The Crisis Facing NHS Dentistry in Wales

The Growing Divide in Dental Care

As more dental practices walk away from the NHS, thousands of patients are left without care, forced to go private, or suffer in silence.

A widening gap is emerging between those who can afford dental care and those who cannot, as increasing numbers of dental practices in Wales turn their backs on NHS contracts. The British Dental Association (BDA), recently published a damning open letter, stating dentists have accused the Welsh government of “peddling half-truths” about the state of NHS dentistry. The letter highlights a concerning reality: dental care in Wales is becoming a luxury, not a basic right.

Understanding the NHS Dental Contract System

To offer NHS services, dentists in Wales must sign a contract with the Welsh government. This contract is based on specific targets, such as the number of patients seen and types of treatments delivered. In return, the dentist receives a fixed sum of money.

However, here’s the catch: if a dentist does not meet their contractual targets, they may be forced to pay back a portion of the money they received.

In simple terms:

A patient who comes in just for a routine check-up counts the same (in terms of funding) as someone who needs several hours of complex treatment.
This means there’s no financial incentive for dentists to take on patients who need extensive care – even though these are the people who need dental services the most.
If targets aren’t met, even due to high-need patients requiring more time, dentists risk financial penalties.

This creates a deeply unfair system where time and effort are not properly rewarded, and many dentists feel it is simply not viable to continue operating under NHS rules.

Why Are Dentists Turning Away from the NHS?

Dentists argue the current system puts them under unsustainable pressure. They must balance tight targets with rising costs, increasing admin, and growing demand. The BDA says many practices are now handing their contracts back—meaning they no longer offer NHS services and instead operate privately.

This shift doesn’t happen because dentists no longer care—it happens because the system forces them to choose between financial survival or public service.

What Happens When Patients Are Left Behind?

The human cost of this exodus from the NHS is staggering. With fewer NHS dentists available, patients are left with difficult choices:

Go private, where costs can run into hundreds or even thousands of pounds.
Go without, risking their oral health deteriorating.
Travel long distances, especially in rural Wales, to find a practice still taking NHS patients.

But what about those who can’t travel?

A Crisis for Disabled and Housebound Patients

For patients with disabilities or mobility issues, the decline in NHS dentistry presents an even deeper crisis. Some cannot travel due to:

Neurological conditions such as MS,
Physical impairments,
Lack of accessible transport or local support.

Without mobile dental services or accessible NHS options, they are effectively cut off from essential healthcare.

This isn’t just a matter of convenience – it’s a matter of human rights. Oral health affects nutrition, self-esteem, and overall well-being. For many, losing access to a dentist can trigger a serious decline in both physical and mental health.

Is This a Case of Wealth Over Health?

Many argue that the dental contract system in Wales prioritises quotas and cost-cutting over patient care. If profit determines who gets treated and who doesn’t, then we risk creating a two-tier system where only the wealthy can smile with confidence.

This begs the question: Have we abandoned the founding principles of the NHS—free care at the point of need?

What Can Be Done?

The Welsh government claims it is working to improve the system, making contracts “fairer for patients and to the dental profession.” But the growing number of dentists abandoning NHS work suggests more urgent reform is needed.

Potential solutions include:

Overhauling the funding model to reflect the complexity and time of treatment.
Protecting dentists from financial penalties for treating high-need patients.
Investing in mobile clinics or home visit services for disabled individuals.
Recruiting more NHS dentists through incentives and fairer contracts.

When Access Fails: The Consequences of Being Denied Dental Care

When individuals are unable to access dental care, whether due to cost, distance, or a lack of NHS availability, the consequences can be far more serious than a toothache.

What Can Happen to Your Teeth and Health Without Regular Dental Care?

If left untreated, even minor dental issues can spiral into major health problems:

Tooth decay can lead to abscesses (painful infections), which, if untreated, can spread to other parts of the body, including the brain.
Gum disease (periodontitis) can result in tooth loss, bad breath, and bone erosion, and is also linked to heart disease and diabetes.
Poor oral hygiene has been linked to malnutrition, especially in older adults who may avoid eating due to pain.
Chronic pain from untreated dental issues can affect sleep, concentration, mood, and overall quality of life.
Speech issues and low self-esteem often follow tooth loss, impacting personal and professional relationships.

