The State of NHS Dentistry in Liverpool - November 2025 update

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Before covid

Before covid it was at times difficult to find an NHS dentist near where people lived in Liverpool. We regularly rang around local practices and could always suggest an NHS practice if people were willing and able to travel. 

Impact of covid

During the first wave of the pandemic (March – June 2020) people couldn’t see dentists and when dentists reopened in summer 2020 it was with fewer appointments because of covid safety measures. 

In 2022

There was a backlog of untreated dental issues, lower numbers of people receiving check-ups or early treatment. This meant dental problems were getting worse and took more time to treat. The problem was getting worse not better and people calling us were more desperate than ever.

For most of 2022 there were no dentists in Liverpool (or elsewhere in Merseyside and Cheshire) taking on new adult NHS patients and very few accepting new child patients. In November 2022 there was one dentist taking on new adult patients from a small area of the city on a postcode basis.

In 2025

There are fewer dental practices with NHS contracts. Some are taking no new NHS patients. Of these who will take on new NHS patients most are limiting this to children and set their own age cut off for this (at the time of writing one practice will only take on under twos). At times over the past year there have been windows where some practices will accept a limited number of new adult patients, most however if they get any new capacity will take patients from their existing waiting lists some of which include 1000s of people hoping to get a dentist in future.

What the public are telling us

For people who were taken off the list of their dentist at the time of the pandemic and haven’t found one since have now been 5+ years without being seen. We hear from adults who are concerns about the long-term impact of not having had check-ups/hygienist appointments for so long.

“I was taken off my dentist patient list following the COVID pandemic as I had not been for two years, and I have not been able to join another dentist therefore I haven’t been to the dentist in 6 years now.” –  young adult who grew up in the pandemic years

We also hear from parents whose children have no experience of dental appointments concerned about the impact on their growing teeth. Fortunately, there are now some dentists taking new child patients, with this and a pilot project in Belle Vale taking referrals for young children and perinatal women, the chance of finding a dentist for children is now improving. Many parents however will not be aware of this, and many children are still going without dental care.

People who contact us are often desperate about the state of their teeth. Many have already been seen by the Emergency Dental Service which provides one-off care for people with urgent needs or as in this case below told that their need is just too complex for an urgent care appointment and have then been told to find a dentist for their ongoing care. 

A young adult told us they had been unable to access regular dental care since moving to Liverpool many years ago, despite going on waiting lists across the North West. For the past decade they have only been able to access emergency treatment resulting in multiple extractions. An emergency dentist told the client they need a referral for full treatment as their mouth was "so bad", but that they can only get this referral from a regular dentist (which has not been and is not possible) or via a GP referral, which GP then confirmed was incorrect. They now need false teeth at a young age and have had to borrow money for restorative work. Client was told on the phone with emergency dentist, that they may only be eligible for restorative care if they lost teeth due to an assault. 

Client without an NHS dentist attended an Emergency dentist. Client was advised that more extensive work is needed for their emergency dental need, but that they can't do this in the allocated time for Urgent Care appointments. Client is diabetic and struggling to eat well.

We hear from people who are desperately seeking NHS care knowing that they cannot afford to go private

“As a person of low income, I cannot afford private dental care, and I am at a loss on where to turn to. … This is causing me a great deal of stress and anxiety. I find it particularly sickening that each and every dentist I contacted were quick to offer private health care as an option but refused to accept new NHS patients.” 

We also hear the frustration of people who had an NHS dentist until they switched to private care leaving them unable to afford the treatment needed.

Client's previous dentist has gone private, and client cannot afford to pay for the work they need doing. They had an assessment done during the pandemic where dentist identified issues and treatment that would be required. Client said that the dentist seemed to delay giving a date for the procedure and said it would be better to wait until after Xmas. Client thinks in hindsight that they were delaying as they knew they were going private and wanted to make more money. Client said that when they did finally get back in to see dentist, they made client take another assessment and charged £55 even though client insisted that this was not necessary as they had already been told what was needed. Client was then quoted £2200 at this appointment and was told it would need to be paid up front. The client expressed shock and that they absolutely cannot afford this. Client has been trying to find another NHS dentist and has personally called about 15 dentists in the past few weeks, but all are saying they cannot take NHS patients.

