Spring Engagement Grants Fund 2025 insight report – Healthy Teeth and Healthy Smiles

Merton and Wandsworth

Executive Summary

The South West London (SWL) 2025 Spring Oral Health Engagement Fund in Merton and Wandsworth focused on understanding people’s day-to-day oral health habits, barriers to maintaining good oral health, and the cultural, emotional and financial factors shaping behaviours. The work prioritised Core20 and underserved communities, where people often face the greatest inequalities and poorest outcomes.

We funded 15 voluntary and community sector (VCS) organisations with grants of up to £2,000 to run focus groups and community research across Merton and Wandsworth. Over 970 people took part across 89 activities, including children and young people, older people receiving care at home, disabled and neurodivergent people, refugees, people experiencing homelessness, and those living in temporary accommodation.

Poor oral health remains a significant challenge in South West London. It is closely linked to wider health inequalities, poverty, disability and ethnicity. Oral disease impacts eating, speaking, sleeping and school readiness, and is strongly associated with other health conditions in later life. Locally, organisations have raised growing concerns about rising problems with oral health, particularly for children and people on low incomes.

Key borough-wide findings

• Financial and practical barriers make good oral health difficult to maintain. Costs of dental care and even basic products, combined with confusion and long waits for NHS dental care, leave many unsure of what support they can access.
• Emotional factors stop people from seeking care. Fear, shame, and past negative experiences especially affect older adults, neurodivergent people, and those who have faced stigma.
• Language barriers can limit access for many communities. A lack of translated information prevents non-English speakers from getting the care they need.
• Early intervention opportunities are often missed Many believe school brushing programmes have ended, leaving children without support.
• Hidden sugars and misleading labelling undermine healthy choices. People feel confused or misled about what foods and drinks contain.
• Dental services are not seen as inclusive or accessible enough. People want tailored, culturally appropriate support alongside clearer and more consistent information.
• Awareness of emergency dental options is low. Many don’t realise NHS 111 can be used for toothache and if they do, they worry that it will lead to costly private care.

Merton specific insight:

• There is a shortage of NHS dentists in East Merton which is a problem for the community living in the east of the borough, particularly for those who must travel on public transport as they feel it’s not well connected to the west of the borough.
• Access can be an issue -people with disabilities faced surgeries upstairs with no lifts, while refugees struggled with English materials and entitlement rules.
• Mobile units and outreach sessions in familiar settings would improve access to people who aren’t near a dentist.

Wandsworth specific insight:

• People know the basics, brushing, fluoride toothpaste, flossing but face challenges due to disability, caring responsibilities, or lack of motivation.
• Awareness of what is available for families who didn’t realise children’s NHS dental care is free.
• Older adults reported cost barriers, lack of home visits, and difficulties maintaining routines due to illness or memory loss.

Next steps:

The insight gathered will help us better understand the role of prevention and where support should be targeted. We will share findings with the South West London and South East London Dentistry Leads to inform programme development including awareness of the School Teeth Brushing Programme and listen to partner recommendations. NHS England will also review NHS Choices to improve visibility of practices accepting new patients, and the insight will support the local SWL NHS 111 campaign.

Introduction

This report details the feedback we received in Merton and Wandsworth during our South West London Spring Engagement Grants Fund 2025 (oral health). Working with community and voluntary sector (CVS) organisations primarily we heard from our Core20 populations and residents in the most deprived areas, ensuring that the voices of the most marginalised and underserved communities were heard. We offered grants of up to £2,000 to organisations to hold focus groups and community conversations about oral health, to help us understand people’s experiences, behaviours, and the barriers that affect how they look after their teeth and mouths.

Our approach for this phase had a focus on listening and gathering qualitative feedback, rather than sharing communications messages as we had in previous grant schemes.

Funding was targeted to address oral health inequalities. Organisations worked with a range of communities including children and young people, older adults receiving care at home, people from Global Majority backgrounds, disabled and neurodivergent people, as well as those who are often excluded from services such as refugees, people experiencing homelessness, and those living in temporary accommodation.

In both Merton and Wandsworth, oral health was chosen because local organisations and residents consistently raise concerns about difficulties in accessing NHS dentists and the rising impact of poor oral health, particularly for children and for people on low incomes. These local concerns reflect national evidence that poor oral health is closely linked to poverty, disability and ethnicity. Oral health matters because it goes beyond teeth – affecting overall health and wellbeing. Dental pain and infection can make it harder for people to eat, sleep and speak, while for children, poor oral health can even impact school readiness. For older people, poor oral health is associated with wider medical conditions such as dementia.

