Dental hygienists and therapists: the untapped frontline of systemic health

Benjamin Tighe highlights the potential of dental hygienists and dental therapists to identify, prevent and co-manage systemic conditions such as diabetes and cardiovascular disease.

It is time to retire the notion that dental hygienists and therapists are the ‘cleaning professionals’ of the dental team. The evidence no longer supports such a limited view. Across a growing body of UK and international research, it is increasingly clear that these clinicians occupy a pivotal position in the identification and co-management of some of the most prevalent systemic conditions in Britain. Yet in too many practices – and in too many commissioning decisions – this potential goes unrealised.

The oral-systemic link: no longer a hypothesis

The relationship between periodontal disease and systemic illness is now one of the most consistently evidenced associations in modern medicine.

The Delivering Better Oral Health toolkit, published by the Office for Health Improvements and Disparities (OHID) and endorsed by all four UK chief dental officers, explicitly acknowledges that periodontal disease shares common risk factors with a range of chronic non-communicable diseases, including type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and respiratory conditions (GOV.UK, 2021).

Risk factors – smoking, poor diet, obesity, and alcohol misuse – do not respect the boundary between the oral cavity and the rest of the body, and nor should clinical care pathways.

Almost half of all adults in the United Kingdom have some degree of irreversible periodontitis (Milward and Roberts, 2024). This is not merely a dental statistic – it is a public health crisis with systemic consequences.

Diabetes: a case study in what integration can achieve

The bidirectional relationship between periodontitis and T2DM is arguably the most clinically actionable of all oral-systemic associations. Uncontrolled diabetes accelerates periodontal disease progression, whilst periodontal inflammation simultaneously worsens glycaemic control – a vicious cycle with real-world consequences for millions of patients (Casanova, Hughes and Preshaw, 2014).

The evidence for intervention is compelling. A Cochrane review informing the 2022 updates to NICE guidelines NG17 and NG28 found moderate-certainty evidence from 30 randomised controlled trials that non-surgical periodontal treatment produces a clinically meaningful reduction in HbA1c compared to no active treatment (NICE, 2022). NICE’s own economic modelling confirms that this degree of glycaemic improvement is sufficient, in some patients, to delay or offset the need for additional pharmacological agents – rendering periodontal care not only clinically but economically justifiable within the NHS (NICE, 2022).

The updated NICE guidelines now explicitly recommend that adults with diabetes be informed of their elevated risk of periodontitis and advised that effective periodontal management can support improvement in blood glucose control (NICE, 2022). NHS England has since published a dedicated commissioning standard for dental care for people with diabetes, calling for the development of local care pathways that formally incorporate oral health assessment (NHS England, 2022).

There are currently an estimated 1.3 million people in the UK living with undiagnosed diabetes (Diabetes UK, 2024). Dental hygienists and therapists, who frequently see patients more regularly than their general medical practitioner, are ideally placed to identify risk factors, initiate targeted conversation, and facilitate timely onward referral.

Cardiovascular disease: the inflammatory pathway

The association between periodontitis and atherosclerotic cardiovascular disease (CVD) is supported by a robust body of evidence linking periodontal bacteraemia to systemic endothelial dysfunction, atherogenesis, and thrombogenesis (BDJ, 2025). Periodontitis is associated with an independently elevated risk of developing cardiovascular conditions, with inflammatory mediators including interleukin-6, TNF-α, and C-reactive protein propagating from a chronically infected periodontium into the systemic circulation (BDJ, 2025).

The European Federation of Periodontology (EFP) and World Heart Federation joint consensus report, cited within UK literature including the BSP’s own resources, notes that severe periodontitis is independently and significantly associated with cardiovascular disease and cardiovascular mortality (EFP, 2019). Importantly, periodontal therapy has been shown to reduce circulating inflammatory markers and improve endothelial function – suggesting the clinical value of treatment extends well beyond the oral cavity (BDJ, 2025).

The British Society of Periodontology has consistently reinforced that, whilst causality between periodontitis and CVD remains subject to ongoing investigation, this should not prevent dental professionals from taking a pragmatic approach: treating periodontal disease, addressing shared modifiable risk factors, and engaging collaboratively with medical colleagues (BSP, 2021).

Beyond diabetes and CVD: a broader mandate

The oral-systemic associations extend considerably further. The Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance on periodontal care in primary care notes emerging associations between periodontitis and adverse pregnancy outcomes, respiratory infections, chronic kidney disease, and rheumatoid arthritis (SDCEP, 2023). The Delivering Better Oral Health toolkit further acknowledges links between oral disease and metabolic syndrome, and notes that the risk factors driving periodontal disease are largely inseparable from those driving the UK’s broader burden of non-communicable disease (GOV.UK, 2021).

This is not an argument for scope creep. It is an argument for appropriate recognition of the clinical reality that dental hygienists and therapists encounter at the chairside daily.

The structural barrier: workforce, contract, and culture

Despite the strength of the evidence, dental hygienists and therapists in England remain systematically underutilised. A regional workforce survey published in BMC Health Services Research found that, despite the range of skills within their scope of practice, the majority of dental therapists in primary care spent most of their time undertaking work traditionally associated with the hygienist role, with factors including NHS contract ambiguity, financial constraints, and cultural inertia identified as key barriers (Farmer et al, 2020).

Progress has been made. The July 2022 NHS contract reforms – the first substantive changes since 2006 – sought to better incentivise skill-mix approaches and removed administrative barriers preventing dental therapists from working to their full scope of practice (NHS England, 2022). NHS England data confirm that the number of dental therapists participating in NHS care has increased significantly since 2022, with the proportion of NHS full-time equivalent therapist activity rising by 28% between March and December 2024 alone (NHS England, 2024).

