Oral Health

Oral health is essential for general health and wellbeing, but good oral health is not equal across the population. Poor oral health can have a negative impact throughout the life course, resulting in difficulties with eating, sleeping, and socialising. Most people are at risk of developing some oral disease during their lifetime. The most common diseases are dental caries (tooth decay), and periodontal (gum) diseases. While oral cancers are the most serious of oral diseases, tooth wear is of increasing concern. The effects of oral disease, particularly dental caries, includes pain, days lost from work or school, and general impacts on quality of life.

The Inequalities in oral health in England report identified poor oral health as almost entirely preventable, yet despite decades of good progress, oral health inequalities remain a significant public health priority in England. Some groups within the population have greater prevalence of poor oral health, for example people who are homeless, in secure settings and the traveller community. The prevalence of dental caries is highest in people from the most socioeconomically deprived areas. The findings from the National Dental Epidemiology Programme (NDEP) surveys found for both 5 year old (2023/24) and year 6 (10/11 year old, 2022/23) schoolchildren, those living in the most deprived areas of the country were more than twice as likely to experience tooth decay as those living in the least deprived areas (5 year old survey and Year 6 survey). Also, the findings from the data on hospital tooth extractions in 0–19-year-olds (2022/23), found the decay related tooth extraction episode rate for children and young people living in the most deprived communities was nearly 3 and half times that of those living in the most affluent communities. Furthermore, tooth decay was the most common reason for hospital admission in children aged between 5 and 9 years (Source: Office for Health Improvement and Disparities (OHID).

There are several reasons why people can suffer tooth decay, including sugar consumption and poor dental hygiene. The toolkit, ‘Delivering Better Oral Health: An Evidence Base Toolkit for Prevention’ seeks to ensure a consistent approach to the prevention of oral disease, which includes, primary, secondary and tertiary prevention (Source: OHID et al.). The toolkit provides evidenced based guidance on a wide range of issues, for example, oral cancer, oral hygiene, fluoride, healthier eating, smoking and tobacco use, and alcohol.

The Health and Care Act 2022 brought changes to oral health provision, with the introduction of Integrated Care Systems (ICS). The responsibility for oral health improvement remains with the local authority, whilst Integrated Care Boards (ICBs) took on delegated responsibility for dental services from April 2023.

The NHS Outcomes Framework and the Public Health Outcome Framework have several indicators that relate to oral health, for example, ‘tooth extractions due to decay for children admitted as inpatients to hospital, aged 10 years and under’ and ‘percentage of 5 year olds with experience of visually obvious dental decay’.  

The 10-Year Health Plan for England includes several specific measures to improve oral health and dentistry, which forms part of the shifts from sickness to prevention and hospital to community:

• Compulsory NHS Tie-In for Dental Graduates: Newly qualified dentists will be required to work in the NHS for a minimum of three years to ensure a steady supply of dental professionals
• Neighbourhood Health Service: Dentistry will be integrated into a new Neighbourhood Health Service, bringing multiple healthcare services under one local team. This aims to shift care out of hospitals and into the community
• Enhanced Preventative Care: The plan includes robust preventative measures for children’s dental health, such as the use of tooth resin sealants and fluoride varnish applications
• Increased Access to Dental Care: The plan aims to tackle the current lottery of access to dentists by ensuring high-quality care is available at the right time and that nobody goes without care due to affordability
• Incentives for Dentists: Reforms to the dental contract will incentivize dentists to take on more NHS work, particularly for patients with urgent and complex needs

These changes are designed to make dental care more accessible, improve preventative care, and ensure that dental professionals are well-integrated into the broader healthcare system.

Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention sets out a consistent, UK wide approach to prevention of oral diseases, using evidence-based interventions.

Core20PLUS5 is a national approach to support the reduction of health inequalities at both national and system level. The approach identifies ‘5’ focus clinical areas requiring accelerated improvement within the Core20PLUS5 for children and young people, this includes oral health (tooth extractions due to decay for children admitted as inpatients in hospital, aged 10 years and under).

There are various National Institute for Health and Care Excellence guidelines and quality standards relating to oral health, for example, Oral health for adults in care homes [NG48] and Oral health promotion in the community [QS139].

The Lincolnshire Joint Health and Wellbeing Strategy (JHWS) aims to have a strong focus on prevention and early intervention, and to tackle inequalities. The oral health work supports these overall aims to be achieved.

