22nd February 2026
The state of dental care across the UK has become a major public concern, but the picture varies sharply between Scotland and England.
While both nations face pressure from workforce shortages, rising demand, and the long shadow of the pandemic, the severity and nature of the problems differ.
Scotland retains a more stable NHS dental system overall, whereas England is grappling with widespread access failures that have left many communities without any realistic route to NHS treatment. Understanding these differences requires looking at costs, wait times, regional inequalities, and the growing divide between NHS and private dentistry.
Costs: Two Very Different Systems
One of the most striking contrasts between the two countries is how much patients pay for NHS dental care. England uses a three‑band charging system, where patients pay a fixed fee depending on the complexity of treatment.
A routine check‑up falls under Band 1, while fillings and extractions fall under Band 2, and crowns or dentures fall under Band 3. These charges have risen steadily over the years, and adults who do not qualify for exemptions must pay the full amount.
Scotland takes a different approach. Routine dental examinations are free for NHS patients, and treatment costs are based on itemised fees rather than broad bands.
Although patients still pay for most treatments unless they qualify for exemptions, the absence of a charge for check‑ups makes preventive care more accessible.
Scotland is also in the middle of a major reform programme that simplifies hundreds of treatment codes into a smaller, more manageable list, aiming to reduce bureaucracy and give dentists more clinical freedom.
The result is that Scotland's system feels more patient‑friendly, especially for those who attend regularly. England's system, by contrast, places a financial barrier in front of even the most basic preventive care.
Wait Times: England's Crisis vs Scotland's Pressure Points
When it comes to wait times, the gap between the two nations widens further. England is experiencing what many describe as a dental access crisis. In numerous regions, residents report that no NHS dentists are accepting new patients at all.
People often wait months or even years for routine appointments, and many are forced to rely on emergency hubs or travel long distances for care. This has contributed to a rise in DIY dentistry, a stark indicator of system failure.
Scotland's situation is better, though not without challenges. Most people are registered with an NHS dentist, and routine appointments are generally easier to obtain than in England. However, Scotland faces its own bottlenecks, particularly in specialist services.
Waiting lists for dental general anaesthetic procedures — often needed for children requiring multiple extractions are long across the country, especially in rural health boards. While routine care is more accessible, these specialist delays highlight areas where the system is under strain.
Regional Differences: A Tale of Two Countries Within Two Countries
Both Scotland and England show regional variation, but the scale of inequality is far more dramatic in England.
In Scotland, urban centres such as Glasgow, Edinburgh, and Aberdeen tend to have good access to NHS dentistry.
Rural and remote areas including the Highlands and Islands face more difficulty, with fewer dentists per capita and greater reliance on the Public Dental Service. Even so, the overall system remains more cohesive than England's.
England's regional disparities are far sharper. Some of the worst‑affected areas include the South West, East of England, and parts of Yorkshire and the Humber, where entire towns report no NHS practices taking new patients. Coastal and deprived communities are particularly hard hit, with high dentist turnover and limited access to routine care. Major cities such as London fare better, but even there, NHS availability is inconsistent.
The result is a postcode lottery in England that is far more severe than anything seen in Scotland.
NHS vs Private Dentistry: A Growing Divide
The divide between NHS and private dentistry is widening across the UK, but again, the pattern differs between the two nations.
In Scotland, the NHS remains the backbone of dental care. Most patients are registered with NHS practices, and although private dentistry is growing, it is not yet dominant. Many people choose private care for cosmetic treatments or shorter waiting times, but the NHS still provides the majority of routine treatment.
England tells a different story. The NHS dental contract — widely criticised for being financially unviable — has driven many dentists to reduce their NHS commitment or leave the system entirely. As a result, private dentistry has become the default option in many areas, not because patients prefer it, but because it is the only option available. Private fees in England are also generally higher than in Scotland, particularly in London and the South East.
This shift has created a two‑tier system in England, where those who can afford private care receive timely treatment, while those who rely on the NHS face long waits or no access at all.
Reforms and the Road Ahead
Both countries are attempting to address their challenges, but their strategies differ. Scotland has introduced a major overhaul of its NHS dental payment system, reducing hundreds of treatment items to a simplified list and aiming to create a more flexible, less bureaucratic model. The goal is to retain dentists within the NHS and improve long‑term sustainability.
England is planning a significant contract reform in 2026, with new payments for urgent care and more support for complex treatments. The government has also announced initiatives such as supervised toothbrushing for young children and expanded water fluoridation. However, many dentists argue that without fundamental changes to the core contract, these measures will not be enough to reverse the decline in NHS participation.
Two Systems, Two Trajectories
While both Scotland and England face pressures, the overall picture is clear. Scotland’s NHS dental system, though imperfect, remains broadly functional, with high registration rates, free check‑ups, and better access to routine care. England, on the other hand, is experiencing widespread access failures, severe regional inequalities, and a rapid shift toward private dentistry.
