You and I know that good oral health isn’t just about teeth. It’s fundamental to our overall wellbeing – leading longer, happier and healthier lives.
And yet, poor oral health outcomes have been a persistent challenge: A quarter of children and adults in London have experience of tooth decay. Inequalities are stark and particularly affect those who are most vulnerable in society.
Harrow is certainly no exception, and partners across the borough have collectively endeavoured to address this. As work has continued to grow in recent years, so has the need to take a step-back, review our current efforts and determine the best direction of travel.
The end-product is the Harrow Oral Health Needs Assessment (OHNA). Published in August 2025, it is the result of 9 months of collaboration between representatives across the health and care system, including dental and oral health promotion services, public health, commissioners, the voluntary and community sector and many others.
The OHNA aims to do exactly what it says on the tin: Understand the oral health needs of our local population, and the vital services that support them. This insight was used to make evidence-based recommendations, with the ultimate goal of improving oral health in Harrow.
Key Findings: Recent progress, but clear and persistent challenges
I have some positive news to share: Some oral health outcomes are improving. Tooth decay rates in 5-year-old children, a key metric, fell by a third in Harrow from 42.4% in 2019 to 27.6% in 2024 (a statistically significant difference).
We have also seen reductions in hospital admissions due to decay and hospital extractions, although it’s unclear how much this is due to expanded care delivery in community settings.
However, we must recognise that unmet oral health need remains prevalent. Local inequalities exist – for instance, those living in more deprived areas experience higher rates of hospitalisation. We also found considerable need amongst vulnerable groups, such as children with Special Educational Needs and Disabilities (SEND).
The reasons behind poor oral health in Harrow are complex. The socio-economic, cultural and physical environment in which people are born, live, work and age shape the varying degrees to which people practice good oral health behaviours.
Dental care access rates are relatively high in Harrow when compared to other North-West London boroughs. However, access can still be challenging for residents, particularly affecting vulnerable groups which risks widening inequalities.
Subsequently, resident experience of receiving dental care in Harrow is largely positive. It is important to note though that issues do arise, especially when additional or complex needs are not accommodated.
Recommendations: A whole-system approach
The state of oral health in Harrow is underpinned by an array of factors at individual, societal and service levels. If we are to make meaningful improvements, we must tackle these collectively.
This will require collaborative whole-system action. The bottom line is: Oral health should be everyone’s business in Harrow.
The OHNA outlines a considerable number of recommendations, promoting such an approach. It is also grounded in the principle of proportionate universalism – providing services at a scale and intensity proportionate to their need. This will ensure all Harrow residents have the capability and opportunity to improve their oral health, while simultaneously reducing inequalities.
As an exceptionally brief summary, the recommendations cover:
- The need to enhance collaboration and integrate oral health across the wider health and care system
- How we tackle root causes and specific risk factors for poor oral health locally
- Scaling up oral health promotion initiatives and maintaining existing programmes like Supervised Toothbrushing in schools
- Opportunities to optimise NHS dental care access and delivery
- How we can continue to improve our insight into resident and frontline service experiences
Collaboration: The key to progress
I strongly echo what Sara Hurley CBE, former Chief Dental Officer for England, said in her recent LDC Confederation article. Collaboration is key, and was one of the most powerful aspects of the OHNA process. Moving forwards, that spirit of partnership will be vital to achieving our shared goals.
Harrow Public Health’s relationship with the LDC has epitomised this. LDC support was instrumental in gathering insight from local frontline dentists and advocating for their perspectives to be embedded into the very heart of the OHNA.
We must be especially mindful as the NHS 10-year Health Plan is implemented. Dental professionals and services are central to the shift in focus from sickness to prevention, a vision which the OHNA aligns with.
Reflecting real-world experiences will be vital to driving genuine, meaningful change. Our close connection with the LDC will ensure that the voices of dentists are heard.
Crucial next steps: Turning this work into action
For everyone’s sake, the Harrow OHNA cannot be a meaningless, lengthy report. It must be used as a blueprint for change.
We have already embarked on translating the recommendations into sustained, system-wide action.
Our efforts must be rooted in collaboration. By working together, we can ensure that every Harrow resident can enjoy good oral health.
Public Health Specialty Registrar
Harrow Council