Education Adviser, Lucie Welch, discusses what dental neglect is, the signs to look out for and what schools can do to support families.

According to research by Public Health England in 2022, 1 in 4 five-year-olds suffered some form of dental decay and in 2022-2023, and tooth decay was the most common reason for hospital admissions in children aged 6-10 (NHS digital).  

While often overlooked, dental neglect can be a significant indicator of broader safeguarding concerns. Poor oral health affects not only a child’s physical wellbeing but can also impact their confidence, concentration and attendance.  

What is dental neglect? 

In Keeping Children Safe in Education 2025, neglect is described as the ‘persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development’ and includes reference to failure to access appropriate medical attention where required.  

Dental neglect is defined by the British Society of Paediatric Dentistry as the “persistent failure to meet a child’s basic oral health needs”. It may be part of wider neglect or it may be the only concern raised about a child’s care.  

Dental neglect is recognised in statutory safeguarding guidance as a form of physical neglect. Working Together to Safeguard Children (DfE, 2023) includes the failure to ensure appropriate medical or dental care as a key indicator of neglect.  

The Faculty of Dental Surgery at the Royal College of Surgeons also highlights that repeated untreated dental decay may be a sign of wider neglect and should prompt safeguarding consideration (RCS, 2019).  

Dental neglect can include: 

• Repeated failure to provide or access treatment for dental issues or gum infections 

• Chronic or untreated dental pain 

• Severe tooth decay with no dental follow-up 

• A child being unable to eat or sleep due to dental problems 

• A child regularly missing school due to dental pain or appointments that never result in appropriate care or treatment. 

Signs of Dental Neglect 

Staff in education settings must be alert to all forms of abuse and neglect and therefore having an awareness of dental neglect is important.  

Oral health is a vital part of a child’s overall wellbeing and being able to recognise the signs early and respond sensitively is a crucial part of protecting children and promoting their welfare. 

The signs and symptoms to look out for can be: 

• Persistent complaints of toothache or mouth pain 

• Difficulty eating or visible avoidance of food 

• Persistent or repeated bouts of foul breath  

• Visibly decayed, broken or damaged teeth 

• Swollen or bleeding gums including tooth loss (of adult teeth) 

• Regular absences due to dental issues 

• Low mood, fatigue or difficulty concentrating linked to ongoing pain. 

Why dental neglect happens: 

Understanding the underlying reasons why dental neglect occurs is vital for providing a compassionate and proportionate safeguarding response. 

While neglect may sometimes be wilful, in many cases, it stems from a range of barriers or vulnerabilities that families are facing.  

Recognising these factors helps professionals avoid parent-blaming approaches and instead focus on appropriate support and early help. 

Common causes can include:  

• A lack of awareness about the importance of oral health.
  Some parents or carers may not realise the long-term impact of poor dental hygiene, particularly for younger children whose milk teeth are sometimes incorrectly viewed as unimportant. 

• Access to appropriate or timely dental care.
  As of 2023, 91% of NHS dental practices in England were not accepting new child NHS patients (Healthwatch England), leaving many families without routine care. In some areas, long waiting lists, limited capacity and a shortage of NHS dentists mean parents are unable to secure appointments even when they actively seek help.

• Cultural beliefs and understanding
  This may influence how dental care is prioritised within the home, as in some communities, oral health may not be viewed as a healthcare priority unless pain is present or traditional remedies may be used instead of seeking dental treatment.  

• Wider safeguarding factors
  Issues such as parental mental health difficulties, substance misuse or broader patterns of neglect can also impact a family’s ability to maintain consistent oral hygiene routines or attend dental appointments.   

• Poverty and housing instability
  Financial hardship can make dental care feel inaccessible, even when it is free for children. If families are struggling with transport, language barriers or time off work it can make accessing a dentist almost impossible. As well as this, families experiencing homelessness or temporary accommodation, may find it hard to maintain routines like toothbrushing or regular dental check-ups.

• SEND or Additional Needs
  Some children with disabilities, sensory issues or neurodiversity, may require adapted toothbrushes or support with sensory regulation- as without these in place oral health routines can break down. In these instances, the issue is less about neglectful intent and more about unmet needs. 

The dangers of untreated dental issues: 

Untreated dental conditions can have serious and lasting effects on a child’s health, wellbeing and development. Persistent dental pain can disrupt sleep and concentration, leading to reduced participation in learning and poorer educational outcomes.  

Visible decay or missing teeth may cause embarrassment, low self-esteem and social withdrawal, particularly as children become more self-conscious with age. In some cases, dental infections can spread, posing significant risks to general health if left untreated.  

Poor oral health can also affect a child’s ability to eat and speak clearly, with long-term consequences for nutrition, speech development and overall growth. In the most severe cases, children may require hospital admission for dental extractions under general anaesthetic.  

What can schools do? 

Schools are ideally placed to spot concerns early and support children and families. DSLs should: 

• Include oral health as part of safeguarding training for all staff 

• Ensure oral health and hygiene are woven into the curriculum and regularly discussed in an age-appropriate way, through science and PSHE  

• Embed dental neglect in safeguarding procedures and referral pathways 

• Build links with local dental practices, school nurses and health visitors 

• Be alert to patterns of absences or pain-related behaviour 

• Have sensitive, non-judgemental conversations with parents or carers 

• Consider offering free dental hygiene resources or workshops in school 

When to act in the child’s best interests: 

If concerns persist despite conversations or signposting or if a child is in visible pain and not receiving care, DSLs must consider whether the threshold for early help or a safeguarding referral has been met. 

Action should be taken when: 

• The child has ongoing dental pain that is not being addressed 

• A dentist recommends treatment but parents repeatedly do not follow through 

• There are wider indicators of neglect in the child’s presentation or circumstances 

• A child discloses distress or hunger related to their teeth 

• Dental issues are significantly affecting the child’s attendance, development or wellbeing. 

Summary 

Dental neglect is a safeguarding concern. While it may be more hidden than other forms of neglect, the impact on a child’s life can be profound. By recognising the signs early and working supportively with families, schools and education settings can help prevent long-term harm and promote every child’s right to health and dignity. 

If you need support with this issue, or with anything safeguarding-related at your school, please feel free to get in touch at safeguarding@servicesforeducation.co.uk

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  About the Author

Lucie Welch – Adviser, Services For Education

Lucie Welch has worked in the field of Primary Education for the last 15 years, holding the positions of Assistant Head of School, Designated Safeguarding Lead, Attendance Lead and Designated Teacher for Looked After Children. Through working across several local authorities and within multi-academy trusts, Lucie has garnered a passion for safeguarding and supporting children and young people to enable them to thrive.

At Services For Education, Lucie is an integral part of the Safeguarding team, sharing her expertise with schools, colleges, trusts, and other educational settings across the city of Birmingham and beyond. Dedicated to improving safeguarding practices in an actionable and impactful way, Lucie works closely with settings to provide bespoke training, supports with reflection on their own practices during Safeguarding audits and always strives to contribute to a better learning environment for all children. Through delivery of statutory training for DSLs and Safer Recruitment, Lucie works with colleagues in all age ranges and is a source of expertise within these areas.

Lucie also wears other important hats within the School Support Team. Not only is she dedicated to ensuring the safety and well-being of students through her role in safeguarding, but she also plays a key part in the PSHE/RSE and Health for Life teams. Additionally, Lucie partners with the Best Practice Network to deliver the Early Career Framework, supporting new teachers in their professional development.