Some dental practices may keep an NHS contract but reduce the work they do when individual dentists within the practice decide to go private only as this patient found out.

A caller was looking for a new NHS dentist because their practice told them that most of their NHS patients were being removed from their books but could stay if they switched to being a private DenPlan patient. The patient had been with this practice for many years but was unable to afford Private treatment as they were only receiving a pension” 

Some other people report that they had been using a private dentist, often taking out private plans in desperation but then later find the cost too much to afford.

A pensioner was unhappy that their private Dental practice had put up their monthly charge from £22 a month to £33 and that they could not afford this amount.

A patient who had registered privately out of desperation told us this has proved costly and they can't really continue to pay these prices. They were unhappy that they have worked in the NHS all their life and now can't even get to see an NHS Dentist.

We hear from people who are going into debt to pay for desperately needed dental care 

Client had severe toothache and after phoning 3 dentists who all said they were not taking on NHS patients, they were desperate and went to a private dentist to get it looked at to get out of their pain. The dentist ended up removing the tooth for £137 and said that other teeth need attention too which would take the cost to £904. Client is a student and paying for their treatment will cause serious debt. 24/10/2023

The problems affect some people particularly severely:

• People who can’t afford to pay privately no matter how desperate they are.
• People who didn’t have a dentist previously (e.g. people who have moved to Liverpool, asylum seekers or refugees, people who have been homeless, people who avoided dental care previously out of poverty, other life pressures or dental fear).
• Families who needed to move because of domestic violence and couldn’t safely access their previous dentist.

Dental pain is not a minor issue. Remember having tooth ache and then imagine living with that for years before you get it treated, while the problem gets worse.

A caller had pulled his own tooth out after struggling 5 years to get registered with a dentist 28/06/2024

“In 2023 I pulled one of my teeth out, for the second time. Once again, I was suffering toothache and could not get an NHS dentist. Nothing was helping to ease my pain, so I decided to do another DIY job. First, I used a spanner, but it was a little bit big to grab hold of my tooth, so I decided to try with a cord. It hurt really bad but the relief I felt when my tooth was out was amazing!! I had felt so desperate with the pain. Would I do it again?? If I couldn't find a dentist then yes I think I would." - L8 resident.

Update from the same patient in December 2024: “after extracting a couple of my own teeth in the past due to the lack of dentists taking on adults, I have spent most of 2024 in agony with a wisdom tooth that needs to be extracted but I’m actually scared to pull this one out myself in case I end up paralysing my face. Any information that will help me find a dentist taking on adults would be greatly appreciated”

The Emergency Dental Service is vital and saves many more people from pulling out their own teeth, but it can be difficult to access because of the volume of need.

A GP called us on behalf of their patient who had been unable to get through to the emergency dentist despite repeated attempts and has had a tooth infection for 3 weeks. The patient been on the phone for over 3 hours while trying to also take care of a young child.

Even some of those who have an NHS dentist can struggle due to the level of need. 

“I am experiencing extreme difficulty getting through to my dentist calling 83 times this morning each time the line was engaged. This is an ongoing issue as I have been trying to get an emergency appointment for two weeks now and each day, I get through I am told that the appointment has been taken. I am advised they only have one emergency appointment per day perhaps two depending on the number of dentists they have in”.

For some people not being able to get dental care makes eating difficult or even puts their physical or mental health at risk too:

An elderly patient with dentures had not needed to visit the dentists in many years and when they did, they found they had been removed from their books. They have lost a lot of weight and their old dentures no longer fit properly making it difficult for him to eat.

Client with complex mental health difficulties was having dental issues to the point that they were not eating properly. Not registered with a dentist. 

A local resident with a shattered denture and very few teeth left, is struggling to eat and is having a negative mental health impact. Client feels their gum disease is going untreated. Client also extracted one of their own teeth recently due to the lack of dentist. Client is unable to afford private care

A person whose childhood trauma led to eating disorders which caused major dental issues has been left with pain, problems eating and extensive tooth loss described the impact of this on their mental health and wellbeing. “It feels like I’m showing the world my trauma when I open my mouth”. As a result, they limit their social interactions and avoid situations where they may have to open their mouth in public. The Urgent Care+ pathway has enabled this patient to be seen.

