistics) or not attending the dentist at all.

Recently, NHS England published the results of a new data collection on the dental workforce. This includes data on staffing, turnover, and NHS dentistry coverage at regional and Integrated Care Board Level (ICB) level which was not previously published. This data can help contextualise inequalities in access to dental care and outcomes and how they are related to access.

Previous NHS dental data

As of March 2024, 32% of adults in the South West had been seen by a dentist in the last two years. This was 12 percentage points lower than in the North East and North West of England. On a more local level, variation was even higher: in Gloucestershire ICB, 27% of adults had been seen by a dentist in the last two years, compared to 54% in South Yorkshire.

These patterns were similar among children, where 48% in the South West and London had been seen by a dentist in the last two years, compared with 62% in the North West. At ICB level, Somerset, at 40%, had the lowest proportion of children seen by a dentist in the last year. This compared with 64% in Greater Manchester. Regional data for adults and children is shown in the chart below.

Two side by side bar charts showing the percentage of adults and children seen by a dentist in the last 12 or 24 months, respectively, as of July 2024 in English NHS Regions. Percentages were highest in the North West and lowest in the South West for both adults and children.
Source: NHSBSA, Dental Statistics – England 2023/24, Geographical breakdown summary tables, table 3d

High vacancy rates in areas with lower dental provision

The new workforce data shows that as of March 2024, there were, on average, 26.2 full-time equivalent (FTE) dentists per 100,000 people in England. This was lowest in the East of England (24.3) and the South West (24.4) and highest in London (27.6) and the North West (27.8) with higher numbers of staff indicating better provision of dentistry services.

The numbers of FTE clinical dental staff (this includes nurses and orthodontists) per 100,000 people in England ranged from 79.3 per 100,000 in London to 96.3 in the North West, as shown in the chart below. The average in England was 86.8.

Side by side bar charts showing the number of dentists and all clinical dental staff per 100,000 population across English NHS Regions as of March 2024. The ratio of dentists and clinical dental staff to population was highest in the North West.
Source: NHS England, Dental Workforce, March 2024, table 7, ONS

The vacancy rate for fully qualified dentists was highest in the South West with 22% and lowest in London at 15%.

Looking at staff turnover in the dental workforce, most regions had about one dentist join the workforce for every dentist that left in 2023/24. However, more dental nurses left the workforce than entered it in every NHS region in 2023/24. In the South West, for every nurse that joined the workforce, two left. However, the rate of new trainee dental nurses was higher than that of leavers in all regions.

Data on staff numbers and turnover are similar to statistics discussed above on adults and children seen by a dentist: vacancy rates are high in the South West where the number of dentists and people seen by a dentist are low. In contrast, there are fewer vacancies in London, and the number of people who have had a dentist appointment recently is higher.

Nevertheless, the proportions of children and adults seen by a dentist were not particularly high in London, indicating that dental staffing levels are not the only factor influencing provision. This may be partly because of differences in need which aren’t taken into account here.

A bar chart showing vacancy rates for dentists across NHS regions in England in 2023/24. Vacancy rates were highest in the South West (20%) and lowest in London and the North East and Yorkshire (15%). A second chart shows the ratio of joiners to leavers in the dental workforce across NHS regions in England. Across all regions, more dental nurses left the workforce than joined it in 2023/24.
Source: NHS England, Dental Workforce, March 2024, tables 10 and 16; ONS, Health geographies population estimates, Integrated Care Boards, 25 November 2024

Use of resources on NHS dental care varies by region

The presence of dentists does not always indicate availability for NHS treatment, since NHS dental practices often deliver private services as well and may only be open to NHS patients some of the time.

On average, dental practices in England with some NHS activity were open for just under 8 hours per day on weekdays. Practices were open for NHS activity between 80% of this time in the South East to 89% of the time in the Midlands and in the North East and Yorkshire, as shown in the chart below.

Two bar charts are showing the proportion of time that dentists were open for NHS activity and the proportion of time their chairs were used for NHS patients across English NHS regions in 2023/24. NHS activity was highest in the North East and Yorkshire and lowest in the South East and South West for both.
Source: NHS England, Dental Workforce, March 2024, table 1 and table 4

Although dental practices across the country were open for NHS activity more than 80% of the time, dental chairs were used for NHS activity 60% of the time in the South West compared to 77% in the North East and Yorkshire. These figures suggest that the availability of NHS dental care was lower in the South West and South East and higher in the North East and Yorkshire in 2023/24.

Dental activity delivery rate

Provision of NHS dental services can also be measured using the dental activity delivery rate. This is the percentage of commissioned NHS dental activity that is actually being delivered.

NHS dental activity delivery rate was lowest (61.6%) in the South West and highest in London (94.7%) in September 2024, as shown in the chart below. In other words, in September 2024, dentists in the South West delivered just over three fifths of the NHS work that NHS England asked them to do for that month.

Two side by side bar charts are showing the dental activity delivery rate across NHS regions in England and the number of A&E visits due to dental problems per 100,000 population in 2023/24. These show that where the dental activity delivery rate was highest (London), the number of A&E visits due to dental problems was lowest and conversely, the where the dental activity delivery rate was low (South West), the number of A&E visits was highest.
Source: DHSC, Dental services, dental activity delivery rate, September 2024; NHS England, Hospital Accident & Emergency Activity, 2023/24; ONS, Health geographies population estimates, Integrated Care Boards, 25 November 2024

Lower availability of NHS dental care correlates with higher demand on A&E

In areas where the above workforce indicators suggest lower NHS dental provision, people visit A&E departments more frequently with dental problems. In the South West, around 1 in every 460 people had been to A&E with a dental problem in 2023/24, as shown in the chart above. This was substantially higher than in London where it was 1 in every 860.

This also holds true at ICB level, as shown in the maps below: ICB areas with fewer dentists (adjusted for population size) and lower dental activity delivery rates were more likely to have high numbers of A&E visits with dental problems than ICBs with high numbers of dentists and dental activity delivery rates.

Two maps showing the dental activity delivery rate and A&E visits due to dental problems in England in 2023/24 by integrated care board (ICB). ICBs in the South West tended to have lower dental activity delivery rates and higher A&E visits due to dental problems.
Source: DHSC, Dental services, dental activity delivery rate, September 2024; NHS England, Hospital Accident & Emergency Activity, 2023/24; ONS, Health geographies population estimates, Integrated Care Boards, 25 November 2024

About the author: Dr Sonja Stiebahl is a statistician at the House of Commons Library.

Photo by: Atikah Akhtar on Unsplash