Dental health: migrant health guide

Question

Accepted Answer

Main messages

A person does not need to wait for problems to appear before seeing a dentist. Regular dental visits can help to prevent problems. For example, children can receive free fluoride varnish to prevent dental decay.

Healthcare professionals should provide new migrant patients with information about NHS dental care, entitlements to dental care, and how to find an NHS dentist. Take an oral case history.

Professional interpreting in a patient’s preferred language should always be offered when language barriers are present. Further information about interpreting and translation can be found in the migrant health guide language interpreting and translation page.

Healthcare professionals can refer to the Office for Health Improvement and Disparities (OHID)’s model of oral healthcare for asylum seekers and refugees to support their access to NHS dental services.

Background

Oral health is an important part of health as it influences the general wellbeing and quality of life of people. It allows them to eat, speak, and socialise without active disease. Poor oral health affects individuals and those close to them. Dental decay is the most common oral disease and is largely preventable. NHS dentistry provides preventive advice and interventions in addition to treatment.

There is a growing body of evidence to support a relationship between poor general health and poor oral health. For example, there is evidence that poor oral health or gum disease can affect blood sugar control in diabetes. Poor oral health is also associated with pneumonia and with atherosclerotic cardiovascular disease (coronary heart disease, stroke and peripheral vascular disease).

Migrants and oral health

In the UK, oral health has improved dramatically since the 1960s. However, poor oral health is still closely linked to factors which may affect certain migrant groups, including:

economic deprivation
social exclusion
cultural differences in perceptions about oral health
availability of dental services in migrants’ country of birth or origin

Prior to their arrival in the UK, some migrants may have never received any:

dental examinations or treatment
advice on oral hygiene and prevention

Malmö University, a collaborating centre in the World Health Organization’s (WHO’s) oral health programme, provides information on the prevalence of dental caries in children by country.

NHS dental entitlements

Entitlements to NHS services for migrants in England

The entitlements to NHS services for migrants in England animation contains a section on access to NHS dental services (section begins at 07:01).

The NHS dental care information provided below primarily concerns England. There is further information about dental care in Scotland, Wales and Northern Ireland.

Dentists are not required to ask for proof of identity, proof of address or proof of immigration status from individuals applying to become an NHS patient.

Dental practices cannot turn down an applicant for NHS treatment on the grounds of dental condition or any protected characteristics:

age
disability
gender reassignment
marriage and civil partnership
pregnancy and maternity
race
religion or belief
sex
sexual orientation

NHS dental charges and free dental care

NHS dental charges apply to all NHS patients, unless:

the treatment is free (for example to remove stitches, stop bleeding in the mouth, repair dentures)
the person is under the age of 18, or under 19 in full-time education
the patient person is receiving certain benefits. Proof of benefits must be shown to the dental practice
the person is pregnant or has had a baby in the last 12 months. A MAT B1 certificate or maternity exemption certificate (MatEx) must be shown to the dental practice

A person can check if they are entitled to free NHS dental care and can check whether they are exempt from NHS charges.

A person with low income or no recourse to public funds who is not receiving qualifying benefits can apply for help with the costs of NHS dental care. Depending on their eligibility, a person can receive full help (HC2 certificate) or partial help (HC3 certificate) with costs.

Further information about dental charges is available on the NHS website.

If a person knows that they will not be able to attend an appointment, they are asked to give as much notice as possible to the dental practice. This allows the practice to cancel the appointment and offer it to another patient.

The dentist can terminate treatment if multiple appointments have been missed without letting the dental practice know. The person may need to pay again for a new course of treatment.

While practices cannot charge a patient for missing their appointment, the dentist may ask them to find another dental practice if they continue to miss appointments.

Remember that migrants may need more support to access and attend for dental services.

Find an NHS dentist

If urgent dental care is needed, contact NHS 111. Do not contact a GP as they cannot provide urgent or emergency dental care.

A person can search for their nearest NHS dentist.

If a person cannot find a dentist accepting new NHS patients, they can contact:

their local NHS England area team
NHS England Customer Contact Centre on 0300 311 2233
their local Healthwatch to get information about services in their area

Migrants’ entitlements to dental treatment in hospital (secondary care) is the same as their entitlements to NHS medical treatment in hospitals. Patients can contact the Patient Advice and Liaison Services for help to access hospital dental services.

Advice for healthcare professionals

Ask new migrant patients about their:

previous history of dental examinations or treatment, including the nature of dental appointments, such as did they attend preventively (no symptoms or concerns) or to address a specific concern
current dental or oral symptoms
oral hygiene practices
dietary sugar intake
tobacco usage
alcohol consumption

Provide new migrant patients with the following general information about dental care:

regular visits with the dentist can help to prevent problems from happening
migrants do not need to wait for problems to appear to see a dentist in the UK
migrants should see a dentist within their first month of arrival to the UK
everyone is entitled to receive NHS dental care, with the NHS providing any clinically necessary treatment needed to keep your mouth, teeth and gums healthy and free of pain
NHS dental treatments include dentures, root-canal treatment, crowns and bridges, fillings, preventive treatment (such as fluoride varnish, fissure sealants, scale and polish as clinically required), and orthodontic (teeth straightening) treatment for children and young people under 18 years
free fluoride varnish is available for all children and can help prevent dental decay; fluoride varnish is also free of any further charges for adults where it is deemed clinically necessary
NHS dental treatment does not cover cosmetic work such as teeth whitening; patients will need to pay privately for cosmetic work even if they are entitled to free NHS dental care
if the dentist recommends that a scale and polish or a trip to the hygienist is clinically necessary, there should be no extra NHS charges for this; if it is not deemed to be clinically necessary, a private charge may be incurred
if a person knows that they will not be able to attend an appointment, they should give as much notice as possible to the dental practice so they can cancel the appointment and offer the slot to another patient
while dental practices cannot charge patients for missing appointments, the dentist may ask them to find another dental surgery if the person continues to miss appointments

Provide new migrant patients with the following information about access to dental care:

migrants’ entitlements to NHS dental care and how to find an NHS dentist
dental practices should not ask migrants for proof of address or proof of immigration status when they apply to access NHS dental care
migrant patients should inform the dental practice if they need interpreting or translation services. The patient does not need to provide their own interpreter or translator
many dentists provide both NHS and private dental treatment, so migrants should check with their dental practice if they are accessing care as an NHS or private patient

Provide new migrant patients with the following information about oral health:

oral health information about oral hygiene and diet
increased risk of dental problems and mouth cancers from drinking alcohol and tobacco use
lifestyle tips for healthy teeth

Resources

Healthcare professionals can refer to OHID’s model of oral healthcare for asylum seekers and refugees to support their access to NHS dental services. This resource can also be used by local authorities and support services that work with refugees and asylum seekers.

The WHO provides information about oral health that is available in multiple languages.

Additional information about NHS dental services in England can be found in this leaflet.

Quick guide to a healthy mouth in children, which gives a summary of the simple steps that parents, carers and children can take every day to protect and improve children’s oral health.

Quick guide to a healthy mouth in adults, which provides a summary of the simple steps that adults can take every day to protect and improve their oral health.