Can Labour's Dental Reforms Save a Crumbling NHS Dentistry System?

The Queue That Says It All

It began on a quiet residential side street, wound past a towering blue mural, and stretched nearly 100 metres along the main road. Hundreds of people, some arriving before dawn with folding chairs and blankets, were queuing simply to register with a new NHS dental practice in Bristol.

Carol Sherman, a local artist, was second in line when the doors opened in 2024.

"I was that desperate, I put some chairs and blankets in the car and got there at five in the morning," she recalls. "So many people around here cannot get a dentist — so it has been an absolute lifesaver."

This scene has repeated itself three times in Bristol over the past two years. Yet Bristol is far from unique. Across England and Wales, the collapse of accessible NHS dentistry has become one of the most visible failures of the public health system.

Reforms Billed as the Most Significant in Two Decades

Both England and Wales are preparing to introduce changes designed to make NHS dental treatment more accessible. The government has described these as the most significant dental reforms in 20 years — a bold claim that reflects just how severe the crisis has become.

Mark Dayan, a health policy analyst at the Nuffield Trust think tank, does not mince words about the scale of the problem.

"Without fundamental change, NHS dentistry will remain a service that has gone for good in many parts of the country," he warns. "At this stage, it is just unhelpful to pretend there is still some kind of comprehensive system in place."

The question on everyone's lips is whether these reforms will be sufficient to rescue a system that has been failing millions of patients for years.

A System Built on Compromise — From the Very Beginning

When Labour's Aneurin Bevan established the NHS in 1948, dental care was included as a free service alongside hospital treatment and GP consultations. But post-war Britain's dental health was in a dire state, and demand far outstripped what policymakers had anticipated.

To control spiralling costs, routine charges were swiftly introduced — £1 for dental work — alongside fees for prescriptions and spectacles. Bevan, by then serving as Minister of Labour, resigned in protest at these charges.

That early decision to treat dentistry differently from the rest of the NHS cast a long shadow. Today, patients in England who do manage to secure an NHS appointment can expect to pay £27 for a routine examination, £75 for a course of fillings, and £327 for a bridge or dentures. Certain groups, including children, continue to receive free treatment.

But those fees are entirely academic for the vast numbers of patients who cannot get an NHS appointment at all.

Real People, Real Consequences

Jean Ann Green, 66, moved from Hertfordshire to Beccles in Suffolk in 2021. Cancer treatment and osteoporosis had taken a significant toll on her teeth, leaving her with six lost fillings and persistent toothache.

"We had a great NHS dentist where I used to live," she explains. "Over the last four years I must have phoned every dentist in Suffolk, and not a single one is taking on new NHS patients."

"You hope and pray your nerve dies so the pain goes away — which cannot be right."

Her only realistic option is to turn to one of the many private practices in her area, but the cost of the treatment she needs could run into thousands of pounds — money she simply does not have.

"Because of my postcode, I cannot have the treatment I desperately need on the NHS," she says. "And that is just immoral."

A Market Tilting Sharply Towards Private Care

The United Kingdom has roughly 12,000 high street dental practices, ranging from large corporate chains to small independent businesses. Each practice can choose to bid for an NHS contract, focus entirely on private work, or — as most now do — operate a blend of both.

That balance has shifted dramatically over the past three decades. According to healthcare consultants LaingBuisson, private dental spending accounted for just 14% of the market in 1990. By 2010, that figure had climbed to 42%. By 2024, it had reached a record 69%.

Healthwatch England, the patient watchdog, reports that dentistry generates more complaints than any other area of healthcare it monitors.

"It is a constant source of frustration, anxiety and distress," says Rebecca Curtayne, the organisation's acting head of policy. "Too many people on low incomes are being forced into private care they can barely afford, or are going without treatment altogether."

Healthwatch's own polling reveals the situation has deteriorated since the pandemic. Around 32% of respondents said they used private dentistry in 2024, a sharp rise from just 22% in 2023.

Complex Treatments Disappearing from the NHS

Official figures paint an even starker picture when it comes to more complex dental procedures. Over the past decade, routine NHS dental examinations in England have fallen by 6%. Root canal treatments — a procedure to remove infection from deep inside a tooth — have plummeted by a staggering 49%.

One dentist from the east of England, speaking anonymously to share her honest assessment, explains why so many of her colleagues are stepping back from complex NHS work.

"I have lots of colleagues who just will not touch NHS root canals now," she says. "It is a complicated procedure, such hard work, and ridiculously remunerated — you can end up spending so much time on it and actually lose money."

As a result, some patients are being presented with a stark choice: have a tooth extracted on the NHS, or pay privately for the specialist root canal work that could save it.

The Broken Contract at the Root of the Problem

Underpinning the entire crisis is the NHS dentist contract — a system the British Dental Association (BDA) has publicly condemned as "ridiculous and discredited."

Introduced in England and Wales in 2006, this contract fundamentally changed how dentists are paid. Rather than receiving payment for each individual procedure carried out, or for the time spent treating a patient, dentists operate under a unit-based system widely regarded as deeply flawed.

For patients, the consequences of this broken model are measured in pain, anxiety, and mounting private dental bills. For the NHS, the consequences could be the permanent loss of a service it was once proud to offer.

Whether Labour's reforms can reverse decades of decline remains to be seen — but for people like Carol Sherman and Jean Ann Green, meaningful change cannot come soon enough.