Oral health inequalities in Wales: position statement

7^th November 2025

Oral health inequalities, including inequity in access and dental care outcomes, are unfair, unjust and preventable.

The purpose of this position statement is to influence dental policy and planning, including resource allocation, at national, regional and local levels within Wales.

This position statement should also act as a reminder to public bodies in Wales that proactive actions on reducing health inequities including oral health inequalities is a legal requirement.

This position statement is in relation to oral health inequalities present within Wales.

The key focus of this statement is to influence Welsh Government’s development of national policy and programmes. This includes direction and intervention nationally on allocation of resources, to eliminate oral health inequalities.

Other NHS Wales organisations, especially Health Boards, have key roles in resource allocation to eliminate oral health inequalities.

A separate WDC position statement is being developed on dental services for vulnerable groups and therefore this statement should be in considered alongside at document.

Social and commercial determinants of health are the root causes of health inequalities including oral health inequalities. Socio-economic disadvantage is highly intersectional. The intersectionality between deprivation, protected characteristics and other characteristics can be thought of as a web, where different areas connect, compounding and exacerbating each other.

There is irrefutable evidence that avoidable oral health inequalities exist in Wales, with people living in the most deprived areas bearing the largest burden of dental diseases.

Although there is some evidence from the literature that there are barriers to oral healthcare for people with protected characteristics at individual and organisational levels, currently there is no mechanism to monitor oral health inequities in relation to protected characteristics.Collection of data on protected characteristics by dental services can be challenging but improvement in data collection on protected characteristics and more importantly analyses to understand inequalities are needed to comply with the Equality Act 2010. 

Wales has several legislations and a government strategy (A Healthier Wales) that requires public bodies in Wales to monitor and proactively address inequity. This includes oral health inequalities. 

Welsh Government has recently announced that Wales is going to be first ‘Marmot nation’ in the world, tackling health inequities nationally.

Delivering Better Oral Health: an evidence-based toolkit describes the risk factors for periodontitis, tooth decay, and oral cancer. Many risk factors for poor oral health are also risk factors for many other chronic diseases including cancers. Common risk factors and relationship between oral health and general health conditions are as follows:

• In addition to plaque build-up, tobacco (smoking or chewing), alcohol use and several general health conditions are risk factors for periodontal diseases. Conversely, there are potential risks to general health resulting from having active periodontal diseases.
• The major risk factors for oral cancers are tobacco use and alcohol consumption (particularly in excess) and in combination with one another. Infection with the human papilloma virus is an important risk for oropharyngeal cancer, possibly in combination with tobacco and alcohol. Excessive exposure to ultraviolet (UV) light is a risk factor for outer lip cancer.
• The main modifiable risk factors for better oral and general health are: smoking including tobacco use, alcohol consumption beyond recommended limit, diet high in sugar and establishment of good oral hygiene routines including use of optimal fluoride toothpaste.
• There is no water fluoridation scheme in Wales. The Designed to Smile programme is the only population level oral health intervention in Wales. It is targeted towards young children in the three most deprived quintiles in Wales. Funding uplift for this programme by health boards has not kept in pace with inflation and dental access rate of children from the most deprived areas in Wales is much lower than child population living in the least deprived areas in Wales (Inverse Care Law).

The Welsh Dental Committee is supportive of Welsh Government’s legislative and strategic intent of reducing health inequities in Wales. The committee supports legislative and other measures to reduce the impact of commercial and social determinants on health, oral health and inequalities.

The WDC shares the 4 UK Chief Medical Officers’ concern about the impact of tooth decay on the child population and supports their joint position statement on water fluoridation (Sept 2021).

WDC is deeply concerned about persistent oral health inequalities and its impact on people’s lives. Inequalities in access to dental care are compounded by the Inverse Care Law, whereby people who most need health care are least likely to receive it. 

Reactive monitoring of oral health inequalities is simply not good enough and the WDC believes that the Welsh Government and NHS Wales must have a proactive and funded plan to reduce and ultimately eliminate oral health inequalities in Wales.

Oral health should be included in relevant wider health and social care policies and programmes to reduce oral health inequalities in Wales. This is essential to reduce oral health inequalities in early years, disadvantaged groups and communities including those with protected characteristics.

It is an ethical and legal requirement to eliminate unfair and preventable oral health inequalities. The following recommendations are made:

Improvement needed in data and insights from evaluation and research

Oral health and dental services data should be analysed to understand oral health inequalities and the degree to which Inverse Care Law impacts on dental service access and outcomes. Quantitative data should be supplemented with information on lived experience of population groups impacted by inequalities. 

Data collection on protected characteristics should be improved with some urgency.

Analyses should include monitoring of proportionate allocation of resources based on need. 

Welsh Government and NHS Wales should collaborate with academic institutions for research and evaluation to understand, in greater detail, any inequities in dental care outcomes and oral health inequalities. This should include detailed analysis of intersectionality in oral health research in Wales.

Proactive and ongoing actions needed to reduce oral health inequalities

Child poverty in Wales must be eliminated. Designed to Smile needs to be sufficiently funded so that a sizeable majority of the targeted child population benefit from the evidence-based interventions offered by the D2S programme.

Inequity in dental access and dental care outcomes must be eliminated. A funded plan is needed to increase dental access rates in deprived areas and the communities that services fail to reach. Dental care experience and outcomes need to be equitable across deprivation quintiles, geographic boundaries, communities and groups with protected characteristics.

Welsh Government should consider using the patient charge revenue (PCR) generated from dental services in addressing oral health inequalities and inequity in dental access. Dental policy, strategies, service planning and commissioning must show how they will also reduce oral health inequalities.

Dental workforce, research, digital development, leadership development and other enablers in the health and care system should always consider equality, diversity and inclusion.

The WDC will review this statement annually which will include discussion on the progress made against the committee’s recommendations.

WDC Secretary: committeesecretariat1@gov.wales