The future of dental care in both nations will depend on whether reforms can address workforce shortages, improve funding, and make NHS dentistry a viable career path once again. For now, Scotland appears to be on a more stable footing, while England faces a steeper climb to restore public confidence in its dental services.
21 February 2026
Latest announcement for England
Patients to benefit from improved access to dental appointments.
Patients across the country will have better access to NHS dentistry, boosting earlier intervention, prevention and continuity of care.
New figures show government is on track to deliver millions more dental appointments this year, with 1.8 million additional treatments already delivered seven months in -
Broadening scope of extra urgent appointments will increase access to NHS dental treatment boosting earlier intervention, prevention, and continuity of care
Alongside dental reforms which prioritise those with the greatest need, and pioneering supervised toothbrushing programme
Patients are benefitting from millions more dental appointments, as new figures show the NHS delivered 1.8 million additional dental treatments in just seven months.
Following calls from the country’s top dentist, the government will expand access to dentistry.
The government pledged to deliver 700,000 extra urgent dental appointments and Integrated Care Boards (ICBs) have commissioned nearly one million appointments in line with this commitment.
The Chief Dental Officer has said the scope of these extra urgent appointments is too narrow and limits cases to the clinical definition of ‘urgent’.
Patients with serious oral health issues are not eligible for these extra appointments, as their issues are not considered clinically ‘urgent’.
Issues like tooth decay or rotting teeth would not automatically be eligible for an urgent appointment.
Shocking reports show that some patients are performing DIY dentistry, pulling out loose teeth themselves due to lack of access.
Following advice from the Chief Dental Officer, the government is today (Friday 20 February) broadening the scope of the target to include all dental appointments, helping many more patients get the dentist appointment they’re chasing.
Through this change and alongside reforms to the dental contract - it is expected that millions more appointments will be delivered, and children and those most in need benefitting most.
Minister for Health, Stephen Kinnock said:
Nobody should be pushed to such a state of desperation that they’re forced to pull their own teeth out, but there are far too many cases of this happening and it’s totally unacceptable.
The idea that a patient in this terrible position may not qualify for an ‘urgent’ appointment is clearly nonsensical, so we’re acting to rectify this absurd situation.
Thanks to the changes we’re making millions more appointments will be delivered this year, with children and those in the greatest need benefiting most.
After more than a decade of decline, we’re putting NHS dentistry on the road to recovery.
Jason Wong, Chief Dental Officer for England said:
Widening access to include other oral health care beyond urgent care means more patients will be seen quickly and get the care they need before problems escalate.
By working closely with government and the dental sector to bring in these changes, we are delivering on the manifesto commitment to make prevention a priority and helping people maintain good oral health.
Data published on Thursday 19 February shows that in 2025, the NHS delivered an extra 1.8 million courses of dental treatment over the first 7 months of 2025-26 compared to the period in the year up to the general election.
By broadening the scope to include all appointments - not just those fitting the existing narrow definition of ‘urgent’– Integrated Care Boards will be able to offer more dental care for more patients – including children and those with serious issues.
All ICBs are required to provide accessible urgent care and have been commissioning additional urgent care capacity since April.
Local areas will have the power to determine what dental appointments best meet the needs of their local communities and may be able to repurpose or recommission services where needed.
From April 2026, high street dentists will also be required to offer a minimum number of urgent or unscheduled appointments, which could include patients who are new to the practice, further boosting access to NHS dentistry.
This comes alongside the government’s pioneering national supervised toothbrushing programme for 3 to 5 year olds, which will support up to 600,000 children this year, with over 4 million toothbrushes and toothpastes delivered already as well as community water fluoridation schemes proven to reduce decay.
Through the 10 Year Health Plan this government is making dentistry fit for the future, boosting the number of dentists through reforming the dental contract and fundamentally shifting dental care from sickness to prevention.
Neil Carmichael, Association of Dental Groups (ADG) Executive Chair said:
The progress made in the delivery of dental appointments is fantastic to hear. The Association of Dental Groups has been aware since the announcement of the 700,000 urgent appointments that some patients have been struggling to understand what was meant by the definition of ‘urgent treatment’, so these efforts to provide clarification will be welcomed by our members.
We need to come together now as a profession to support this intervention to succeed, and the ADG recommends that Integrated Care Boards should act quickly now to implement these changes in their local areas, so patients benefit.
We must also address the issue that we will not meet patients’ needs until we increase the dental workforce. Currently the gap in our dental teams is massive.
Shiv Pabary, Chair of the British Dental Association’s General Dental Practice Committee said:
This uptick in activity is progress, and reflects the commitment of thousands of dentists who have continued to deliver NHS care against all odds.
But millions are still going without care. After years of savage cuts, ending this crisis will hinge on promised reform being backed by sustainable funding.
The Government must build on this progress with urgency and ambition. To give NHS dentistry a future, we need a response proportionate to the challenges we face.