Westminster's five-year-olds are experiencing tooth decay at a rate of 32%, exceeding the England average of 23%, according to a recent report discussed at the Vulnerable Adults, Health and Communities Policy and Scrutiny Committee meeting. The report on Access to Local Dentistry Services and Oral Health Promotion states that survey findings in 2018-19 show that 32% of 5-year-old children suffer from tooth decay in Westminster. This is above the England average of 23% but below the London average of 27%. The report identifies the consumption of sugary foods and drinks as the main cause of tooth decay in children, and notes that these issues are seen more in communities where there are higher levels of deprivation. For example, children in areas of high deprivation are estimated to be more than twice as likely to experience tooth decay than children in areas of least deprivation.
The report, which accompanied an NHS England report on Oral Healthcare and Access to Dental Services in Westminster City Council, highlighted prevention and early intervention measures to combat poor oral health in both children and adults. Public Health has a statutory responsibility to ensure that interventions are inclusive and address the health needs of all including ethnically diverse groups, SEND and Looked After Children and young people as well as homeless and care homes residents. The report also notes that Public Health commissions the Community Dental Service (CDS) to provide NHS dental care for rough sleepers from their bases in the Soho Centre for Health and Care Frith Street. They also work directly in outreach settings in Westminster, where experienced staff provide oral health advice, check-ups and referrals for treatment. The CDS team also support hostels and temporary accommodation settings, offering treatment and cleaning, resources, information and support registering with a dentist. Key workers and hostel staff continue to receive dental health training from the OHP team to raise awareness and continue to support the homeless population.
While Westminster's rate is higher than the national average, it remains lower than the London average of 27%. The committee reviewed current and future strategies to improve access to local dentistry services and promote better oral health across the borough.
Prevention and Early Intervention
The report identified three key evidence-based interventions to reduce tooth decay:
- Reducing dietary sugars
- Brushing teeth twice a day with fluoride toothpaste
- Regular visits to the dentist (from the age of 6 months)
Public Health has a statutory duty to assess oral health needs, develop strategies, and commission oral health improvement programmes. These programmes must be inclusive and address the needs of diverse groups, including those with special educational needs and disabilities (SEND), looked after children, and homeless individuals.
Existing Services and Initiatives
Westminster currently has a range of services and initiatives in place, including:
- Healthy Start Vouchers: Promoting the use of vouchers to purchase healthy foods.
- Breastfeeding Support: Developing an Integrated Breastfeeding Plan.
- Health Visiting Service: Providing oral health promotion training for staff.
- Healthy Early Years and Healthy Schools Programme: Supporting settings to improve oral health provision.
- Keep Smiling Programme: A supervised toothbrushing and fluoride varnishing programme in targeted schools.
- Change4Life: Embedding oral health messages in weight management services.
- Community Outreach: Providing oral health promotion at community events.
- Community Dental Service (CDS): Providing NHS dental care for rough sleepers.
- Care Homes Pilot: Training and supporting care home staff to implement oral health care plans.
- Oral Health in Early Year Settings Pilot: Upskilling early year setting staff to deliver supervised toothbrushing.
The report on Access to Local Dentistry Services and Oral Health Promotion indicates a downward trend in tooth decay among five-year-old children in Westminster since 2007/08, when 38% were affected, to 32% in 2018-19. This suggests that existing services and initiatives have had some positive impact. The report also mentions that provision of oral health promotion has historically been very good locally compared to neighbouring boroughs.
Challenges in Accessing NHS Dentistry
The report also acknowledged challenges in accessing NHS dentistry, including difficulties in registering with NHS dentists, negative experiences post-Covid, and the rising cost of dental services. A 2025 Healthwatch Westminster report highlighted that struggling to afford dental treatment was a significant barrier for residents. Healthwatch also worked in partnership with the London Dental Committee team to design strategies to alert people who are likely to be eligible for dental support based on the findings of residents' experiences accessing or using dental services. They have since released a more succinct and easy-to-understand eligibility criterion on their website.
NHS Investment
NHS North West London (NW London) invested £98.5m in 315 NHS dental practices across NW London in 2023 and has developed a plan to improve access and availability of dentistry and address inequalities for children and young people. This investment has led to an increase in the number of people getting to see an NHS dentist, supporting people to see NHS dentists in an emergency via 111, and reducing waiting times for children and young people needing dental procedures, with extra capacity to treat children who need dental procedures under general anaesthetic. NHS NW London have developed a plan, with key areas of focus on improving access and availability of dentistry and addressing inequalities for children and young people in areas with poorer health outcomes.
Next Steps
Public Health developed an action plan to increase the uptake of the next dental epidemiology survey for five-year-old school children, working in partnership with NHS England. They also received an additional £38,000 as a new allocation from government to deliver oral health promotion in early years for 2025-26. The report on Access to Local Dentistry Services and Oral Health Promotion also notes that the council is currently exploring options to enhance the current offer, which will align with a Pan-London approach.
Public Health will continue to work in partnership with NWL IBC, the Local Dental Committee, NHS England, council teams and commissioned services on oral health early prevention and intervention.