As a Community Dental Officer, I witness daily the resilience of colleagues delivering care to society's most vulnerable – patients with complex medical needs, severe dental anxiety, learning disabilities, or those requiring sedation or general anaesthetic (GA). This work demands not only clinical expertise but deep ethical commitment. Despite the vital role Community Dental Services (CDS) play, workforce morale remains low.

Systemic pressures create fertile ground for moral injury – when clinicians cannot deliver care they believe is right, due to constraints beyond their control. In the 2025 study ‘Valuing and retaining the dental workforce', one clinician described feeling ‘like a hamster on the wheel… constantly chasing UDAs', as resource limits forced prioritisation of throughput over patient-centred care.1

Unlike high-street practices, CDS often work with stretched teams, ageing infrastructure, and limited access to sedation or GA. These issues fuel long and growing waiting lists, especially for domiciliary care, paediatric GA, and comprehensive dental treatment. Patients with significant needs face unacceptable delays.

When placed in this context, the risks are magnified. In CDS settings:

  • Clinicians may witness patients deteriorating while awaiting care

  • Distressed families appeal for help the system cannot deliver

  • Complaints arise when expectations go unmet, yet staff feel powerless

  • Repeated exposure erodes morale, professional identity, and retention.

BDA survey data show that only 20% of practice owners and associates rated morale as ‘high' in 2023, down from 40% in 2015.2 For community dentists, the situation is compounded by poor career progression. Moreover, nearly a third are considering retirement within five years3 – a stark warning of workforce decline.

In many trusts, opportunities for leadership remain limited, despite the skilled nature of the work. We cannot address oral health inequalities without supporting those delivering this care. Improving morale demands more than funding – it requires addressing ethical strain. Solutions must include embedded psychological support, flexible working, protected CPD time, and structured progression pathways.

As calls grow for a national workforce plan, CDS must not be overlooked. We are not an adjunct but a cornerstone of NHS dentistry, especially as referrals from general practice rise. Future planning must recognise our essential role and deliver meaningful reform. Crucially, the moral and emotional toll on clinicians must be addressed. Without urgent action, the system risks becoming unsustainable, driving burnout and workforce loss. If we are serious about equity and timely, safe care for vulnerable patients, supporting the CDS workforce must be a national priority – not an afterthought.

To protect the patients we serve, we must first protect the professionals entrusted with their care.