Methodology

To support programme delivery, we worked in partnership with Merton Connected and Wandsworth Care Alliance who hold trusted relationships with their communities and could provide the expertise needed to gather insight effectively. Grants were awarded based on who organisations could reach and how closely their approach matched with the people and groups we most needed to hear from.

In Merton and Wandsworth, we awarded grants to 15 local organisations to deliver focus groups, community discussions, and creative activities that encouraged conversations about oral health. Their engagement reached just over 970 local people across 89 activities. Each organisation was asked to explore topics such as daily oral health routines, barriers to maintaining good oral hygiene, cultural or financial factors shaping people’s choices, and how services could be made more accessible.

Successful organisations were invited to an online training session to support them in collecting inclusive and accessible insight. Following their events, groups submitted summaries of what they heard, together with anonymised quotes and photos. Where additional support was needed, we followed up directly with one-to-one conversations with a sample of organisations.

Organisations funded to deliver Spring Oral Health Grants in Merton and Wandsworth

Merton

In Merton, we worked with eight CVS organisations engaging 450 local people who led 26 engagement activities as part of their community research.

Most participants came from Abbey, Colliers Wood, Cannon Hill, Figges Marsh, Cricket Green, Longthornton, Lavender Fields, Pollards Hill, Raynes Part, Graveney, Lower Morden, St Helier, and Merton Park. Six of these, Figges Marsh, Cricket Green, Lavender Fields, Pollards Hill, Ravensbury, and St Helier are Core20 wards for Merton.

Community organisations combined activities with oral health discussions, running lunch clubs, carers’ groups, youth events, mosque gatherings, school sessions, and public workshops. Guided conversations using toolkit questions kept feedback consistent.

In-person engagement worked best, from focus groups in church halls and community centres to drop-ins at events like the Mitcham Carnival. Residents also completed short surveys, while informal chats gave extra insight.

Creative approach encouraged discussion such as a theatre performance (Falling Out) explored myths and barriers through comedy, followed by a quiz, dental talk, and Q&A; another organisation used arts workshops with dance, writing, and drama.

Focus groups of 8–12 people included older residents, young people, refugees, asylum seekers, people with disabilities, and non-English speakers. Post-it notes, translated materials, and Easy Read resources supported participation, while one-to-one interviews captured personal challenges such as navigating care as new arrivals or managing oral health alongside medication.

Other engagement methods included online surveys, phone interviews, and take-home questionnaires, promoted through WhatsApp, newsletters, mailouts, and community noticeboards.

Wandsworth

In Wandsworth, we worked with seven CVS organisations reaching 522 local people who led 63 engagement activities as part of their community research. 

Most participants came from Roehampton, Queenstown, Shaftesbury, West Hill, Battersea Park, Falconbrook, Lavender, Nine Elms, Southfields, Tooting Bec, and Wandsworth Town. Queenstown is one of our Core20 wards for Wandsworth.

Organisations used a mix of in-person and online activities, led by the communities themselves to engage parents, children, carers, and underrepresented groups. Activities included small workshops, parent–child sessions, one-to-one support, and broader community events such as volleyball, coffee mornings, and trips. Online engagement via Zoom also reached dozens of families.

Creative methods encouraged participation, from arts and crafts to themed Health Café sessions with printed resources. Interpreters for Somali and Polish speakers supported focus groups and interviews, while Easy Read and translated materials (e.g. into Urdu) made information accessible. Children and young carers joined through games, quizzes, drawing, and food discussions.

Feedback was gathered through surveys, Google Forms, one-to-one conversations, and Zoom chat. Outreach and promotion took place via WhatsApp, social media, posters, and community celebrations such as Eid. Practical items like toothpaste squeezers, timers, and smiley packs were also distributed.

All feedback was recorded in a shared template with demographic data. Working with trusted organisations and flexible methods helped reach communities often underrepresented in consultations.

Oral Health cross cutting themes

Knowledge and understanding of good oral health and maintaining a good healthy mouth

Most people know what helps keep teeth healthy, such as eating less sugar and regular check-ups but the biggest barriers are money (cost of dental care), practical issues (hard to find clear information), and emotions (fear or anxiety about going to the dentist. Due to these challenges, people often delay going to the dentist or avoid treatment, use home remedies, or only go when they are in serious pain. People want more affordable, accessible and inclusive dental care.

“My grandma always said sugar is for special days.” (M)

Most people understood the basics of good oral hygiene, such as brushing twice daily and using mouthwash. However, fewer individuals reported flossing regularly, because they found it painful or they found it difficult. People want clearer information, stronger public health campaigns, better education on oral hygiene and hidden sugars. Honest labelling of food and drink products was also seen as important.

Families and teenagers felt that advertising could contribute towards poor dietary choices. Junk food was seen as cheaper and more visible than healthy food. Parents felt more should be done to help make healthy choices easier, including restrictions on advertising, better labelling, and healthier food being more affordable. Some suggested visual warnings (like cigarette packets) to show the effects of decay.