Incomes in Liverpool are lower than the national average, and many people have no chance of affording private dentistry which is all they can find:

Client hasn’t had an NHS dentist for a long time. They are on a very limited income, developed massive tooth pain and was scared that it was going to become a really bad abscess and couldn’t get an NHS dentist at all. Out of desperation they registered as a private patient. The dentist quoted £8k to fix their dental situation – removing the tooth, putting in a false tooth and then a crown over it. “My jaw dropped through the floor”. They are still shocked at the cost. They ended up paying £120 instead to have it removed and the gap left.  They say they have spent about £1k in total in the last year or so on dental treatment that they really can’t afford. They has been cutting down on essentials like heating so can’t afford to be spending that kind of money on dentistry. 

Some people, out of desperation try to pay for private care by dipping into savings, juggling finances or borrowing money. Private finance for dentistry is now widely advertised but risks putting people into debt they cannot afford to pay. People should have the option of NHS care. We are often in the uncomfortable position of telling people that it might be years before they will get an NHS dentist, but that private care is immediately available to those who can pay. 

What we hear from health and care staff

We hear from a range of professionals desperate to get dental help for their residents, service users or patients seeing how much pain and distress they are in. 

We have heard of cases where people’s dental issues have complicated their overall health through malnutrition, infection or social withdrawal.

We have also heard where dental issues have been caused by or complicated by domestic violence, addictions or mental health issues and how a lack of dental care can make recovery from these harder by providing an ongoing reminder of what they have experienced.

Care homes

On our Enter and View visit to care home as well as speaking to residents and family members we also interview care home managers. When we ask about the challenges they face dentistry often comes up.

Very few dentists provide visits to care homes. There are limits on what can be done on site without the full dental environment but where homes can find a dentist to visit to do mouth checks on a regular basis it builds a relationship which makes it easier to know when someone needs a full appointment in the practice. Several care homes have highly praised one dental practice, Shiel Road Dental, who had a dentist willing to come out to visit their homes and providing follow up care in the practice when needed. This was however dependent on the good will of that one dentist and during their extended sick leave this year care homes were again unable to arrange dental visits.

We have also heard strong praise of the Mersey Care special care dental team which provides care to people with additional needs whose needs can’t be met in a mainstream dental practice. For those residents who are eligible and who can get there it provides much needed and person-centred care. 

“We have had residents where we thought there was no way to get them to have a scan, but they do” a care home manager about Everton Road special care dental team

Some homes have been able to describe their Mouth Care Matters approach to oral health with charts listing dental care for each resident that is filled in morning and night and residents are given a new toothbrush every 4 weeks. This is very good to hear, and we would like it to be implemented in all care homes, supported by access to dentists when needed.

Action so far

• We continue to be in regular contact with the NHSE regional team who have been liaising with dentists to get help for the most urgent of our dental enquirers, those whose dental issues are impacting on their physical or mental health to a dangerous extent. 