The Better Lives Lincolnshire Integrated Care Partnership (ICP) Strategy (ICP Strategy) has Prevention and Health Inequalities as one of its strategic enablers, with oral health being specifically highlighted in several of the four life course themes, for example, 0-5 years.

The Lincolnshire Dental Strategy 2023-2026, has four Themes: developing the dental workforce, improving access to dental services, increasing the focus on prevention and strengthening the integration of oral health into wider health and care services (Lincolnshire Dental Strategy).

The geography of Lincolnshire and its population demographics presents challenges for oral health. It is well established that poor oral health is associated with deprivation. The National Dental Epidemiology Programme (NDEP) surveys provide a local picture of oral health. The National Dental Epidemiology Programme (NDEP) shows that about a quarter of 5-year-old children have experienced some form of dental decay in England and figures vary considerably across Lincolnshire. Boston has the highest proportion of 5-year-olds with dental decay, significantly higher than the other districts, Lincolnshire and England. North Kesteven and South Kesteven have the lowest proportions and are significantly lower than England.

The 2023/24 hospital tooth extraction data for 0-19 years olds Hospital tooth extractions in 0 to 19 year olds 2024 provides information on the extent of this amongst Lincolnshire’s children and young people, which includes where caries was the primary diagnosis. During 2023-24 there were 70 tooth extractions where caries was the primary diagnosis, and 35 of these were amongst children aged 5-9 years. (Source: OHID)

There is strong evidence that water fluoridation is an effective public health intervention for reducing the prevalence of tooth decay whilst improving dental health. Approximately 250,000 people, a third of the population in Lincolnshire, are supplied with artificially fluoridated water as reported in the British Fluoridation Society the Extent of Water Fluoridation Report. This includes Lincoln, Gainsborough, Sleaford, Grantham, parts of Market Rasen and a large number of rural communities across the west and central areas of the county.

Lincolnshire is a large, predominantly rural county and in some areas of Lincolnshire, it can be difficult to access NHS general dental services. Most general dental practices are in areas of highest population density and therefore rural areas are less served than urban areas. This means that it is likely that people living in rural areas have to travel further to access dental care or may have difficulty accessing care because of limited public transport. Unlike General Practice (GP) services, patients are not restricted by registration or geography when choosing where to access primary care dental services. This can mean that patients can travel considerable distances to access care and the distance travelled is also influenced by availability of services. (Source: Oral Health Needs Assessment Lincolnshire ICB, January 2024).

The Lincolnshire Oral Health Alliance Group (OHAG) coordinates oral health improvement work across the Lincolnshire system. The Group has a wide range of organisations represented, including Lincolnshire Couty Council, Lincolnshire ICB, NHS England, Community Dental Services, Lincolnshire Dental Network/Committee and the Lincolnshire Care Association (LinCA).   

Since April 2023, the Lincolnshire ICB assumed responsibility for commissioning NHS dental services, which includes primary, secondary and community dental services. Private dental services are not within the scope of the ICB’s commissioning responsibility. Lincolnshire County Council has responsibility for oral health improvement and dental epidemiology.

Primary dental services are one of the four pillars of the primary care system in England. NHS dental services in Lincolnshire include general dental services, urgent dental services, community dental services, and dental services in NHS Hospitals. The NHS provide clinically necessary treatment to keep the mouth, teeth and gums healthy and free of pain. Common dental treatments available on the NHS include scale and polish, fillings, root canal treatment and crowns and bridges. NHS dentists are commissioned for Units of Dental Activity (UDAs) which are a measure of the amount of work done during dental treatment.

Where patients require a complex dental extraction within a primary care setting, this is provided by the Intermediate Minor Oral Surgery Service (IMOS). Where a patient requires referral for dental treatment at a hospital, within Lincolnshire this is provided by the United Lincolnshire Teaching Hospitals NHS Trust. United Lincolnshire Hospitals NHS Trust. Special care dental services for adults and children are provided by Community Dental Services (CDS).

