National statistics

Adult oral health survey 2021: service use and barriers to accessing care

Published 25 January 2024

Applies to England

Usual pattern of dental attendance

Introduction

The 2021 adult oral health survey took place in February and March 2021, after a year in which access to dental care had been severely restricted due to the coronavirus (COVID-19) pandemic.

From 25 March 2020 access to general dental services in England was paused due to the COVID-19 pandemic. Services began to reopen in England from June 2020. Although some access to dental services was maintained throughout subsequent lockdowns and changes in restrictions, there were longer-term impacts on access to dental services. These included the time needed to clear appointment backlogs, staff availability, physical distancing and other infection prevention and control requirements, some of which still applied in February and March 2021, when the adult oral health survey was carried out.

An earlier report from the 2021 adult oral health survey outlined the reported effect of the COVID-19 pandemic on access to dental treatment and care.

Questions within the 2021 adult oral health survey consequently focused on patterns of behaviour before the pandemic. Participants were asked about their dental attendance before March 2020 (the first COVID-19 lockdown), and what they would usually do if they were able.

Usual reason for going to the dentist

All participants (16 years and over) were asked about their dental attendance before March 2020 (the first COVID-19 lockdown). When asked what they would usually do if they were able:

• 63% reported that they had usually attended for regular check-ups
• 15% said they attended for occasional check-ups
• 18% said they went to the dentist only when they had trouble with their mouth, teeth or dentures
• 4% said they had never been to the dentist

Sex

The patterns of attendance reported by men and women were different.

Women (68%) were more likely than men (57%) to say they usually went to the dentist for regular check-ups.

Men were more likely than women to report that they went to the dentist for occasional check-ups (17% of men, compared with 14% of women), only when having trouble (20% and 15% respectively) or that they never visited the dentist (6% and 3% respectively).

Figure 1: usual pattern of dental attendance by sex

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 1 in the data tables.

Age

The proportion of those who reported they attended the dentist for a regular check-up was lowest among those aged 25 to 34 years (45%) and increased with age to 79% of those aged 65 to 74 years.

The proportion of those who report going for occasional check-ups decreased with age, from 26% among those aged 16 to 24 years to 6% of those aged 65 years and over.

Figure 2: usual pattern of dental attendance by age

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 1 in the data tables.

The proportion who reported that they only went to the dentist when they had problems was higher among those aged 25 to 34 years (25%) and those aged 35 to 44 years (22%) than among other age groups.

The proportion who said they had never been to the dentist varied by age between 3% and 7% with no clear pattern.

NHS region

The reported usual pattern of dental attendance varied by region. The proportion of adults who reported attending the dentist for regular check-ups was highest in the South West (69%) and lowest in London (52%).

The proportion of adults who said they went for occasional check-ups was lowest among those living in the Midlands (11%) and highest among those living in London (20%) and the North West (19%).

Fourteen per cent of adults who lived in the South West said they only attended a dentist when they had problems. This proportion increased to 24% of those living in London.

Figure 3: usual pattern of dental attendance by region

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 1 in the data tables.

The proportions who reported that they never went to the dentist varied between 3% in the South East and the South West to 6% in the Midlands.

Household income

Those living in lower income households were less likely to report going to the dentist for regular check-ups than those living in the higher income households.

Half (50%) of those in the lowest income quintile said they went to the dentist for a regular check-up. This proportion increased with income. Sixty-eight per cent in the highest income quintile and 71% in the second highest income quintile said they attended for a regular check-up.

Over a quarter (27%) of adults in the lowest income quintile said they only went to the dentist when they had trouble compared with between 12% and 13% in the 2 highest income quintiles. The proportion of those who said they never went to the dentist was small and decreased with increasing household income from 8% of those in the lowest income quintile to 1% in the highest income quintile.

Figure 4: usual pattern of dental attendance by household income

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 1 in the data tables.

Neighbourhood deprivation

Reported usual pattern of dental attendance varied by neighbourhood deprivation. The proportion of those reporting they usually attended the dentist for regular check-ups was highest among those living in the least deprived quintile (76%) and lower among those living in the most deprived quintile (51%). Conversely, the proportion reporting usually attending only when having problems was highest in the most deprived quintile (25%) and lowest in the least deprived quintile (10%). Never going to the dentist followed a similar pattern with 7% among those in the most deprived areas and 1% among those in the least deprived areas saying they never went to the dentist.  

Figure 5: usual pattern of dental attendance by neighbourhood deprivation

Base: all adults.

 Error bars show the 95% confidence interval around the estimates.