Dental Recovery Plans

• The National Dental Recovery Plan announced in February 2024 was very limited in scope and did not bring additional funding. Cheshire and Mersey ICB launched its own local Dental Improvement Plan 2024-2026 that went beyond the national plan. This plan included 5 pathways, one of which was not implemented because of worsening NHS finances during the year. The ICB established a Dental Recovery Board which we sit on.
• Pathway 1 – maintaining Urgent Care Centres including a telephone helpline to triage and book urgent appointments. This is in addition to the commissioned urgent care service. This is not included in national plans but is vital in getting people a route out of the most desperate immediate pain. Without it we would have seen many more people result to self-extractions. The practices involved in this pathway also see vulnerable individuals using specific referral pathways
• Pathway 2 – Urgent Care Plus. This provides substantive care following an urgent care appointment. Patients are offered a full examination and any clinical care identified, not just for the presenting condition but this does not provide ongoing, routine care. This Pathway is also what is used to meet the needs of those we escalate as being in particularly high clinical need dental situations.
• Pathway 3 Routine Care for All - This focuses on mainstream provision and maintaining this. Dental practices undertaking this scheme commit to taking on a specified number of new patients (defined as not having seen a dentist in the previous 24 months), they also link with a vulnerable group within their locality for example family hubs.
• Pathway 4 – Access for Children with additional preventative treatment needs. Locally this has included a pilot in Belle Vale which has provided additional capacity focused on children and perinatal women.  
• Pathway 5 – Access for “cared for” frail and vulnerable adults.  This included plans to pilot work with care home residents. This work did not happen in 2024-5 due to financial pressures within Cheshire and Mersey ICB.
• Pathway 6: A pilot scheme delivering care through specific pathways to vulnerable patients with a focus on outcomes rather than targets. This practice offers Vulnerable patients substantive care and ongoing routine care, delivered using skill mix, patients include:
  • Children
  • Nursing & Expectant mothers
  • Those Referred from Social Care/hospital
  • Provider works primarily with Liverpool Beyond Team Midwifery Team. Recently linked with 3 care homes,
  • Refugee referrals and Knowsley Drug and Alcohol Team for new mothers
• The local recovery plan can only take place within the national contract and within the dental budget. Much more needs to be done. Patients need to know that this problem is going to be fixed. An end to the dental crisis would require more fundamental change including:
  • Major changes to the dental contract
  • A long-term commitment to NHS dentistry

Public health action on dental care for children

Since 2024 Public Health have been working with Tiny Teeth to support the delivery of supervised toothbrushing training to early years settings and workforce oral health training and developing Oral Health Peer Supporters. Over 70,000 toothbrush / toothpaste packs for children aged two to seven years old have been distributed to a range of settings through funding from All Together Smiling. This includes schools, children’s centres and family hubs, food banks / community food spaces, community champions, early help, children in care, foster carers and kinship carers. 

“It has been positive to have a stock of children's toothbrushes and toothpaste at our community food markets, so that children in each household can receive a brand new toothbrush, something that has become unaffordable and a 'luxury' item for many who are struggling on a small budget.” - A quote from a local Food bank: 

In addition, as part of Sugar Awareness Week in November 2024, schools received “Save Kids From Sugar” water bottles, to encourage children to drink water and the School Health Team delivered a number of oral health awareness sessions.

People with additional or high priority needs

While the dental crisis is still being felt so acutely it is tempting to focus solely on access. However, even if a considered national plan was put in place reprioritising and revitalising NHS dentistry there would still be a need for specific consideration to be given to those with additional oral health needs. These groups are likely to have suffered most from the crisis and need additional focus in the recovery. The following groups are some examples.

People with dental phobias – pre-covid a significant portion of our dental enquirers were people with phobias around dental care who had put off dental care and were now looking for dentists with an empathy for nervous patients. The dental crisis will have given many such people a ‘reason’ to not seek dental care for longer and they are likely to have built up greater problems and have even more fears about accessing care if it became more available.

Childhood or sexual trauma - For many people who have experienced previous trauma, any healthcare, especially treatment where theyhave to stay still while being examined can be difficult. Most of the respondents quoted in our report on the impact of sexual trauma spoke about gynaecological examinations but we have also heard from that dental appointments can also be difficult for some people. Awareness amongst dental staff could make this easier. We are delighted that the Special Care Dentistry at the Dentl Hospital have joined the Sexual Trauma project (alongside Liverpool Womens Hospital and Brownlow Primary Care Network)to raise awareness of staff and enable the provision of trauma informed care.

People in mental distress

As the Oral Health Foundation have noted there is evidence to suggest those who experience mental illness also suffer with poor oral health.

