From ‘dental deserts’ to neighbourhood dentistry: rethinking dental health provision for the next decade

Introduction

Access to NHS dentistry in England has reached a critical state, with far-reaching consequences for individuals, communities and the wider healthcare system. Moreover, satisfaction with NHS dentistry has fallen to a record low. 

Years of chronic underfunding, growing workforce shortages and a flawed contractual model have left millions without access to even the most basic dental services. More than 13 million adults – over one in four – are struggling to find NHS dental care, while entire areas of the country have become ‘dental deserts’. Areas of high deprivation are disproportionately affected by shortages, which deepens already widening health inequalities. Indeed, children living in the most deprived areas of England are more than twice as likely to have experienced dental decay than those in the least deprived. 

But 2035 tells a different story. By 2035, England’s dental care system stands as one of the most transformed pillars of the NHS – a service once teetering on the edge of collapse, now renewed through innovation, integration and bold reforms to its funding model. Central to this transformation is the adoption of new care models that see dentistry not just as a service to be accessed in an emergency, but with oral health professionals fully integrated within a neighbourhood health model, and where oral health and education is everyone’s business, embedded in public health, education and community life. 

In 2035, no one is talking about oral health – because it’s no longer a crisis, no longer siloed, and no longer neglected. It has become so seamlessly integrated into everyday health and wellbeing that it simply is. This should be our ultimate measure of success.

From fragmentation to integration

At the heart of the transformation is the neighbourhood oral health team: a model that can flex to suit local contexts, and that has matured into a globally respected standard. These teams include dental therapists, dental nurses, oral health educators and dentists, working in partnership with GPs, pharmacists, health visitors, social care workers and voluntary, community and social enterprise (VCSE) sector colleagues. Together, they manage shared patient lists and coordinated digital health records, offering holistic, preventative care across entire communities. 

Routine check-ups, restorative treatment (within their scope of practice), and oral hygiene support are delivered by dental therapists who now form the backbone of NHS dental provision, supported by a wider team of oral healthcare professionals. Their training – once limited by a bottleneck of placements and financial disincentives – has been scaled nationally through government investment in dental therapy education hubs and community-based placements. Changes to how dentistry is commissioned enables a mixed-model approach that can see dental therapists holding contracts, as well as dentists. As a result, areas previously deemed ‘dental deserts’ can now provide equitable access to treatment and oral health. 

Dentists, too, have found renewed purpose. No longer pressured to deliver high volumes of procedures, they are now the clinical leads for complex care, mentors for dental therapists and supervision of dental teams through a distributed leadership model. Their work is outcome-driven, measured by reductions in disease prevalence and patient transitions from high to low risk – not the number of extractions or restorations performed. 

Dentists and dental therapists are not only providers of patient care, but also clinical leaders shaping strategic decisions at the system level. They play a pivotal role in primary care provider collaboratives, helping to transform services and deliver care through a neighbourhood model. By adopting a ‘one workforce’ approach, they contribute to optimising productivity, shifting care out of hospital settings, and prioritising prevention – from oral health to broader areas such as screening and vaccination.

A digital, decentralised system

Digital innovation and greater use of technology has ensured safe, scalable care. In 2035, a seven-year-old child in a former ‘dental desert’ can receive a digital scan at their local neighbourhood hub or community diagnostic centre, which is analysed remotely by AI and verified by a central NHS diagnostic hub. If treatment is needed, they’re referred to a nearby health centre where a dental therapist already familiar with their medical and social history –can begin care within days. 

This ‘distributed dentistry’ model is particularly powerful in underserved and rural areas. Mobile dental units staffed by dental therapists and dental nurses now visit farming villages and care homes on a rotating schedule. For vulnerable adults or those with mobility challenges, care is no longer a battle, it’s a basic entitlement. 

After decades of being a ‘digital desert’, dental practices are fully integrated into NHS systems, and paper prescriptions consigned to history. Digital interoperability and electronic prescribing have become the norm, allowing oral health professionals to work in tandem with wider health partners, and provide seamless care to patients.

Prevention as the first line of care

Most importantly, 2035 is the year prevention eclipsed intervention – oral health and oral education is everyone’s business. Not just delivered by dental care professionals, teams across health, social care and education are trained as oral health educators. Inspired by models in Finland and Japan, oral health education begins at nursery and continues through every school year. Sugar awareness campaigns are embedded into local authority wellbeing strategies and all medicines for children, including antibiotics, are sugar-free. 

Crucially, dental nurses have emerged as community oral health champions. From parenting classes to food banks, they teach parents how to brush their children’s teeth, interpret food labels, and access free dental packs. In 2035, the rate of hospital admissions for dental decay in children dropped below 5,000 for the first time in over 40 years – a tenth of what it was a decade earlier

Conclusion

The vision for 2035 is clear – and achievable. But to achieve it, we must start delivering on it today. Through bold reform, smarter commissioning, investment in a diverse oral health workforce, and full integration into the wider health and care system, we can move dentistry from the margins to the mainstream of NHS care. 

This is not about tinkering around the edges but requires a reimagining of purpose and a shared commitment to prevention. Oral health can no longer be a neglected afterthought – prevention must become the first line of defence. And how will we know if we’ve succeeded? When oral health is no longer a public health emergency. When it is so deeply embedded in everyday life, systems and behaviours that it no longer requires a separate conversation. 

That is the future we must create – starting now.