Food insecurity and the dental team: a pilot study to explore opinions

The 2022 oral health survey reported a national prevalence of enamel or dentinal decay in 5-year-old children of 29.3% with marked regional variation. Dental caries remains a leading cause of hospital admissions for children in the UK, with 26,741 extraction episodes in 0–19-year-olds in 2021–2022 at a cost of £50.9 million. Food insecurity—defined as insufficient financial resources to reliably access adequate, nutritious food—affects millions of UK households, with an estimated 3.7 million children living in food-insecure households as of June 2023. Rising costs of energy and housing further constrain food budgets, and the poorest households would need to spend about 50% of disposable income to meet a healthy diet. Food insecurity is considered an independent predictor of dental caries in children and adolescents. Prior evidence in dentistry suggests clinicians may provide standardised advice rather than tailoring to individual circumstances, underscoring the need to understand socio-economic determinants such as food insecurity. The aim of this study was to explore the awareness, understanding, and confidence of dental team members regarding food insecurity, their roles in oral health education, and perceived barriers and support needs for providing care to families experiencing food insecurity.

Multiple systematic reviews indicate a direct association between food insecurity and oral disease. Families experiencing food insecurity may rely on cheaper, energy-dense foods with lower nutritional value and higher fat and sugar content, contributing to increased caries risk. Studies suggest children in food-insecure situations have higher rates of untreated dental caries, dental pain due to caries, and higher prevalence of restorations and extractions. Nutritional deficiencies associated with food insecurity, such as vitamin D deficiency (linked to enamel hypoplasia and periodontal disease) and vitamin C deficiency (scorbutic gingivitis), further affect oral health. This body of literature frames food insecurity as a significant determinant of oral health outcomes and service use. Additionally, prior research in health care indicates limited evidence on dental professionals’ confidence addressing food insecurity, though some work has explored medical professionals’ perspectives.

Design: Cross-sectional study using an anonymous, voluntary, self-administered online questionnaire. Ethics: Approved by the University of Liverpool ethics committee (Protocol 2023 number 12323). Instrument: A 21-item questionnaire developed after a literature search (no validated tool found), peer reviewed and piloted with local dental staff; revisions incorporated feedback. Question types: Combination of closed- and open-ended items; closed-ended items used mixed response formats and five-point Likert scales (strongly disagree to strongly agree) assessing confidence and understanding regarding oral health education and food insecurity. Sampling and recruitment: Email distribution via the BSPD lead administrator to 698 BSPD members during June 2023, with a reminder at two weeks. Inclusion criteria: Health professionals currently undertaking clinical sessions with children and BSPD members. Exclusions: Practitioners not regularly treating children and administrative staff without clinical roles. All respondents met inclusion criteria on analysis. Data analysis: Quantitative data exported to Microsoft Excel 2019 for descriptive statistics and graphical trend analysis. Qualitative data exported to NVivo 12 for thematic analysis. Coding was conducted by the lead researcher; themes were refined with input from a second experienced qualitative researcher and agreed by the team.

• Response rate: 9.6% (76/698).
• Demographics: Age 18–64; majority 25–34 years (51.3%, n=39). Female 90.8% (n=69), male 9.2% (n=7). Most qualified 6–10 years (35.5%, n=27).
• Roles and settings: Hospital dental service 55.3% (n=42), Community dental services 40.8% (n=31), General dental practice 3.9% (n=3). Predominantly dentists 96% (n=73); dental therapists 2.6% (n=2); one dental student.
• Oral health education: 94.7% (n=72) agreed diet is a major component of oral health. 96% (n=73) felt dental professionals are responsible for dietary counselling. 80.3% (n=61) reported adequate knowledge to provide advice; 19.7% (n=15) were less confident.
• Food insecurity awareness and confidence: 80.3% (n=61) were aware of the impact of food insecurity on oral health. Only 36.8% (n=28) felt confident identifying individuals who may be experiencing food insecurity, and 32.9% (n=25) felt comfortable discussing it.
• Professional responsibility: 81.6% (n=62) agreed dental teams have a role in advising patients experiencing food insecurity; some free-text responses suggested this is not the dentist’s role and other services are more appropriate.
• Barriers to discussing food insecurity: Lack of time 65.8% (n=50); lack of confidence to ask 77.6% (n=59); difficulty identifying patients 71% (n=54); lack of knowledge 73.4% (n=56); lack of counselling skills 68.4% (n=52). Additional barriers: remuneration, lack of public policies, insufficient onward support, family reluctance, and perceptions that it is not part of the dental role.
• Support availability: 32.9% (n=25) aware of services accessible to families; 18.4% (n=14) able to signpost patients.
• Thematic analysis (enablers): Need for sensitive, structured communication and universal screening questions; training (including counselling/role play and undergraduate/postgraduate curricula); resources for signposting (posters, leaflets, websites, referral pathways); recognition by some that broader policy/media attention is needed.
• Experience effects: Confidence in dietary counselling generally high across all experience levels, with a small number of recent graduates (0–10 years) less confident. Confidence to discuss food insecurity was lower across all experience bands, with a greater proportion disagreeing or strongly disagreeing that they had confidence to discuss it.

The study addresses the gap in understanding dental professionals’ perceptions of food insecurity and their role in supporting affected families. Findings indicate strong consensus on the importance of diet in oral health and professional responsibility for dietary counselling, but much lower confidence in identifying and discussing food insecurity. Perceived barriers—time constraints, limited knowledge, counselling skills, and patient identification—suggest that training and system-level supports are needed. Integrating structured, non-stigmatising screening questions into routine histories, enhancing communication and coaching skills, and providing clear signposting resources could facilitate conversations. Given the high volume of child dental contacts annually in the UK, dental teams are well-positioned to identify and support families who may be unknown to other services. Aligning interventions with national initiatives such as Making Every Contact Count and adopting a team-based, patient-centred approach could reduce inequalities. Broader contextual factors (cost-of-living increases, affordability of healthy foods) underscore the relevance of addressing food insecurity within dental care. The results suggest curricular enhancements and professional development to improve confidence and competence, along with co-designed interventions with people who have lived experience to avoid stigma and ensure practicality.

This pilot study is the first to explore dental professionals’ views on recognising and supporting families experiencing food insecurity. While most respondents understand the link between food insecurity and oral health and accept a professional role in support, confidence to identify and discuss food insecurity is limited. Proposed strategies include structured, sensitive screening, enhanced training (including counselling skills) at undergraduate and postgraduate levels, and accessible signposting resources. Future research should engage patients and dental teams to co-design interventions, investigate effective screening and referral pathways, evaluate educational interventions, and examine broader policy and system supports to address food insecurity within dental care.

• Low response rate (9.6%; n=76) limits generalisability; the study should be viewed as a pilot. A larger sample (approximately 235 responses) would be needed for 95% confidence intervals.
• Respondents were predominantly dentists; perspectives from wider dental care professionals were limited.
• Sampling confined to BSPD members, potentially biasing toward those with paediatric/NHS experience and not representative of all dental settings.
• Survey timing (June) and short open window may have reduced participation (e.g., summer holidays).
• Potential response and self-selection bias toward those interested in the topic.