Source: Table 1 in the data tables.

Frequency of going to the dentist

Participants who said they went to the dentist were asked how often they usually attended.

Among adults who reported that they visited a dentist before March 2020:

• 46% reported attending at least once every 6 months
• 28% said they attended at least once every year
• 9% said they went at least once every 2 years
• 7% said they attended less often
• 9% reported they did not have a regular attendance pattern but saw a dentist only when they had trouble with their teeth or dentures

Sex

Almost half of women (49%) reported usually attending the dentist at least once every 6 months compared with 42% of men.

Women were less likely than men to attend infrequently, either less often than every 2 years (5% and 9% respectively) or only when having trouble with their teeth or dentures (8% and 11% respectively).

Age

Reported frequency of going to the dentist decreased between the 2 youngest age groups but then increased steadily with age. Forty-four per cent of adults aged 16 to 24 years said they went to the dentist every 6 months, compared with 28% of those aged 25 to 34 years.

Those aged 65 years and older were most likely to report they attend the dentist at least every 6 months (58% of those aged 65 to 74 years, 62% of those aged 75 years and over).

NHS region

The proportion of adults reporting attending the dentist at least once every 6 months was highest among those living in the Midlands (53%) and lowest among those living in London (33%).

The proportion who said they only attended the dentist when having problems with their teeth or dentures was highest among those living in London (12%) and lowest among those living in the South West (7%).

Household income

The proportion of those reporting to attend the dentist at least once every 6 months varied with household income but with no clear pattern.

The proportion of those reporting only attending the dentist when having trouble was highest among those living in the lowest income quintile (15%) and lowest among those living in the second highest and highest income quintiles (both 6%).

Neighbourhood deprivation

Those living in the least deprived neighbourhoods reported more frequent dental attendance compared with those living in the most deprived neighbourhoods.

The proportion who reported that they attended the dentist at least once every 6 months varied from 39% in the second most deprived quintile and 41% in the most deprived quintile to 52% of those living in the least deprived quintile.

Those living in the 2 most deprived quintiles (14%) were most likely to say that they only went to the dentist when they had trouble. This was least likely among those living in the least deprived quintile (5%).

Reasons for not seeing a dentist at least once every 2 years

Participants who had reported that they visited the dentist less frequently than once every 2 years before March 2020 were asked to choose why they did not attend more frequently from a list of possible reasons. Participants could choose more than one reason and:

• 50% said they had no need to go to the dentist or that there was nothing wrong with their teeth
• 34% said they could not afford the charges
• 23% said they kept forgetting or did not get round to it
• 19% said they were afraid of going to the dentist
• 15% said they had had bad experiences with the dentist
• 12% said they could not find a dentist
• 12% said they did not have the time to go
• 3% said it was difficult to get to and from the dentist
• 7% reported something else

Sex

Men were more likely than women to report not having time as the reason they did not attend the dentist at least once in the last 2 years (15% and 9% respectively).

Over a quarter of women (26%) reported being afraid of going to the dentist as the reason they did not attend more frequently compared with 14% of men.

Age

The proportion of adults who said they did not attend the dentist more frequently because they had no need to go or there was nothing wrong with their teeth decreased with age, from 71% among the youngest adults (aged 16 to 24 years) to 34% among those aged 65 to 74 years.

Sixteen per cent of adults aged between 25 and 34 years and 15% of those aged between 35 and 54 years cited time as the reason they did not go to the dentist more frequently. This proportion was 10% or lower in younger and older age groups.

The proportion who said they had forgotten or not got round to it reduced with age from between 30% and 31% among those aged 16 to 34 years to 7% among those aged 75 years and over.

The youngest (aged 16 to 24 years) and oldest adults (aged 75 years and over), between 4% and 5%, were less likely to say a bad experience with a dentist was a reason why they did not attend more frequently, compared with between 14% and 22% in other age groups.

NHS region

The proportion of those who said they did not go more frequently because they had no need to go or there was nothing wrong with their teeth was highest among those living in London (62%) and the lowest among those living in the South East (40%).

Just 2% of those living in London said they did not go to the dentist more frequently because they could not find a dentist. In other regions this proportion varied between 10% in the South East and 22% in the North East and Yorkshire.

Household income

The proportion of those reporting they could not afford the charges as the reason for not attending the dentist at least once every 2 years decreased from 42% among those in the lowest income quintile to 23% among those in the highest income quintile.

Not attending more frequently because they did not have the time to go was lowest among those living in the lowest income quintile (7%) and increased with income to 23% of those in the highest income quintile.