“There’s too much sweet stuff by the tills – it’s hard to say no.” (M)

Barriers to good oral health

Language and cultural barriers affected access to care for non-English speakers, asylum seekers, and refugees. The lack of translated materials and the use of medical jargon create confusion about what people are entitled to and how to access services.  Misunderstandings about fluoride, check-up frequency and the NHS 111 service for dental emergencies were common. Suggestions included providing multilingual resources and culturally competent care.

For many migrants or newly arrived families, navigating the dental system was described as overwhelming. People didn’t always know they were entitled to NHS dental care, or how to register. Information was often only available in English, and although younger people said they could translate online using Google or ChatGPT, older adults and parents often struggled.

“It’d be nice to have it in our language or with clear pictures” (M)

The cost of dental care and oral health products is a significant barrier, especially for individuals on low incomes, carers and older adults. Many people reported having to choose between essential expenses like food and bills instead of their dental needs. Even basic items such as toothpaste, dental floss and toothbrushes were described as luxuries. NHS dental appointments, including routine check-ups, were often seen as unaffordable, and the unpredictability of treatment costs discouraged people from seeking preventative care.

“We can’t afford electric toothbrushes for the whole family.” (Merton organisation)

The cost of dental careincluding checkups, cleanings, orthodontics, and hygiene treatments was the most mentioned obstacle, often preventing people from visiting the dentist unless in pain.

“Going to the dentist costs a significant amount of money” “They used to do a little cleaning during the checkups, but now they just look at your teeth and then send you to hygienist for any cleaning, which is extra £100” (Wandsworth organisation)

Access to NHS dental services was frequently described as confusing, inconsistent, and limited. People reported long waiting times, being deregistered for missing appointments and difficulty finding practices with available NHS spaces. Physical access was also a concern, particularly for disabled people. Those in unstable housing situations find this is a barrier to them being able to register with NHS services. The closure of nearby practices further reduces realistic options for many individuals. These barriers often led individuals to delay visits to the dentist or rely on home remedies such as saltwater gargling and painkillers.

“The nearest dentist to our building was closed last year… now it’s in Morden – too far with my walking stick” (M)

Difficulty booking appointments, long wait times, and being limited to private options were major frustrations. Several people expressed that they felt excluded from options like braces or cosmetic treatments due to cost or assumptions related to disability.

“People think we don’t care what we look like. We do.” (W – Baked Bean Charity)

Emotional and psychological barriers such as fear, anxiety, and trauma associated with previous childhood negative experiences were common, particularly among older adults, individuals with mental health conditions and neurodivergent people. Shame or embarrassment about their teeth, and fear of being told off or judged contributed to delays in seeking care. This was sometimes compounded by a sense of low self-worth or historic neglect. For others, sensory processing difficulties made visits extremely stressful.

“I haven’t gone since I was 18 – too scared now.” (M)

Neurodivergent people, particularly young people with autism or ADHD, highlighted sensory overload and routine disruption as major barriers. The feeling of bristles on teeth, the noise of an electric toothbrush, or the intensity of flavours in products could make daily oral hygiene overwhelming.

“Flossing or brushing makes me gag. They don’t understand – they think I’m gross.” (M)

Common concerns including fear of needles, pain, unpredictable procedures, sensory overstimulation caused by bright lights, loud tools or the feeling of instruments in the mouth. Many people with learning disabilities or sensory sensitivities shared that they would benefit from reasonable adjustments at the dentist, such as clearer explanations, softer lighting, or noise-reducing headphones.

“For a long time, I was very scared of the dentist and refused to open my mouth. Then my mum found Dr Moody at Balham Health Centre, a dentist who specialises in working with people with learning disabilities who fear the dentist. We go slowly; he gives me headphones and sunglasses. This made it easier for me. I like going now.”  (W – Baked Bean Charity)

The environment of dental practices can feel unwelcoming and intimidating, particularly for young people. Young people spoke about the sensory experience of visiting the dentist and how the clinical environment could make them feel anxious and unwelcome. They noted that the smells and sounds of drilling were particularly uncomfortable.

Suggestions for improvement included “cosy music to keep your mind off the experience”, “having a TV to watch”, and “soundproofing the rooms so you can’t hear drilling or sounds from different rooms.” (M)

Children, young people and families

Early routines and family influence were seen as crucial to developing good oral health habits. Parents expressed that early routines and attention to dental care could help children avoid serious issues and unnecessary operations later in life. Parents, grandparents and schools played a key role in teaching children to brush regularly and make dental care part of daily life. The loss of nursery and school-based brushing programmes was noted as a gap in support. Tailored support, sensory-friendly tools and workshops were especially helpful for children with special needs. Parents also highlighted the need for information and public campaigns which focus on health benefits rather than cosmetic outcomes would be encouraging.

