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Unlocking Potential

Smiles All Round

Liberalising dentistry to improve access and cut costs
Tim Leunig
May 6, 2024
Smiles All Round

“We need to liberalise dentistry to help more people see a dentist and stay healthy. For routine check-ups and procedures, there's no need to see a fully qualified dentist instead of a dental therapist or hygienist. It's like insisting on having a doctor on a pharmacy's front desk.”

England is now so short of dentists that fewer than half of us can see one at the right time. Swathes of England are becoming ‘dental deserts’, where as few as one in ten people can get an appointment with an NHS dentist locally. Many people have given up trying. The problems are now so bad that the NHS is spending £50 million a year extracting rotten teeth from children. 

Some people will visit a dentist privately, while others may actively avoid regular dental check-ups altogether. However, this doesn’t explain why 32 million adults and children haven’t seen a dentist at the recommended time – and why numbers continue to decline. So few do because there is a shortage of NHS dentists, who are too expensive to train and employ.



Thankfully, few of us ever need to see a dentist — check-ups, polishes, and fillings can all be performed by dental therapists. However, England’s dentist-led model means dental therapists cannot operate independently, establish their own practices, bill the NHS, or administer local anaesthetics for simple procedures. The Government’s recently published action plan on dentistry set out some positive steps to address these problems, but we need to go much further.

Onward’s Smiles All Round paper argues that England should liberalise dentistry to ramp up appointments. Under the proposals, people would see dental therapists instead of dentists for routine check-ups and simple procedures like fillings. These therapists would be able to run independent practices and employ dental hygienists who scale and polish teeth. Patients would only see dentists if referred for more complex treatments such as tooth extraction, straightening or realignment. 

The paper also argues for a new approach to dentistry university courses to double the number of dental therapists in training. All dentistry students would start a three-year university course to become dental therapists but can opt out after two years as qualified hygienists or extend by two years to become fully qualified dentists. It would cost the Government half as much to train a dental therapist, meaning they could double the spaces available for the same overall cost to taxpayers. 

Over time, it would double the number of NHS dentist appointments available as the Government can double the number of dental therapists it trains, enabling more adults and children to receive regular dental check-ups.

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