A similar pattern was seen for those reporting forgetting or not getting around to it, from 15% in the lowest income quintile to 41% in the highest income quintile. 

Neighbourhood deprivation

The proportion of those reporting they could not afford the charges as the reason for not attending the dentist at least once every 2 years decreased from 45% in the most deprived quintile to 25% in the second least deprived quintile and 26% in the least deprived quintile.

Other reasons for not attending the dentist in the last 2 years that have not been mentioned when describing differences by socioeconomic characteristics were not significantly different.

Most recent visit before March 2020

Introduction

 All participants who reported that they had been to a dentist previously were asked about their last visit before March 2020. This may have been some time ago, so may have been difficult for some participants to remember.

Participants were asked about the most recent dental visit before March 2020 and not completed course of treatment.

Type of care received

Free NHS dental care is available to young people aged under 18 years or aged under 19 years if in full-time education; pregnant women and those who have had a child in the last 12 months; and people receiving low-income benefits and their dependants aged under 20 years. Dental treatment in an NHS hospital may also be free.

Survey participants who had previously attended the dentist were asked what type of care they received on their most recent visit before March 2020:

• 20% reported receiving free NHS care
• 48% reported receiving paid-for NHS care
• 6% reported having mixed private and NHS care
• 22% reported they had had private care
• 1% reported some other type of care

Age

Over half (53%) of those aged 16 to 24 years said they had received free NHS care at their last visit compared with 17% or less among adults aged 25 years and over.

The proportion who said they had paid for NHS care varied between 44% and 54% for those aged 25 years or older compared with 24% of those aged 16 to 24 years.   

The proportion of adults who received private care increased with age from 9% of those aged 16 to 24 years to 32% of those aged 75 years and over.

Figure 6: type of care received on most recent visit by age

Base: adults who had been to the dentist.

Error bars show the 95% confidence interval around the estimates.

Source: Table 4 in the data tables.

NHS region

The proportion of adults who reported to have received free NHS care varied between 14% in the South West and 25% in the North West.

Those living in the North East and Yorkshire and the Midlands (both 53%), the North West (52%) and the South West (51%) were most likely to report having had paid-for NHS care. The proportion was lower in other regions and lowest in London and the South East (both 42%).

The proportion of those receiving private care was highest among those living in the South East (30%) and lowest among those living in the North West (13%).

Household income

The proportion who received free NHS care at their last visit to the dentist decreased with household income, from 38% among those in the lowest income quintile to 7% among those in the highest income quintile.

The proportion who had received paid-for NHS care also varied with income and was highest among those in the third and fourth quintiles (both 54%).

The proportion of those receiving private care increased from 10% among those in the lowest income quintile to 37% among those in the highest income quintile.

Figure 7: type of care received on most recent visit by household income

Base: adults who had been to the dentist.

Error bars show the 95% confidence interval around the estimates.

Source: Table 4 in the data tables.

Neighbourhood deprivation

The likelihood of receiving free NHS care increased with increasing neighbourhood deprivation from 14% in the least deprived quintile to 34% in the most deprived quintile.

The proportions who had received paid-for NHS care were lowest in the most and least deprived quintiles (43% and 45%) and highest in the second and third quintile (both 52%).

The proportion who received private care increased from 11% of those living in the most deprived quintile to 32% of those living in the least deprived quintile.

Usual pattern of dental attendance

Twenty-six per cent of adults who said they only went to the dentist when having trouble received free NHS care last time they went to the dentist, compared with 23% of those who said they went to the dentist for occasional check-ups and 17% who went for regular check-ups.

Fifty per cent of those who said they went for regular check-ups received paid-for NHS care compared with 43% who said they only went when having trouble.

Twenty-five per cent of those who said they went for regular check-ups received private care at their last visit compared with 18% of those who said they went for occasional check-ups and 15% of those who went only when having trouble.

The type of care adults reported receiving on their most recent visit to the dentist was similar for men and women.

Reasons for using private care

Participants reporting that they received private care at their most recent visit to the dentist were asked why. Participants could select more than one answer. For technical reasons these are based on the responses submitted by web only. Responses submitted by paper followed a similar pattern. The reported reasons were:

• 32% said it was to receive a better quality of care (treatment, standards, expertise)
• 25% were unable to find an NHS dentist
• 19% reported that their NHS dentist had ‘gone private’
• 19% cited the better reputation of the surgery or a recommendation from friends or family
• 18% mentioned the practice location (more accessible or easier to get to)
• 15% cited shorter waiting times
• 11% said there were more types of treatment available
• 7% said it was because of more convenient opening times
• 5% had insurance provided by their employer or job
• 13% said it was another reason

Age

The proportion of those reporting they received private care because they were unable to find an NHS dentist was highest among those aged 45 to 54 years (33%) and lowest among those aged 65 to 74 years (19%).