“Early cleaning and monitoring can prevent later problems” (W)

Some parents mentioned that they lacked the tools, money, time or understanding to build these habits consistently. People want accessible, school-based solutions that would support children and parents together, including brushing clubs, visual resources, and take-home packs.

“Schools used to teach us to brush our teeth, now they don’t – it needs to come back.” (M)

Older people

Age-related issues came up frequently in conversations with older adults, especially concerning gum health. Receding gums, loose teeth, ongoing gum discomfort were more prominent among older participants, reflecting that gum care becomes increasingly important with age.

Older adults reflected on their own experiences and expressed a desire to help younger generations avoid similar issues. Challenges included limited availability of home visits, high costs and insufficient support for carers. Many felt that their needs were overlooked compared to younger populations and called for clearer service information and practical dental care tips.

“The elderly are cared less for and more emphasis is put on younger people and middle aged people rather than over 60’s”(W)

Many people wanted better information about available services, including support for those with mobility or accessibility needs. Participants asked for clearer guidance on who to contact for home visits and support, noting that dentists typically only send reminders every six months without offering further assistance.

NHS111 awareness of urgent dental treatment

People feel there is a lack of awareness about the NHS111 service with reluctance and uncertainty about cost meant that they would avoid using it unless absolutely necessary.

Concerns about cost and a lack of transparency around what NHS 111 offers left many people uncertain about whether treatment would involve charges. This confusion created a barrier to using 111, even in urgent situations. Cultural hesitancy and unfamiliarity with NHS systems also discouraged some communities from seeking help, particularly recent migrants and asylum seekers who were unsure of their entitlements. For many, there was a reluctance to use an unfamiliar service without a personal recommendation or direct support. As one organisation explained: “I wasn’t sure if I would be eligible to use 111 because of my immigration status.” (Merton group)

Merton – key insight  

Barriers to good oral health

Discrimination, trauma, and fear are significant deterrents to accessing dental care, especially for marginalised groups. Some people, particularly those from LGBTQIA+ communities described facing discrimination or being misgendered, which stopped them from seeking any type of healthcare.

“Being misgendered all the way through my care… I desperately need a respectful dentist to give me care.”  

Fear, anxiety, and trauma were barriers, particularly among older adults, people with mental health conditions and neurodivergent individuals. Several described traumatic childhood experiences with school dentists or judgmental treatment by dental professionals. Shame, embarrassment about their teeth, and fear of being told off or judged also caused people to delay or avoid care. This was sometimes exacerbated by a sense of low self-worth or historic neglect of their teeth. For others, sensory processing difficulties made visits extremely stressful.

“I haven’t gone since I was 18 – too scared now.” (Merton organisation)

Cost of dental care and oral health products is becoming increasingly difficult to keep up with, particularly for those on low incomes, carers and older adults. People described having to prioritise essential bills or food over dental care. People couldn’t predict what dental issues they might have and were reluctant to pay higher banding fees. This uncertainty about the cost and type of treatment often deterred individuals from seeking preventative care.

“I can buy food or toothpaste – sometimes I can’t do both.” (Merton organisation)

Challenges for people with disabilities, neurodivergence, or mental health conditions face daily struggles including fatigue and reduced mobility make brushing and flossing difficult.

“I can’t use floss properly because of problems with my hands.” (Merton organisation)

Access to NHS dental services was widely described as confusing, inaccessible, and unavailable. People spoke about long waiting times, being “deregistered” after missing a check-up, or calling multiple practices only to be told there were no NHS spaces. The closure of NHS dental practices, particularly in East Merton, has made it even harder for residents to find care, with some needing to travel long distances and others giving up altogether. For those who could find a dental practice, physical access was another barrier, especially for people with disabilities, as many surgeries are upstairs with no step-free entry.

Language and communication difficulties also kept people from accessing care, with a lack of translated materials and the use of medical jargon creating additional barriers for asylum seekers, refugees, and those for whom English is not a first language. Many did not know they were entitled to NHS dental care or how to register.

“No one goes to a dentist in Merton – they’ve all gone private.”

Knowledge and understanding of good oral health and maintaining a healthy mouth

Good oral health was linked to early routines and habit-building. Parents, grandparents, and schools were seen as key to instilling positive behaviours in children. Families described the importance of brushing their teeth together, building good habits and making dental care part of daily life.

Some people also felt that there was a role for schools and nurseries in providing oral health advice and were unsure if programmes were still available. They had been important for helping children build good habits early on, particularly for those who may not have regular support with oral hygiene at home. Without them, there is concern that opportunities to establish healthy behaviours are being missed, especially among children in more disadvantaged families.