• “Some of the most common mental illnesses that can have a negative impact on a person’s oral healthinclude: anxiety and panic attacks, depression, eating disorders, obsessive-compulsive disorder, self-harm, schizophrenia and psychosis.
• Some of the main issues for those suffering with mental illness include:
• Neglect: Research has shown that those suffering from mental illnesses tend to avoid dental care so much that their oral hygiene is neglected. This can result in gum disease and tooth decay.
• Anxiety: Many people suffer from some form of dental phobia and as a result, stop seeing their dentist regularly. Infrequent dental visits have a severe impact on oral health.
• Eating disorders: Those who suffer from conditions such as Bulimia often experience dental erosion from the acidity in vomit. Low levels of calcium are also common, which could affect the health of the teeth.
• Brushing actions: Over-vigorous brushing actions by those with bipolar as similar disorders could result in them brushing away the enamel on the surface of the tooth.
• Medication: they are taking may produce adverse oral effects, especially dry mouth, which is as a result of reduced salvia flow.”

We have heard from people with severe depression that during their worst times they forget personal care and then once they’re feeling a little better are hit with guilt, shame and judgement about the state of their dental damage.  This is something that can trigger another decline in their mental health. People can therefore have reasons to avoid attending the dentist even in a better period for fear of being judged.  In the current situation where getting a dentist takes a lot of persistence and luck, it is harder than ever for people in mental distress to get the dental treatment they need. 

The impact of unaddressed dental issues can make being around people difficult – we have heard of people unable to face job hunting, socialising, being seen in the street or being in family photographs in case their missing or decayed teeth are noticed.

Eating disorders 

Disordered eating has serious consequences on dental health and increase someone’s need for dentistry.  The lack of vitamins to the system and / or the presence of stomach acid wearing away tooth enamel and damaging gums over many years have disastrous consequences on oral health. Also, due to lack of care of their teeth and general health, people with eating disorders can have a sense of shame and/or fear of judgement. 

There is also the factor of letting a stranger so close to them during an examination as many people have had childhood trauma which has been a significant factor in their disordered eating developing. 

For some people, ‘objects’ (hands/implements/foreign objects) being put into their mouth during a dental examination may cause gagging/vomiting due to years of self-abuse. Therefore, many people with eating disorders have both more need for dental care as well as finding accessing care traumatic. 

For more information see https://ldc.org.uk/policy/eating-disorders/ and https://www.dentalhealth.org/blog/how-eating-disorders-can-affect-your-mouth

There is a short online awareness training for health staff on noticing signs of an eating disorder and how to communicate sensitively with a patient about this and help people get the support they need. https://www.beateatingdisorders.org.uk/training-events/find-training/training-dieticians-community-pharmacy-oral-health/

Homeless people

Groundswell’s research with homeless people in London found much higher levels of dental issues than among the general population

• 90% of participants had an issue with their mouth health since becoming homeless
• 30% of respondents were experiencing dental pain at the time
• 7 in 10 reported lost teeth since becoming homeless. 15% of respondents had pulled out their own teeth.
• Alcohol and drugs were commonly used in an attempt to manage oral health issues. 27% of participants had used alcohol to help them deal with dental pain and 28% had used drugs.
• 27% had been to A&E for dental problems 

https://homeless.org.uk/knowledge-hub/inclusive-dentistry/

Carers

Many carers struggle to make time for their own health care, often waiting until the need is desperate before seeking help. Not attending for check ups and preventative care not only worsens their dental health but means they don’t have a dentist to turn to when they do reach dental crisis.

An elderly carer was supported by the Carers Centre, as they cared for their partner who has mobility problems. The carer needed to find someone to stay with their partner if they went out so had delayed seeking dental care.  The Carers Centre had concerns for the carer as they presented frail and reported that they had lost at least 2 stone in weight as they were struggling to eat due to their dental problems. The carer required extensive dental treatment, was not registered with an NHS dentist, and no practices had any places. They eventually visited an emergency dentist who advised that they could be treated privately, but the cost would be over £1000, and the carer could not afford this. This was raised by the Carers Centre with the carers GP as a medical issue. The carer provided feedback several months later that they had been supported to find an NHS place. The NHS cost of £300 was still a lot for them to find but the private cost was impossible.

People who don’t read English

We have heard rom community partners that some people, unable to understand messages sent out in English about being taken off a dentist’s list if they do not attend for checkup go to their dentist when they next have pain and are surprised to find that they no longer have a dentist. We have heard of multiple examples of this from Chinese elders alone.