Older adults were most likely to report that their NHS dentist had ‘gone private’ (between 29% and 35% across age groups from 55 years and older). Among adults aged under 55 years, the proportion was 12% or less with no clear pattern by age.

NHS region

A third of adults living in the North East and Yorkshire (34%) and the South West (33%) said they received private care because they were unable to find an NHS dentist. Adults living in London (18%) and the East of England (20%) were least likely to report this.

A quarter of adults living the North West (25%) reported their NHS dentist had ‘gone private’ as the reason they received private care. This proportion was lower in other regions and was lowest in the East of England (18%) and London (9%).

Almost a quarter (24%) of those living in the South East cited the location of the dentist as the reason they received private care compared with 12% of those living in the South West.

The proportion of those whose private dental treatment was paid for by insurance provided by their employer or job was highest among those living in London (11%). This varied across other regions from no reported cases in the Midlands to 7% in the South East.

Household income

The proportion of adults reporting they had insurance provided by their employer or job as the reason for receiving private care increased from 2% in the 3 lowest income quintiles to 8% in the highest income quintile.

Neighbourhood deprivation

The proportion of adults reporting their NHS dentist had gone private was lowest among those living in the second most deprived areas (10%) and highest among those living in the least deprived areas (25%).

The proportions selecting other reasons did not vary by neighbourhood deprivation.

Usual pattern of dental attendance

Adults who said they only went to the dentist when having trouble were twice as likely to report that they were unable to find an NHS dentist than those who said they went to the dentist for regular check-ups (43% and 21% respectively).

Adults who said they went to the dentist for regular check-ups (23%) were more likely than those who said they went for occasional check-ups (10%) or who said they only went to the dentist when having trouble (5%) to report that their NHS dentist had ‘gone private’ as the reason they used private care.

Adults who said they went to the dentist for regular check-ups were also more likely than those who said they only went to the dentist when having trouble to report better quality of care as the reason they used private care (35% and 21% respectively).

The proportions selecting other answers did not vary by usual pattern of dental attendance.

Men and women reported similar reasons for receiving private care at their most recent visit to the dentist.

The proportions of adults selecting other reasons for receiving private care at their most recent visit not mentioned when describing differences by socioeconomic characteristics were not significantly different.

Cost and treatment choices

Introduction

Participants were asked whether the cost of dental care had affected the type of dental care or treatment they received in the past or caused their treatment to be delayed.

Cost and the type of dental care or treatment received

A third (33%) of adults reported the cost of dental care had affected the type of dental care or treatment they had received.

Age

The proportion of adults who reported that cost had influenced the type of dental care or treatment received varied by age. Adults aged between 25 and 44 years were most likely to report this (40%). It was least common in the youngest and oldest age groups (22% of those aged 16 to 24 years and 21% of those aged 75 years and over).

Figure 8: has cost ever influenced the type of dental care or treatment received by age

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 8 in the data tables.

Household income

The proportion of adults who reported cost had influenced the type of dental care or treatment received decreased from 44% in the lowest income quintile to 21% in the highest income quintile.

Figure 9: has cost ever influenced the type of dental care or treatment received by household income

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 8 in the data tables.

Neighbourhood deprivation

The proportion of adults who reported cost had influenced the type of dental care or treatment received decreased from 43% in the most deprived quintile to 26% in the least deprived quintile.

Figure 10: has cost ever influenced the type of dental care or treatment received by neighbourhood deprivation

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 8 in the data tables.

Self-assessed oral health

The proportion of participants who reported that cost had influenced the type of dental care or treatment received varied by self-reported oral health. Twenty-five per cent of adults who said they had very good or good oral health reported that cost had influenced their dental care or treatment compared with 61% of those who said they had bad or very bad oral health.

Usual pattern of dental attendance

The proportion of adults who reported that cost had influenced the type of dental care or treatment received varied by usual pattern of dental attendance. Twenty-six per cent of adults who said they attended for regular dental check-ups reported that cost had influenced their dental care or treatment compared with 37% of those who said they went for occasional check-ups and 52% of those who said they attended only when they had trouble.

The proportion of adults reporting the cost of dental care had affected the type of treatment they have received did not vary by sex or NHS region.

Cost and delay to dental care or treatment

A quarter (25%) of adults reported they had had to delay dental care or treatment because of the cost.  