Dental care, treatment and products can sometimes feel impersonal and confusing. People shared experiences of being “upsold” products whilst in the dental chair which left them feeling frustrated and some felt it was manipulative. Alongside this, people described feeling overwhelmed by the sheer volume of dental products and conflicting advice, from toothpastes to water flossers, which they found confusing and stressful. Many said it was hard to know what to trust, particularly when faced with misinformation online or on social media from influencers.

“Teeth whitening, water flossers, electric toothbrushes, different colour toothpastes – what should I be using?”

Children and young people and families

Healthy routines, diet, and habit-building are valued but need reinforcement. Brushing twice daily, limiting sugar, drinking water and using fluoride toothpaste were widely recognised as essential. Families stressed modelling behaviour, starting routines early and creating engaging habits with children. Social and emotional wellbeing was linked to having healthy teeth and a confident smile.

“The better your oral hygiene and health is, the better chance you have of overall health, as a lot of digestion issues stem from oral health.” (Merton organisation)

Younger people aren’t aware dentists are available on the NHS.

“I’m gonna be honest I didn’t know the NHS did teeth, I thought it was all privatised.” (Merton organisation)

Fear, lack of personalised support, anxiety and past trauma deters children, especially children with SEND or neurodivergence from attending dental appointments. Calm environments and dentists using visual aids to help explain what will happen during their visit, would make appointments less intimidating and easier to understand.  

“For a long time, I was very scared of the dentist… then my mum found a dentist who specialises in working with people with learning disabilities… I like going now.” (Merton organisation)

Older people

Older people value a healthy mouth, but ageing can make it harder to maintain, with bone loss, receding gums, dry mouth from medication, fatigue, pain, and memory loss all creating barriers. Despite this, many remain committed, having been “brought up to take care of it” and aware of the long-term consequences of neglect. They highlighted the need for free or low-cost dental services that are easier to access for over-60s, and support for memory loss, such as reminder tools to help maintain routines.
 “We need more free treatments for over-60s and the housebound.” (Merton organisation)

NHS111 awareness for urgent dental treatment

Knowledge of the 111 dental service was low. People expressed surprise and appreciation upon learning that they could call 111 for urgent dental treatment. People felt that there should be clear, accessible advertising in GP surgeries, pharmacies, social media, schools, and community centres to increase awareness.

Mixed experiences with NHS 111 reduce confidence in using the service for dental problems. Among those who had used NHS 111 for dental care, experiences were varied. Some reported positive, efficient care, while others described frustration with long callbacks, referrals back to dentists who could not help, and feeling misunderstood by non-dental health advisers.

Language and communication barriers limit access to NHS 111, especially for migrant and refugee communities. People from non-English speaking backgrounds or with lower English proficiency often struggled to use phone-based services like 111. Many said they would prefer face-to-face contact or support with interpretation.

“Most of us would be happy to phone but may struggle with English, so prefer someone face to face.” (Merton organisation)

Cultural hesitancy and unfamiliarity with NHS services discourage some from using 111 for dental care. Some communities expressed uncertainty about their eligibility for NHS 111, especially recent migrants or asylum seekers who were unsure about their NHS entitlements. There was also a general hesitancy to use unfamiliar health systems without personal recommendation or direct support.

“I wasn’t sure if I would be eligible to use 111 because of my immigration status.” (Merton organisation)

Community-led solutions

Provide mobile and outreach dental services in Merton. Mobile dental units, pop-up clinics, or community-based services should reach people who cannot easily access a dentist, including those with mobility issues.

“Bring the dentists into communities so people with mobility issues can still get care.”

Offer education and prevention programmes for all ages. Practical guidance on diet, sugar intake, brushing techniques, and support with registering with a dentist would improve oral health for both adults and children.

“I’m 42 and I don’t know how to brush my teeth properly.”

Expand free or low-cost dental care. Make check-ups, oral hygiene essentials like toothbrushes and toothpaste, and support for maintaining routines more accessible for children, families, and older adults, including reminder tools for those with memory loss.

“If you had a tooth care package like you do with glasses and opticians – that would help a lot.”

Ensure clear and accessible communication. Provide information on NHS dental banding in multiple languages and formats, including visual and easy-read resources, to support people with limited literacy or neurodivergence.

Wandsworth – detailed insight

Knowledge and understanding of good oral health and maintaining a healthy mouth

For many people having a healthy mouth and teeth are part of their daily routine, overall wellbeing, and self-confidence. Maintaining good oral hygiene primarily involves brushing twice a day, often with an electric toothbrush, and using mouthwash. While most people are consistent with brushing, far fewer reported flossing regularly, often citing discomfort or difficulty as reasons for avoiding it. Some also emphasised brushing after eating sweet foods to protect their teeth.