The government has further committed to upskilling dental therapists and hygienists to ‘work at the top of their clinical potential’ from 2026 to 2027, and the 2026 contract reforms include funded annual appraisals for associate dentists, hygienists, and therapists delivering NHS care – a meaningful signal of professional recognition (House of Commons Library, 2025; GDC, 2026).

However, Eaton, Ramsay and colleagues, writing in the British Dental Journal, noted that urgent action remains required to address workforce recruitment and retention, and that contract reform alone will not be sufficient unless accompanied by cultural and remuneration changes that recognise the full breadth of what hygienists and therapists are trained to deliver (Eaton et al, 2023).

Making every contact count

The Delivering Better Oral Health toolkit is explicit: all clinical teams should ‘make every contact count’ and support patients in making healthier choices – not only for their oral health but for their general health (GOV.UK, 2021). This is not aspirational language. It is a government-endorsed standard of care applicable to every member of the dental team.

Dental hygienists and therapists are, in many cases, the healthcare professional a patient sees most consistently. They take medical histories, assess risk factors, monitor disease progression, and motivate behaviour change across multiple appointments and many years. They are skilled clinicians with detailed knowledge of the systemic implications of oral disease. When properly empowered – through training, direct access, appropriate commissioning, and inter-professional collaboration – they have the capacity to transform the detection and co-management of chronic disease at scale.

A call to act

The NHS faces sustained pressure from rising chronic disease prevalence, workforce shortages, and a primary care system stretched beyond its means. Dental hygienists and therapists represent an underutilised resource with a proven clinical evidence base, consistent patient contact, and a natural focus on prevention. The barriers to realising their full contribution are not clinical – they are structural, cultural, and contractual.

The evidence is there. The NICE guidance is there. The commissioning standard is there. What remains is the collective will – across dentistry, medicine, and the NHS – to put the mouth where it belongs: at the centre of systemic health care.

References

• British Dental Journal (2025) ‘The interrelationship between periodontal disease and systemic health’, British Dental Journal. Available at: https://www.nature.com/articles/s41415-025-8642-2 (Accessed: 6 July 2026).
• British Society of Periodontology and Implant Dentistry (BSP) (2021) Delivering better oral health: an evidence-based toolkit for prevention. Available at: https://www.bsperio.org.uk/assets/downloads/Delivering_better_oral_health.pdf (Accessed: 6 July 2026).
• Casanova, L., Hughes, F.J. and Preshaw, P.M. (2014) ‘Diabetes and periodontal disease: a two-way relationship’, British Dental Journal, 217(8), pp. 433–437.
• Diabetes UK (2024) Facts and stats. Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics (Accessed: 6 July 2026).
• Eaton, K.A., Ramsay, C., Foley, J. and Gallagher, J. (2023) ‘The dental workforce recruitment and retention crisis in the UK’, British Dental Journal, 234, pp. 235–240.
• European Federation of Periodontology (EFP) (2019) Consensus report on periodontitis and cardiovascular diseases. Available at: https://www.efp.org/news-events/news/consensus-report-on-periodontitis-and-cardiovascular-diseases (Accessed: 6 July 2026).
• Farmer, J., Currie, M., Lawton, S. and Cairns, J. (2020) ‘Findings from a regional workforce survey and symposium in England’, BMC Health Services Research, 20, 255.
• General Dental Council (GDC) (2026) NHS dental contract reforms: a positive step forward for our profession. Available at: https://www.gdc-uk.org/news-blogs/blog/detail/blogs/2026/01/29/nhs-contract-reforms-positive-step-for-profession (Accessed: 6 July 2026).
• GOV.UK (2021) Delivering better oral health: an evidence-based toolkit for prevention – Chapter 5: Periodontal diseases. Office for Health Improvements and Disparities. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-5-periodontal-diseases (Accessed: 6 July 2026).
• House of Commons Library (2025) NHS dentistry in England, Research Briefing CBP-9597. Available at: https://commonslibrary.parliament.uk/research-briefings/cbp-9597 (Accessed: 6 July 2026).
• Milward, M.R. and Roberts, A. (2024) ‘Assessing periodontal health and the British Society of Periodontology implementation of the new classification of periodontal diseases’, Dental Update. University of Birmingham Pure Research Portal. Available at: https://pure-oai.bham.ac.uk/ws/files/90918584 (Accessed: 6 July 2026).
• National Institute for Health and Care Excellence (NICE) (2022) Periodontal treatment to improve diabetic control in adults with type 1 or type 2 diabetes: evidence review for NG17 and NG28. Available at: https://www.nice.org.uk/guidance/ng17/evidence/d-periodontal-treatment (Accessed: 6 July 2026).
• NHS England (2022) Dental contract reform: building dental teams — supporting the use of skill mix in NHS general dental practice. Available at: https://www.england.nhs.uk/primary-care/dentistry/dental-commissioning/dental-contract-reform (Accessed: 6 July 2026).
• NHS England (2024) Data analysis: impact of the Dental Recovery Plan. Available at: https://www.england.nhs.uk/long-read/data-analysis-impact-of-the-dental-recovery-plan (Accessed: 6 July 2026).
• Scottish Dental Clinical Effectiveness Programme (SDCEP) (2023) Prevention and treatment of periodontal diseases in primary care: references. Available at: https://www.periodontalcare.sdcep.org.uk/references (Accessed: 6 July 2026).

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