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There are currently 9½ million people in England and Wales over retirement age and nearly 4 million of these are over 75 years. 1 Age itself is not a disease and 70% of the population over 65 are functionally independent. However, ageing is associated with an increase in the prevalence of chronic disease and disability 2 and 20% of people over 65 years are frail and a further 10% are functionally dependent, either homebound or institutionalised. 3 The implications of this demographic change on oral health has been investigated. Reports show oral health for the well elderly is improving, 4 creating a demand for dental services, which this group are able to access, but maintenance of oral health and access to dental treatment is a problem for disabled elderly people, who, for their daily activity are dependent on carers.

The use of a community-based mobile dental unit has the potential to be a cost-effective method to remove barriers to dental care access, both for the treatment of vulnerable children and as a first point of contact in the dental care pathway.

A considerable number of children with an oral healthcare need under 16 years of age are not brought to their Barts Health Special Care Community Dental Service (BHSCCDS) appointments. The BHSCCDS needed to understand more about why parents/ carers (parents) were failing to bring their children, in order to identify appropriate strategies to reduce the non-attendance.Thus, an audit was conducted to assess the number, frequency and reasons for all missed appointments (MA); this included feedback conversations with dental staff and parents. Information obtained from this cohort of high-risk children's families through personal, respectful and supportive contact improved understanding of the parents' individual and collective issues and led to recommendations that could reduce the number of MA in the future.

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