“Brushing is the best way I keep my mouth and teeth clean.” 

Cleanliness and appearance play a major role in how people define a healthy mouth. People identify clean, shiny teeth and fresh breath as signs of good hygiene. Many participants linked the look and smell of their mouth to self-esteem, with some noting that discoloured or damaged teeth can lead to a loss of confidence. For some, especially carers and young people, being pain-free was a key indicator of oral health. This included being free from toothaches, sensitivity, bleeding gums, bad breath, discomfort while eating or sleeping.

“When teeth aren’t good or your mouth smells, you don’t feel confident”

Oral health is essential for overall wellbeing. People feel that good gum and tooth health supports mental health, confidence, and helps prevent more complex health issues.

Diet emerged as a significant factor in maintaining oral health. Many people mentioned that eating vegetables, reducing sugary snacks, and drinking water were key parts of keeping their mouth healthy. Among young people, there was increased awareness around sugar content in foods, and some expressed intentions to make healthier choices as a result

“Improving oral health involves eating crunchy fruits and vegetables, diary produces and drinking plenty of water”

What helps you look after your teeth and mouth, and what makes it harder?

People know what to do to keep their teeth healthy but sticking to it can be hard. People said brushing twice a day with fluoride toothpaste and flossing helps keep teeth and mouths healthy. But keeping up these habits can be difficult, especially for children and people with special needs. Things like visual aids, timers, sensory-friendly brushes and group brushing sessions at school were said to help make routines easier.

Personal challenges make maintaining regular oral hygiene difficult, particularly for people managing multiple children or complex care needs. Some carers reported resistance from loved ones due to dementia or disability, while others described physical limitations, such as difficulty standing, poor coordination, or illness, that make thorough brushing challenging. Motivation can also be a barrier, with some people needing reminders about the importance of oral health.

“With 3 kids, brushing is always rushed or missed.”

Traditional or cultural methods were also mentioned such as using charcoal, miswak sticks, baking soda, or peppermint oil and seen as more accessible alternatives to expensive dental care.

“In my community some people use a miswak to clean their teeth from the age of 5,6 years old”

Children, young people and families

Many families highlighted the need for increased awareness that dental treatments are free for children under the NHS, as well as clearer information on how to register with a dentist.

Tailored oral health education should begin in schools with current advice too general and lacks personalisation. Dentists can sometimes be dismissive, offering the same standard advice to everyone regardless of individual needs.

“Everything feels very generalised and each person is different; dentists do not give many personalised approaches and are quick to dismiss a patient with common generalised feedback about appointments”. 

Better tasting toothpaste or a variety of flavours would help encourage more regular brushing. with many still relying on parents for reminders. Children find it difficult to brush for two-minutes when using timers during school sessions and highlighting the need for tools and habits that are age-appropriate and engaging.

Some families need extra support to help children feel comfortable with dental care. Families with children who have special educational needs said sensory-friendly tools and visual aids made a big difference. They also found workshops where parents and children can learn together in a calm setting very helpful.

Parents play a big role in helping children keep their teeth healthy. Some people felt that poor oral health in children often comes from a lack of parental guidance or awareness, not the child’s fault. Many parents said it can be hard to look after their own teeth while also supporting their children, as this takes extra time and effort.

“A lot of people blame children for bad oral health, but I think this is on the parents” 

People had different views about who should get dentist appointments first.
Some felt children should be seen before adults because they depend on others to care for their teeth. Others said everyone should have equal access to appointments.

Older people

Older people want oral health education, tailored advice, and better access to affordable dental care. Clear information about services, practical care tips, and support to book and attend appointments are essential, as many feel overlooked compared to younger age groups.

“We need more honest dental health adverts; all the ones I have seen are about teeth whitening.” 

Getting dental care at home can be difficult for people who need it most.
Home visits are important for people with conditions like dementia, but they can take months to arrange. This makes it hard for some people to get the care they need. Carers also said it’s difficult for them to attend their own appointments because of their caring duties.

Financial barriers were widely reported. Many participants shared that older adults struggle with the cost of dental care, including check-ups, hygienist visits, and x-rays due to being retired and no longer working. This financial pressure prevents many from maintaining regular six-monthly visits. Some diabetic individuals also reported additional challenges with oral health, making consistent care even more essential, yet harder to access.

Some groups rely on community support groups to book dentist appointments, older people in the Asian carers group at Wandsworth Carers Centre often depended on family members to book appointments.