In extreme cases, lack of treatment can become a life-threatening medical emergency. For vulnerable populations, such as the elderly, disabled, or immunocompromised, these risks are magnified.

Can a Dentist Refuse to Treat You If You’re Not Registered?

Yes, if you’re not currently registered with an NHS dentist, many practices can refuse to treat you, especially if they’re not accepting new NHS patients. NHS dentists work under strict contracts with limited capacity, and once their NHS list is full, they’re not obligated to take on new patients, even if you’re in pain.

However, if you’re experiencing a dental emergency (such as uncontrolled bleeding, facial swelling, trauma, or severe pain), the situation changes. You are entitled to emergency treatment either through an NHS urgent care dental centre or by contacting NHS 111 in Wales (or your local health board). Practices that offer NHS urgent slots may be able to see you even if you’re not registered, but this varies depending on funding and availability.

If all local dentists are turning you away and you cannot travel or afford private care, it’s not just a health issue—it could potentially violate your right to healthcare, especially under the Equality Act 2010 if you’re disabled or housebound.

While dentists aren’t breaking the law by refusing non-registered patients, the system itself is failing patients. If your health is being put at risk, you should:

Call NHS 111 (or the dental helpline in Wales),
Request an emergency appointment through the local health board.
Make a formal complaint to the NHS if no reasonable care has been offered.
Contact a solicitor or patient advocacy group if you’re being neglected and have health complications as a result.

What Can You Do If a Dentist Refuses Treatment While You’re in Pain?

If you’re in chronic dental pain and a dentist refuses to treat you, especially when you’re unable to afford private care, you may feel helpless, but you do have rights. NHS dentists have a duty of care to patients registered under the NHS, and if you’re experiencing urgent or emergency dental issues (such as severe pain, swelling, or infection), they should provide you with emergency care or direct you to a local urgent care service.

If a dentist refuses to treat you and your condition worsens, especially if it becomes life-threatening, you may have grounds to file a complaint with the practice, the Local Health Board (LHB) in Wales, or escalate it to the Public Services Ombudsman for Wales. In cases where negligence can be proven (for example, if they ignored serious symptoms or refused to refer you for emergency care), legal action may be an option.

You may be able to sue for clinical negligence if:

The dentist owed you a duty of care,
That duty was breached (e.g., by refusing treatment without just cause),
And you suffered harm as a direct result (worsening health, infection, hospitalisation).

Always document your symptoms, any refusals, and correspondence, and seek legal advice from a solicitor who specialises in medical or dental negligence. In some cases, Legal Aid may be available depending on your circumstances.

Is This a Breach of Human Rights?

Many experts and campaigners believe that denying people access to basic dental care does breach fundamental human rights.

Under the European Convention on Human Rights (ECHR), to which the UK is still bound through the Human Rights Act 1998, every person has the right to:

Article 2 – the right to life
Article 3 – freedom from inhuman or degrading treatment
Article 8 – the right to respect for private and family life, which includes physical and mental integrity
Article 14 – the right not to be discriminated against when accessing other rights (including disability discrimination)

If someone is left in pain, suffering, or isolation due to lack of access to dental services—especially when they are physically or financially unable to go private—it can be argued that this neglect violates their dignity and right to health.

For disabled individuals and those with chronic conditions, the denial of accessible dental care could also breach the Equality Act 2010, which requires reasonable adjustments be made to services.

A System Failing Its People

Dental care is not a luxury—it is a critical component of overall health. When the system fails to provide equitable access, it doesn’t just neglect people’s teeth—it undermines their wellbeing, confidence, and basic human rights.

It is not just a policy issue. It is a moral issue.

Conclusion: A National Emergency in Dental Care

NHS dentistry in Wales is at breaking point. Patients, especially those from low-income or disabled communities, are being forced into impossible situations—choose between pain and poverty, or simply go without. It’s clear that unless urgent reform is implemented, the gap between public need and private care will only grow.

The NHS was created to serve all, not just those who can afford it. It’s time to restore that promise—because nobody should be forced to suffer just to smile.