Background
Dental services are organised differently from most other care provided by the NHS. Unlike GP services, patients are not registered with an NHS dentist, and dental practices are not required to maintain patient lists. This allows dental practices to choose whether to offer NHS services based on their capacity, and while they must complete any course of treatment started, there is no obligation to maintain a long-term relationship with the patient. Patients are charged for treatments based on a tiered system known as NHS dental treatment bands, which vary according to the complexity of the treatment. However, specific groups, such as children, pregnant women, and individuals on certain benefits, are eligible for free dental care.
Dental providers are reimbursed for NHS work through the Units of Dental Activity (UDAs) system, where complex procedures count for more UDAs than simpler ones. This approach, however, prioritises treatment volume over quality and contributes to variations in service delivery. As a result, the current policy framework requires comprehensive reform to improve access, ensure equitable service delivery, and promote preventative care across the UK.
For more information on the state of the NHS dentistry and the future possible actions, visit the policy briefing “Bold action or slow decay?” published in December 2023.
Access to NHS dentistry services
The graph illustrates the trends in NHS dental activity in the number of Units of Dental Activity (UDA) from 2018/19 to 2023/24, categorised by treatment band. Under the Covid-19 protective measures, NHS dental practices ceased routine dentistry from 25 March to 8 June 2020, following which access was limited – explaining the unprecedented drop in UDAs observed across all bands for 2020/21 (except for Urgent).
Band 1 (basic treatments) remained stable throughout the period 2018/19 to 2019/20 at around 23 million UDAs per year, but decreased by 79 percentage points (or 4.9 million) in 2020/21 and steadily increased up to 19.92 million in 2023/24. Band 2 (moderate dental work), which consists of the majority of the UDAs, follows a similar pattern. Band 3, which covers more complex treatments (e.g. crowns), fell from 23.29 million UDAs in 2018/19 to 5.98 million in 2020/21, but there was a less pronounced rebound to 16.57 million in 2023/24. Disparity in dental activity between band 2 treatments and bands 1 and 3 increased after the pandemic, as access to treatments in bands 1 and 3 did not recover to pre-pandemic levels. Meanwhile, urgent care services remained relatively stable from 2018/19 to 2023/24, averaging 4.40 million UDAs per year.
For more information on the meaning of each band, see the 'About this data' section below.
Tracking the proportion of adults and children seen by NHS dentists within the recommended timeframes reflects how well the system is meeting the needs of patients. Unless clinically indicated, adults are advised to have a dental visit at least once every 24 months and children once every 12 months.
Before the Covid-19 pandemic, around 58% of children visited an NHS dentist in the past year and 50% of adults did so in the past two years. However, both groups experienced a decline following the onset of the pandemic in March 2020, children more so than adults. The proportion of children visiting a dentist began improving after March 2021, while recovery for adults only began a year later in March 2022. In May 2023, 53% of children and 41% of adults visited the dentist in their respective recommended timeframe.
Tracking emergency hospital admissions for tooth decay is important for measuring the quality of dental care, as it indicates gaps in access to routine and preventive services. High emergency admission rates suggest that patients may not be receiving timely dental care, leading to avoidable complications and increased healthcare costs.
The graph shows the number of emergency hospital admissions for dental caries (tooth decay) compared with elective and other types of admissions. From 2016-17 to 2020-21, the number of emergency admissions increased from 1,004 to 1,860, making up about 60% of total admissions for tooth decay in 2020/21 due to the Covid-19 pandemic limiting elective procedures. Emergency hospital admissions decreased in 2022/23 to pre-pandemic levels but increased to an unprecedented high of 2,528 in 2023/24. This suggests a growing need for urgent dental care, which may indicate worsening dental health or limited access to preventive services over time.
Conversely, the number of elective admissions increased between 2017-18 and 2019-20 (2,402 in 2019/20), followed by a significant drop in 2020-21 to 1,036 admissions, likely due to the impact of the pandemic on non-urgent medical procedures. Since then, elective admissions have shown a constant increase, reaching 2,315 elective admissions for dental caries in 2023-24. As part of the Dental Recovery Plan, the Department of Health and Social Care has rolled out a consultation on the expansion of water fluoridation across the North East, a treatment which is known to prevent tooth decay and other oral health issues.