NHS111 awareness for urgent dental treatment

Limited awareness of the 111 service for urgent dental care varies across different groups with awareness highest among young carers who have accessed the service previously. A common issue across all groups was the lack of publicity, with many stating they had never seen any leaflets or advertising about this option. 

Quality of support from 111 was highly praised by some individuals noting that it was more helpful and personalised than traditional dental reception services.

“They were actually much better, more personalised and helpful than any dentist practice receptionist or dentist”. 

However, there were also concerns about the suitability of 111 for people with additional needs, particularly among parents of children with autism, who worried the service might not understand or accommodate their child.

While some participants said they would now consider using the service after learning about it, there was a general sense that people only saw 111 as a last resort, used in cases of extreme pain or when other options had failed.

Community-led solutions

Make dental services and products more affordable and transparent – expand access to NHS dentists and reduce costs of treatments and oral health products to help those most affected. Also have clearer information on NHS and private pricing to build trust with people.

The increase in private dentistry has caused a problem with pricing, many people do not know what is the going rate and any dentist can charge whatever they like.”

Deliver public awareness campaigns focused on health, not cosmetics. Move away from treatments such as whitening and towards the health benefits of brushing, check-ups, and sugar awareness to better support families. Have posters, leaflets, and educational materials in hospitals, schools, and dental clinics could raise awareness and counter misleading advertising.

“Get rid of lies on packaging that says no or low sugar but has other sugar alternatives that will still impact oral health.”

Embed oral health education earlier in schools. Build strong habits from a young age by having regular lessons on oral health and hygiene, sugar in foods and the long-term benefits of dental care.

Provide more inclusive and personalised care for vulnerable groups. Training dentists to better support people with special educational needs, autism, and communication difficulties, alongside more accessible information and hands-on tools such as electric toothbrush demonstrations, would make care more inclusive

“I had a very friendly dentist who kept me well informed. I was able to take support with me which helped me feel calm. The dentist spoke to me and my support worker so I felt in control.”

Community-led recommendations

This section outlines the community-led recommendations that organisations asked as part of their engagement.  The following includes suggestions for what could be done differently or improved to support people to have better oral health.

• Early and culturally sensitive education. Teach new arrivals how dental care works in the UK. Simplify, translate, and tailor information so it is easy to understand and culturally relevant.
• Support for families where English is not a first language. Provide targeted guidance and practical support for families where English is not a first language including how to register with a dentist, understand NHS entitlements, and access affordable care.
• Accessible and affordable dental care. Reduce costs of visits, treatments, and oral care products. Have clear guidance on NHS entitlements and how to register with a dentist. Give out free or subsidised essentials, like toothbrushes and toothpaste, for families and vulnerable groups.
• Mobile and outreach services. Bring dental care to people who cannot easily travel e.g. mobile units, pop-up clinics, or services in schools, children’s centres, and GP surgeries. People feel the NHS should prioritise older adults, people with disabilities, and those without private transport.
• Interactive and inclusive education. Use creative approaches like games, crafts, and sensory-friendly tools for children with learning disabilities or neurodiverse needs. Provide training for dental staff, advice on diet and brushing, and guidance to navigate the dental system.
• Clear communication. Make information on how to register, where to go, and NHS charges easy to understand. Provide materials in multiple languages and formats, including visual, audio, and interpreter support for those with limited literacy or English.
• Community-based learning. Deliver workshops in familiar spaces like leisure centres, GP surgeries, clubs, and faith centres to build trust and confidence. “If it was at my leisure centre or GP, I’d go without hesitation.”
• Health-focused awareness campaigns. Emphasise the health benefits of brushing, flossing, and reducing sugar, not cosmetic outcomes. Use school programmes, visual resources in clinics, and community campaigns to counter misinformation online. “We need more honest dental health adverts; all the ones I have seen are about teeth whitening.”

Next steps

The insight gathered will help better understand the role of prevention and identify where support could be better targeted in the future. Working with colleagues in the National Public Health team (NHS England) and our local NHS teams, the next steps will include some immediate actions and support for future work.  

We will take the insight to a future meeting of the SWL Local Dentistry Committee to share our high-level insights. Additionally, we will take the insight to the joint SEL/SWL Dentistry Leads meeting which includes partners such as Public Health, Local Authorities, and NHS representatives responsible for dentistry. We plan to present our insights there as well and listen to any recommendations that emerge. The School Teeth Brushing Programme was consistently valued by participants, who expressed concern that it was no longer running in schools. NHS England have confirmed it will return as part of a new Government initiative delivered by Local Authorities. Attending the dental leads meeting will allow us to share this feedback and contribute to the development of the programme.

Other recommended actions include NHS England conducting a mystery shopping exercise of the NHS Choices website to identify which practices are currently accepting new patients. They will also explore ways to promote the site more widely to improve public awareness and access.

