You’re not ugly – you’re just poor: How teeth became Britain’s biggest class divide

Getting an NHS dentist has never been harder, with private appointments and procedures often running into thousands of pounds. As costs soar, many are now living in pain and with lost teeth, so how has dental work become not about health but hierarchy, writes Zoë Beaty

The British Dental Association says that more than 12 million adults haven’t seen a dentist in more than two years (Getty)

Let’s be honest, the British have never been known for our gnashers. The perfect smile – bright white, suspiciously straight – has long been an American export, while British teeth have long been the punchline to their jokes. But now, the nation known for smiling through crisis has run into irony – we can no longer afford to.

In 2025, the state of your teeth says more about your class than your accent ever could. Up and down the country, queues snake around the block when a rare NHS practice opens its doors, as they did in Bristol in September, where more than 150 lined up outside from 7am, hoping for a coveted place on a list that closed within hours. It’s not surprising when you consider that, in 2024, fewer than one in five practices in England were accepting new adult NHS patients. Some regions, such as Cornwall and Cumbria, had none at all.

The British Dental Association says that more than 12 million adults haven’t seen a dentist in more than two years; one in five delay treatment because of escalating costs. In some areas, patients are pulling their own teeth out with pliers or turning to YouTube tutorials to fix what they can’t afford.

Britain is heading towards a next generation of children whose parents were too scared of the dentist’s bill to take them (Getty/iStock)

Horror stories are everywhere. One friend is facing three years of finance to pay for the removal of two teeth, a bone graft needed to hold two implants, which her dentist said would cost almost £9,000. Another witnessed a woman in a pharmacy with a swollen cheek, clearly in pain, unable to afford the £150 fee for an emergency appointment. Frantic, she was explaining that she couldn’t take the painkillers being offered to her due to her ongoing cancer treatment. Go to A&E was the pharmacist’s advice.

Dentistry shouldn’t be a luxury. It should be a right that everybody can access. But, even if you’re well off, you’ll struggle to afford it in some areas

Simon Thackeray, a Nottinghamshire dentist

On Facebook, whole threads are made up of similar stories: a husband who has lost seven teeth and Budapest clinics that are cleaning up where British dentists are failing. Implants, crowns, painful root canals, chips and cracks are all discussed as problems that no one can afford to throw a cheque at. Recent surveys show that around one in four five-year-olds has decay, which remains the leading reason for hospital admissions for young children. Having a dentist is now not only about health, but hierarchy.

The thing is, this was the inevitable conclusion of government policy that treated teeth as optional, says Simon Thackeray, a Nottinghamshire dentist who spent decades watching the NHS crumble from the inside. “Dentistry shouldn’t be a luxury,” he says. “It should be a right that everybody can access. But, even if you’re well off, you’ll struggle to afford it in some areas.”

The NHS budget for dentistry would need not just to double, but to quadruple to meet demand – and private dentists are inevitably filling that gap (Getty)

Thackeray started as an NHS dentist after training, but soon found that it was almost impossible to stay afloat. “The NHS dental contract has never worked,” he explains. “It was designed to let dentists care for high-needs patients. But the sums never added up.

“A dentist would get paid the same whether someone needed one filling or 12. It costs you more in time, more in materials, but you couldn’t claim more. So dentists stopped taking on those patients – not out of greed, but because it was costing them money to keep their doors open.”

Basically, the government underfunded dentistry so severely that the system turned on those who needed it most. “NHS funding has only ever covered dentistry for about half the population,” Thackeray says. “That’s written somewhere in the paperwork. So what happens to the other 50 per cent?”

The NHS budget for dentistry would need not just to double, but to quadruple to meet demand – and private dentists are inevitably filling that gap. Research from late last year by MyTribe Insurance showed that charges had reached “eye-watering” levels, with patients paying up to 32 per cent more for the same treatments compared to 2022.

