NHS dental payment reform: equality impact assessment record

The equality impact assessment (EQIA) considers the potential impact of NHS dental payment reform on people with protected characteristics.

Stage 2: Data and evidence gathering, involvement and consultation

Include here the results of your evidence gathering (including framing exercise), including qualitative and quantitative data and the source of that information, whether national statistics, surveys or consultations with relevant equality groups.


Evidence gathered and Strength/quality of evidence


Data gaps identified and action taken


Older age groups – People in older age groups are most likely to have no natural teeth:

  • 22% for 75+
  • 10% for 65-74 years
  • compared to average of 4% across all age groups;

or fewer than 10 natural teeth:

  • 12% for 75+
  • 6% for 65-74 years
  • compared to average of 3% across all age groups.

All age groups – Between 10% and 26% of people feel 'a bit' or 'very' nervous about attending the dentist.

Scottish Health Survey (shinyapps.io)



People with Learning Disabilities - Evidence shows that people with learning disabilities often have:

  • higher levels of gum disease
  • greater gingival inflammation
  • higher numbers of missing teeth
  • increased rates of toothlessness
  • higher plaque levels
  • greater unmet oral health needs
  • poor access to dental services and less preventive dentistry

People with physical disabilities – Some physical disabilities may result in people having difficulty accessing dental care due to problems getting to the surgery. People may also have issues with dexterity resulting in poorer oral health.

People with mental health conditions – Evidence suggests that 1 in 4 people in Scotland are affected by a mental health problems each year. Individuals with mental health disorders, such as depression, anxiety or dental phobias, are at higher risk of developing poor oral health. This can be attributed to reduced effort to maintain/improve oral hygiene, or inability to attend their dentist regularly, which can lead to issues such as periodontal disease or, due to required medication, antidepressant induced xerostomia.

Oral care and people with learning disabilities - GOV.UK (www.gov.uk)

Oral health and physical disabilities - Oral Health Foundation (dentalhealth.org)



Evidence suggests that men are more likely than women to ignore their oral health, have poorer oral hygiene habits and higher rates of periodontal disease, oral cancer and dental trauma. Men also tend to visit the dentist less frequently and are more likely to do so for acute problems.

Women are less likely to be in full-time employment than men, therefore could have more financial concerns regarding dental charges.

Men and Oral Health: A Review of Sex and Gender Differences - PubMed (nih.gov)


Pregnancy and Maternity

During pregnancy hormonal changes may result in a person's body reacting differently to bacteria on the teeth which can lead to gum disease and periodontitis.

During pregnancy, and whilst breastfeeding, amalgam fillings are not recommended.

Oral health and pregnancy: six things every mum needs to know | Oral Health Foundation (dentalhealth.org)


Gender Reassignment

We are not aware of any research that suggests gender reassignment specifically impacts oral health. People undergoing gender reassignment will continue to be able to access NHS dental services in the same way as the general population.


Sexual Orientation

Evidence suggests that clinical measures of oral health do not differ according to sexual orientation. However, self-reported rating of oral health did show some differences dependent on sexual orientation.

Sexual orientation‐related oral health disparities in the United States - Schwartz - 2019 - Journal of Public Health Dentistry - Wiley Online Library



Research has shown that with the presence of more teeth and fewer dental extractions, oral health was better among non-White groups, despite lower use of dental services. The differences could be partially explained by reported differences in dietary sugar.

Ethnic differences in oral health and use of dental services: cross-sectional study using the 2009 Adult Dental Health Survey | BMC Oral Health | Full Text (biomedcentral.com)


Religion or Belief

We are not aware of any research which suggests that religion has an impact on oral health.


Marriage and Civil Partnership

(the Scottish Government does not require assessment against this protected characteristic unless the policy or practice relates to work, for example HR policies and practices - refer to Definitions of Protected Characteristics document for details)

N/A – policy does not relate to work related practices such as HR policies.


Socio-Economic Status

Evidence shows that people from deprived areas are more likely to have decayed teeth, poor oral hygiene and higher levels of periodontal disease.

Furthermore, patients in the most deprived areas are less likely to participate in dental treatment compared to those in the least deprived areas. They are also less likely to have received restorations.

People living in the lowest SIMD areas are more likely to have no (or less) natural teeth compared with people living in the least deprived areas.

Scottish Adult Oral Health Survey 2016-2018 (scottishdental.org)

Dental statistics - NHS registration and participation 24 January 2023 - Dental statistics - registration and participation - Publications - Public Health Scotland

Scottish Adult Oral Health Survey 2016-2018 (scottishdental.org)



Email: nhsdentistry@gov.scot

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