Dimitri Mulkern, University of Birmingham student

In this article Dimitri Mulkern, a final year student studying BDS Dentistry at the University of Birmingham and tutor at UniAdmissions, explores the barriers patients face when accessing treatment, and the dental service that is responsible for dealing with this problem.

The concept of inequality in healthcare is not a new one. However, despite the numerous increases in preventative, awareness and screening programs, the vast majority of dental services go underused by most of the public. This phenomenon may exist due to four barriers that many potential patients face.


Many people feel threatened from a simple toothache, because they have hit their first barrier to treatment. Fear. Fear of the dentist is very common. This usually results in avoidance behaviour until the problem cannot physically be ignored anymore.

Having primed their ‘fight or flight’ response, arriving to the clinic with anticipatory anxiety, these patients require more complex support. They will not report the same quality of care as Mrs. Smith who has been calmly sat in the waiting room for her routine six-month check-up.


Access to dental services here in the UK is actually pretty good, with around 80% of all patient appointments being made within 2 weeks. Unfortunately, a key problem lies in the public/private healthcare divide. Over half (65%) of dental surgeries offer private appointments when public ones are not available; a situation that erodes patient trust in the NHS by forcing them to go private to access healthcare. 

It is honesty, transparency and trust that forge every relationship between a dentist and their patients – definitely not something you want to be undermining. These relationships take a long time to nurture into a positive light. A small slip-up like this can have lasting damage to that relationship.


Another thing patients don’t like undermining are their wallets. With the growing uncertainty in cost, up to 20% of patients are delaying or even refusing treatment. And with fewer people willing to literally put their money where their mouth is, crucial healthcare fails to reach those that need it the most. 

First Impressions

While good communication will help alleviate the uncertainty of cost, it will not overcome the barrier of the dreaded front door. First impressions are everything, and your practice image speaks volumes about your healthcare and the public perception of your healthcare. 

Bad publicity in 2016 rated only marginally worse than the receptionist’s manner. This shows that first impressions really do mean a lot. When consumers are seeking that one “good” dentist who avoids “unnecessary” treatment, even minor barriers can hinder access to treatment.

So what is being done against these barriers?

Although there are multiple schemes in place to alleviate some of these issues, a large scale scheme in place is the Community Dental Services (CDS). It doesn’t specifically target each of these issues but it does make each one a little less impactful.

Manned by salaried dentists, CDS are comprised of priority groups driven by the needs of the population, not the demands. As well as providing local and targeted education programs to raise awareness and counteract barriers to healthcare, they also train complimentary services such as personal carers in oral hygiene to make sustainable improvements to a population’s oral health.

Because of their advantageous position, many CDS are also involved in epidemiological surveys that collect large volumes of data on disease prevalence within their local populations, allowing targeted health strategies to be developed and refined for long term impacts. Dependent upon the area, specialist services are also maintained as required.

Then there’s the barrier of money. Unlike health care in the UK, dental care has a cost associated with it. Due to this simple fact, many would-be patients ignore their problems and let dental issues worsen over time.

As I mentioned above, uncertainty to cost is a huge barrier, alongside the cost itself. The government does offer benefits to those who physically cannot afford dental care, and the CDS scheme helps alleviate concerns of those uncertain about dental care costs.

There are solutions being presented to the problems at hand, but are they enough to reduce inequality and barriers to oral healthcare? Programmes like CDS are a move in the right direction, but there is still much more work to be done.