UK Dentistry Has Gone Back 30 Years. The Smart Practices Will Use It to Move Forward

For the first time in decades, adult oral health in England has gone backwards.

National data now shows tooth decay levels have returned to where they were in the late 1990s. Not stabilised. Not slowed. Reversed. While this is rightly being framed as a public health crisis, there is a second conversation UK dentists urgently need to have.

Because this shift is not just about disease. It is about access, demand, risk, profitability, workflow pressure, and how practices position themselves for the next decade.

Those who read the data purely as bad news will struggle. Those who understand its business implications will adapt and thrive.

The data UK dentists cannot ignore

The Adult Oral Health Survey 2023 presents an uncomfortable picture:

• 41 percent of adults now have obvious dental decay, up from 28 percent in 2009

• When early enamel damage is included, 64 percent of adults show signs of decay 

• Around 20 percent have decay severe enough to require urgent or extensive treatment 

• 43 percent report oral health already affecting daily life 

• Routine dental attendance has fallen to 52 percent, down from 61 percent in 2009

In simple terms, patients are arriving later, sicker, and with more complex needs.

This is not a short-term Covid hangover. It reflects systemic access issues, declining prevention, widening inequality, and delayed care. From a business perspective, this fundamentally changes the operating environment for UK practices.

Why this changes the economics of practice life

More decay does not automatically equal more profit. In many practices, it is already doing the opposite.

Rising disease burden is driving:

• More emergency and pain-led appointments 

• Longer chair time per patient with higher clinical risk 

• Greater consent complexity and expectation management

 • Increased referrals, rework, and failed treatment journeys 

• Patients who are anxious, cost-sensitive, and less trusting

The wrong response is to squeeze harder on the diary and chase volume.

The right response is to redesign the business model around predictability, prevention, and informed decision making.

This is a prevention problem and a business design problem

The historic assumption that patients attend early, regularly, and with manageable disease is no longer valid.

Practices must now rethink how they:

• Segment patients by risk, not just attendance 

• Structure recall and hygiene pathways 

• Allocate time between prevention, stabilisation, and restoration 

• Communicate complex treatment ethically and clearly 

• Protect clinician confidence, wellbeing, and judgement

Those that fail to adapt will feel permanently busy yet financially exposed. Those that do will regain control in a high-demand environment.

Where smart practices are focusing next

At BOD, we see five strategic shifts emerging directly from the data.

1. Prevention as a profit protector, not a cost

Early intervention, caries risk management, and minimally invasive care are no longer optional extras. They reduce volatility, protect future treatment success, and preserve patient trust.

Prevention-led systems, including products and protocols such as those developed by vVardis, allow practices to intervene earlier, stabilise disease, and extend the lifespan of teeth before restorative escalation is required.

This is not about selling prevention. It is about defending margin, reputation, and long-term patient value.

2. Diagnostics that create clarity, not just images

As disease complexity rises, diagnostic uncertainty becomes expensive.

Digital tools such as 3Shape intraoral scanners allow practices to visualise early lesions, structural compromise, and progression clearly for both clinicians and patients. This supports better diagnosis, stronger patient understanding, and more confident staged treatment planning.

When patients can see the problem, they accept the solution faster and with less friction.

3. Structured pathways instead of reactive diaries

High disease environments require systems, not heroics. Clear clinical pathways from diagnosis through prevention, stabilisation, and restoration reduce open-ended consultations and protect diary flow.

Practices that rely on improvisation burn out clinicians and erode margins.

4. Confidence-based treatment acceptance

Patients presenting late are more anxious and less decisive. Practices that stage care, explain options visually, and price transparently will outperform those relying on speed or pressure.

Predictability builds trust. Trust drives acceptance.

5. Positioning the practice as capable, not overwhelmed

Patients judge practices quickly. Modern diagnostics, prevention-led messaging, and calm structured delivery signal competence at a time when public confidence is fragile.

Being seen as organised and in control is now a commercial advantage.

Why this matters now

The profession is entering a period defined by:

• Rising demand 

• Constrained access 

• Workforce pressure 

• Fragile public trust 

• Increasing financial and regulatory scrutiny

Practices that optimise their business model alongside clinical delivery will gain a decisive advantage.

This is where the Business of Dentistry conversation belongs.

Not doom. 

Not denial. 

But design.

The BOD perspective

Tooth decay returning to 1990s levels is a warning sign. But it is also a signal.

The old way of running practices will not survive unchanged. Practices that treat dentistry as both a clinical discipline and a commercial system will be better placed to navigate rising disease, rising expectations, and rising pressure.

This data is not just a public health story. It is a business intelligence briefing for UK dentistry.

And those who read it properly will be ready for what comes next.

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