The insight about NHS 111 will be used to support the local SWL NHS 111 campaign. 

Appendix

Appendix A: Questions asked in Engagement

1. What does having a healthy mouth, and teeth mean to you?

Why:

• We want to understand what people understand about oral health and how it fits into their daily lives. This will help us understand how much of a priority it is and what motivates or stops people from taking care of their teeth and mouth.
• It will help us explore the different cultural or personal beliefs e.g. appearance, it will also help us understand awareness of good oral health. It could help us identify to benefits or barriers of early intervention – do people only go to the dentist when they are in pain, or do they go often for regular check-ups.

Prompts/areas to explore:

• Thinking about people with autism or ADHD, are there any specific sensory sensitivities or routines that might make oral hygiene challenging?
• How do we know our mouths are healthy, and what do we do to keep them that way?
• Who do you talk to about your teeth?
• How does having a healthy mouth and teeth affect our everyday lives? Think about things like eating, talking, and feeling good.
• Has anyone had a time when their mouth or teeth hurt? What happened next?

2. What helps you look after your teeth and mouth, and what makes it harder?

Why

• We want to explore what influences oral health behaviours within families and communities such as habits, misconceptions and any traditions they might follow. This will help us to look at whether people feel good habits such as brushing twice a day are widely followed or whether misconceptions exist such as “it’s just baby teeth – they don’t really matter”.
• We want to understand the practical barriers and other priorities in the family home or community such as cost. We’d also like to understand whether people see oral health as a personal responsibility.
• This could help us challenge misconceptions with more targeted education, it could help us understand if there are any reasons why someone may not visit the dentist.

Prompts areas to explore:

• Are there sensory sensitivities (e.g., textures, tastes, smells) that make brushing challenging?
• What do people in your family or community do to keep their teeth and mouths healthy? Are there traditions, home remedies, or family habits related to oral health that you have learned or passed down?
• How do people learn about looking after their teeth, where do you think they’d find out the information?
• What things in your daily life make it difficult to brush your teeth regularly?
• Are there things people believe about teeth or oral health that might not always be true?
• What are the biggest challenges people face in looking after their teeth—cost, time, information, other priorities?
• What makes it easy or hard for you to get the dental care you need?

3. What do you think children, families, and older people need to keep their teeth and mouths healthy?

Why:

We want to explore how/if oral health needs change across different life stages and what (if any) support is missing. It could help us to understand if parents feel informed about children’s oral health, or whether further education is needed. It could help us understand if older adults or those who long term conditions face specific challenges e.g. difficulty getting help from services and also how cultural or generational factors influence oral health.

Prompts/areas to explore:

• Are the information sources (e.g., leaflets, websites, verbal instructions) accessible and understandable for people with different learning styles, including those with autism or ADHD?
• What do you think helps children start good habits with their teeth?
• Do you feel parents and carers are given enough information about looking after children’s teeth? Where do they get this information?
• Older adults are keeping their teeth for longer—how do you think oral health needs change as people get older?
• Do older adults in your family or community get the help they need to look after their teeth?
• Do you think people with long term conditions such as diabetes get the right help to prevent problems with their teeth?

If not, what would make a difference?

• Do you think there are any cultural or religious beliefs that affect how people in your community look after their teeth?
• Do you think older and younger generations look after their teeth differently?

4. If you could change or improve something to help more people/you have healthier teeth and mouths, what would it be?

Why:

• To look at ideas for improving oral health and to understand what solutions (if any) people would use. It could be around more support for families in school, it could be around how people want to receive information or whether communities want to have more tailored support or information.
• It could help us to design more effective and accessible information.

Prompts areas to explore:

• Are there things that could be done in schools, community groups, or local services to help you/people look after your/their teeth better?
• What information or support would make a difference? How would you want to receive it?
• Do you think there could be groups of people who might need more help with their teeth? What kind of support do they need?
• Are there any changes in food, drink, or lifestyle that would help improve your oral health?
• What would make looking after teeth feel easier or more natural in everyday life?
• Of all the ideas we’ve discussed, which one do you think would have the biggest impact?

5. Have you heard that you can call 111 for urgent dental treatment? What do you know about it? Would you use it?

Prompts areas to explore:

• Were you already aware that 111 can help with urgent dental problems?
• Have you ever seen any adverts or leaflets about calling 111 for dental help?
• If you had a dental emergency and couldn’t get an appointment, would you feel confident calling 111?
• What kind of information would make you more likely to use 111 for dental care?
• Where would you like to see information about using 111 for dental issues (e.g. GP surgery, pharmacy, social media, text message, posters)?
• Have you ever used 111 for any reason before – if yes, how was your experience?
• What would stop you from using 111 for urgent dental help?