The ICB is involved in a wide range of activity to support the national dental contract recovery, for example, new patient premium scheme and dental recruitment incentive scheme. In addition, the Hypertension Case Finding Pilot is a collaborative pilot between the Lincolnshire Dental Committee, Lincolnshire Optical Committee, Lincolnshire Pharmacy Committee and Lincolnshire Medial Committee. The pilot, which began in November 2024 and ended at the end of July 2025, aimed to undertake opportunistic hypertension case finding in non-traditional settings, such as dental services. Five dental service providers have taken part in the pilot in areas of greatest need and areas of greater Health Inequalities such as those arising from deprivation, geographical location and limited transportation infrastructure. Hypertension prevalence in Lincolnshire (18.2%) is much higher than the national average of 14.8%. (Source: Department of Health and Social Care (DHSC)). Early identification and appropriate management of hypertension can contribute to prevention of other cardiovascular conditions such as stroke and heart failure and as higher rates of hypertension have been shown to be related to higher levels of deprivation and health inequalities, this pilot could help to identify key opportunities to improve the rate of identification.

An oral health promotion and epidemiology service is provided by the CDS. This service delivers a range of prevention activities to support good oral health, for example:

• A supervised toothbrushing programme (Lincolnshire Smiles) across targeted education settings.
• Training so staff can deliver the oral health component of the Early Years Foundation Stage (EYFS) Framework.
• Carrying out the national dental epidemiology surveys in sampled settings.
• Carrying out targeted oral health activities for vulnerable groups, for example, people who are homeless, the travelling community.
• Supporting the Swallowing, Oral Health and Nutritional Ambassadors (SONA) programme for social care providers.
• Supporting oral health campaigns which promote good oral health, such as National Smile Month.
• Supporting the Holiday Activities Food (HAF) Programme which supports children in receipt of free school meals during holiday periods.

In March 2025, the Government announced plans to expand supervised toothbrushing, and work is taking place locally in relation to this Supervised toothbrushing for children to prevent tooth decay.

In addition to the CDS led projects/services, the Food Education Team at Lincolnshire County Council lead a wide range of projects that contribute to the oral health of children and young people. These projects are in place to support early years and schools to educate young children and their parents / carers in better oral health practices and healthier eating.

Whilst not specifically oral health improvement, a range of other commissioned services support people to maintain their oral health. For example, Lincolnshire’s integrated lifestyle service, ‘One You Lincolnshire’, supports people with a range of issues such as drinking less alcohol and becoming smokefree.

The Lincolnshire ICB Oral Health Needs Assessment (January 2024) included a section on service user feedback. It identified that service user and public feedback is collected by Healthwatch and access to dental care remains an ongoing theme of comments to Healthwatch. Access is particularly difficult for those who do not have an ongoing relationship with a dentist or who cannot afford to travel or to pay for private care.    

The GP patient survey collects information from patients and the findings are published by NHS England. The survey asks questions about access to services and experience of the service (Statistics » GP Patient Survey Dental Statistics).

The National Adult Oral Health Surveys (Adult oral health survey 2021 – GOV.UK) and the  NDEP surveys (Oral health – GOV.UK) also provide an opportunity to gain the views of the public on dental services.

• Data on the oral health of the population is limited to the surveys that are carried out and the population groups that these report on. As further NDEP surveys are carried out, updated data will allow us to formulate intelligence on the oral health needs of the population.
• Nationally it is recognised that there are challenges with access to dental services and lots of work is taking place on the national dental contract recovery. The NHS England 2025/26 Planning Guidance provides direction on the national priorities and success measures for the next financial year, which includes improving access to general practice and urgent dental care and increasing the number of urgent dental appointments in line with the national ambition to provide 700,000 more (national).
• Water fluoridation is an effective public health intervention for reducing the prevalence of tooth decay, yet a large proportion of the Lincolnshire population do not receive artificially fluoridated water.
• There are inequalities in oral health in Lincolnshire, particularly evidenced in the NDEP surveys. Some preventative interventions, e.g. Lincolnshire Smiles, are targeted in areas of greatest need. However, there are gaps in provision due to limited resources, with many more areas and their communities having the potential to benefit from these programmes. Further targeting of services/projects will continue to address oral health inequalities.

• Members of the Lincolnshire Oral Health Alliance Group will continue to work together to address oral health needs of Lincolnshire’s population. This will support the oral health needs of the wider population whilst having a focus where there are the greatest health inequalities, for example, certain geographical areas and specific populations.
• Organisations will continue to commission and provide services to meet the oral health needs of the population which includes access to primary care dental services.
• Members of the OHAG will continue to raise the awareness of the provision of artificially fluoridated water in Lincolnshire, to seek to address the differences in provision.
• The Lincolnshire system will continue to support the National Dental Epidemiology Programme, by supporting and participating in surveys to gather data on the oral health needs of the population, to enable interventions to be focussed on those with greatest need.