The result is a two-tier system that mirrors every other British inequality. Working-class patients who often need the most care – they’re more likely to have a poorer diet, less time and education when it comes to dental care – are now the least likely to get it. One rung up, the middle classes are squeezed into payment plans and credit schemes. Meanwhile, those at the top quietly keep their veneers gleaming.

Teeth are such an enormous part of your appearance; intimacy lives in our mouths (AFP/Getty)

And the rest of the country is in dental exile. For years, particularly after the Covid-19 pandemic, when it seemed as though everyone was getting a brand new set of (shockingly) pearly whites, “dental tourism” has meant Turkey, where thousands of Brits flock every year. It became the great dental equalisers of social media: the same blinding grin, mass-produced uniformity; all chasing the perfect smile and coming back with the same one. Or, for many, the same set of problems. Copy-and-paste veneers left people with hypersensitivity, prone to dangerous infections and gum damage, or worse, all costing much more to fix in the UK.

Now, things have moved on to Budapest, which, says writer Rowan Pelling, 57, is “the new capital of British teeth”. Pelling describes herself as “a victim of 1970s and 1980s dentistry”, drilled and filled before anaesthetics were common. “And then, of course, once you’ve had a filling, it gets replaced with a bigger one, and then eventually the tooth cracks,” she explains. “I don’t think my teeth were bad, they were just overfilled when I was a kid.”

Now, after a disastrous few weeks with two broken crowns, she needs implants – at a cost of around £8,000 in London, which is more than Pelling’s modest earnings and emergency savings fund can afford. “I’ve been told it’s about half the price in Budapest,” she explains. “I’m not looking for a perfect smile, I just want to be able to chew.”

There’s a grim pragmatism to her decision. “I suddenly felt precarious,” she says. “Like, more precarious than any other financial thing. The fact that I could feel this great chasm in my mouth, and knowing the one next to it wasn’t great either… I felt really undermined by it all. I went to the hairdresser just to make myself feel human again because I started to feel like a toothless old hag.”

Teeth are such an enormous part of your appearance; intimacy lives in our mouths. It’s impossible not to feel it personally when something goes wrong. If dentistry is now the clearest indicator of Britain’s class divide, it’s because the mouth has always been moralised – good teeth means good discipline, self-respect, a decent diet. But bad teeth? The visible marker of neglect or, worse, poverty.

Social pressure around that comes down to the well-worn idea that “you’re not ugly, you’re just poor” – a joke that has never felt so fitting when it comes to British teeth. You can see why those like Pelling choose to try and fix them wherever they can, even if that means a few trips abroad and a big risk.

And it is a risk, says Thackeray, who sees the fallout of “Turkey teeth” first hand. “People come back with 28 once salvable teeth ground down into stubs,” he says. “They’ve paid maybe £7,000 abroad – but it costs them £40,000 to fix here.” Some of those cases are horrific – infections, implants through sinuses, one currently doing the rounds on TikTok is a woman whose entire nose is now black, necrotic tissue after her procedure went wrong.

But Thackeray is careful not to sneer. “It’s hard to blame people,” he says. “But would you choose your surgeon [based] on who’s cheapest? The problem is that the state has left many people with little choice.”

Part of the reason it’s so much more expensive over here is regulation – “Abroad, you don’t know what materials they’re using,” Thackeray warns, “or what comeback you have [if something goes wrong].”

The government insists reform is coming, but Thackeray is sceptical. “They’ve been saying that since 2006,” he says. In the meantime, Britain is heading towards a next generation of children with Victorian mouths, whose parents were too scared of the dentist’s bill to take them, or simply couldn’t afford to. Schools see it on a daily basis. Reports of children arriving with abscesses and blackened baby teeth are rife around the country – and the knock-on effects will continue for years.

The NHS’s founding promise – care from cradle to grave – falters at the gumline. In the end, the British smile tells the truth our politics won’t: that you can now trace a person’s wealth in the health of their teeth. And, in every cracked crown and missing molar, you can see the gap where our national health service used to be.