Tooth decay is a significant yet preventable issue among young children, with nearly a quarter of 5-year-olds and 11% of 3-year-olds in England affected, especially those from deprived backgrounds. Moreover, NHS dental services are free for under 18s and up until 19 years for people who are in full-time education.
This indicator shows a decline in the number of hospital admissions for dental caries in children aged 0 to 5 years old between the periods 2015/16–17/18 and 2020/21–22/23. During 2015/16–17/18, admissions were around 340 cases per 100,000 admissions, which steadily decreased to approximately 200 cases per 100,000 admissions, in 2020/21–22/23. This represents a reduction of about 140 cases per 100,000 admissions, or approximately 41% over the eight-year period. The decline has been consistent over time.
About this data
NHS Dental Statistics
The NHS Dental Statistics dataset provides an annual summary of NHS dental activity in England. The data highlights the impact of Covid-19 on dental services, noting that dental practices were required to close for routine care from March 25, 2020, and began reopening on June 8, 2020. Consequently, reported figures on activity and patient visits were lower than expected during this period due to restrictions.
Courses of Treatment (CoT) are categorised into different bands based on the complexity of the treatment provided. Band 1 includes basic procedures such as examinations, x-rays, and preventive advice. Band 2, deprecated as of November 24, 2022, covered mid-range treatments like fillings and extractions, but has been divided into new subcategories: Band 2a covers standard treatments, Band 2b involves non-molar endodontics or three or more teeth requiring fillings or extractions, and Band 2c covers molar endodontics on permanent teeth. Band 3 includes complex treatments such as crowns, dentures and bridges. The “Urgent” classification refers to a specified set of treatments (including up to two extractions and one filling) provided to a patient where oral health is likely to deteriorate significantly, or the person is in severe pain by reason of their oral condition, or to prevent significant deterioration or address severe pain.
Patient counts include orthodontic visits, but it is not possible to distinguish which patients were seen specifically for orthodontic care. The population estimates for financial years 2019/20 to 2023/24 are based on 2020 population data, while the 2018/19 financial year uses 2019 population data.
Starting from the 2023/24 period, the dataset will be published by the NHS Business Services Authority (BSA), having previously been managed by NHS England (formerly NHS Digital). Historical publications from calendar year 2006 to the financial year 2022/23 are also available for reference.
Hospital Admitted Patient Care Activity
The data source for the Hospital Admitted Patient Care Activity dataset is the Hospital Episode Statistics (HES) database, which records all admissions, appointments, and attendances at NHS-provided or funded services in England. The dataset uses ‘Finished Consultant Episodes’ (FCEs) to represent periods of care for admitted patients under a single consultant at a single hospital. As a result, the report details the number of episodes of care rather than the number of individual patients treated.
The data used for the indicator focuses on “Dental Caries” (K02) as being the primary or secondary diagnostic reason the patient is being treated. The dataset includes records of hospital admissions identified as "zero bed day cases" where patients did not have an overnight stay and did not transition to another episode of care at the same provider. While a small number of these records reflect patient death or transfer to another hospital, the majority are noted as being discharged directly from the hospital.
Public Health Profiles - Dental services
The Dental Activity Delivery Rate measures the performance of NHS dental services by comparing the volume of dental activity delivered by NHS dentists to the contracted levels within a specific month.
The indicator provides insights into hospital admissions for dental caries (tooth decay) in children aged 0 to 5 years, using Hospital Episode Statistics (HES) from the Admitted Patient Care (APC) dataset. The data is presented as crude rates per 100,000 population, based on mid-year estimates from the Office for National Statistics (ONS) and aligned with the 2011 Census, with revisions following the 2021 Census. Data quality issues identified in specific NHS trusts, such as East Sussex Healthcare and Frimley Health Foundation Trust, may affect certain years, while the introduction of Same Day Emergency Care (SDEC) reporting has influenced recent admission numbers. The Covid-19 pandemic also led to a significant reduction in hospital activity in 2020–21. Methodological changes in age groupings and procedure codes since 2017–18 have improved data consistency but limit comparability with earlier years. This dataset supports monitoring dental health trends in young children and informs public health strategies.