Sex

Women were more likely than men to report they had delayed dental care or treatment because of the cost (28% and 23% respectively).

Age

The proportion of adults who had delayed dental treatment because of the cost varied by age. Adults aged between 25 and 44 years were most likely to report this (35%), and adults aged 75 years and over were the least likely to report they had delayed treatment because of the cost (8%).

NHS region

Adults living in the Midlands were least likely to report they had delayed dental care or treatment because of cost (21%). Adults in London were most likely to report cost delaying their dental care or treatment (32%).

Household income

The proportion of adults who reported they had delayed dental care or treatment because of the cost decreased from 35% in the lowest income quintile to 20% in the second highest and 19% in the highest income quintile.

Figure 11: has cost ever delayed dental care or treatment by household income

Base: all adults.

Error bars show the 95% confidence interval around the estimates.

Source: Table 11 in the data tables.

Neighbourhood deprivation

The proportion of adults who reported they had delayed dental care or treatment because of the cost decreased from 34% in the most deprived quintile to 19% in the 2 least deprived quintiles.

Self-assessed oral health

The proportion of adults who reported that they had delayed dental care or treatment because of the cost varied by self-reported oral health. Seventeen per cent of adults who said they had very good or good oral health reported that they had delayed dental care or treatment because of the cost compared with 55% of those who said they had bad or very bad oral health.

Usual pattern of dental attendance

The proportion of adults who reported that they had delayed treatment because of the cost varied by usual pattern of dental attendance. Seventeen per cent of adults who said they attended for regular dental check-ups reported that they had delayed treatment because of the cost compared with 29% of those who said they went for occasional check-ups and 47% of those who said they attended only when they had trouble.

Dental anxiety

Introduction

Dental anxiety was assessed by the Modified Dental Anxiety Scale (MDAS).

Survey participants with natural teeth were asked about dental visits before the first COVID-19 lockdown in March 2020.

They were asked how they would feel in 5 situations:

• going to the dentist for treatment
• sitting in the waiting room (waiting for treatment)
• about to have a tooth drilled
• about to have their teeth scaled and polished
• about to have a local anaesthetic injection in the gum above an upper back tooth.

For each situation they could choose a response from a 5-point scale (‘not anxious’, ‘slightly anxious’, ‘fairly anxious’, ‘very anxious’ or ‘extremely anxious’). Responses were scored from 1 (not anxious) to 5 (extremely anxious).

The lowest possible score was 5, indicating no anxiety at all. The maximum possible score on the MDAS was 25. Scores of 19 and above indicated extreme dental anxiety, which may be indicative of dental phobia.

Prevalence of dental anxiety

The proportions of adults reporting feeling very or extremely anxious in different situations were as follows:

• going for the treatment tomorrow: 13%
• sitting in the waiting room: 12%
• about to have a tooth drilled: 28%
• about to have teeth scaled and polished: 11%
• about to have a local anaesthetic injection: 25%

Almost half of adults with natural teeth (46%) had an MDAS score of between 5 and 9, indicating low or no dental anxiety. Two fifths of adults with natural teeth (42%) had an MDAS score of between 10 and 18 indicating moderate dental anxiety and a further 12% had a score of 19 or more which suggests extreme dental anxiety.

Sex

Women were more dentally anxious than men. Sixteen per cent of women had MDAS score of above 19 indicating extreme dental anxiety compared with 8% of men. 

Age

The prevalence of extreme dental anxiety decreased overall with age from 14% among those aged 16 to 24 years to 6% among those aged 75 years and older.

Figure 12: proportion of adults with extreme dental anxiety by age

Base: all adults with natural teeth.

Error bars show the 95% confidence interval around the estimates.

Source: Table 14 in the data tables.

Household income

Extreme dental anxiety was less prevalent among those in the highest and second highest income quintiles (both 10%) and was slightly more prevalent among those in lower income households, being highest among those in the lowest and second lowest income quintile (both 14%).

Neighbourhood deprivation

The proportion of adults who reported extreme dental anxiety decreased from 15% in the most deprived quintile to 9% in the 2 least deprived quintiles.

Self-assessed oral health

Eight per cent of adults who said they had good or very good oral health reported extreme dental anxiety, compared with 35% of adults with who said they had bad or very bad oral health.

Usual pattern of dental attendance

Eight per cent of adults who said they usually attended the dentist for regular check-ups reported extreme dental anxiety, compared with 12% who said they attend occasionally and 22% who said they only attended when having trouble.  

The prevalence of extreme dental anxiety did not vary significantly across NHS regions or household income.