Abstract
Introduction: Reducing social inequality along with oral health inequality in Wales is a policy objective. In this ecological study the relationships between deprivation, dental workforce and oral health are explored. Method: Twenty two Unitary Authorities (UAs) serving the population of Wales were studied. The number of dentists were obtained from NHS Business Services as well as the 2019 population figures from StatsWales. As data for whole time equivalent General Dental Practitioner (GDP) workforce were not available, GDP sites were used. The condition of teeth at the age 12 years was used as a measure of oral health from the most recent epidemiological survey available. The relationship between oral health and workforce was established using the Welsh Index of Multiple Deprivation (WIMD).Results: Associations were observed between dental sites and population as well as between oral health and deprivation. A new composite variable called the University of South Wales Dental Index (USWDI) was introduced by combining the number of dentists with their corresponding WIMD of the most deprived 10% of the population. Using regression modelling the USWDI demonstrated its superiority in using either the number of dentists or the WIMD most deprived 10% alone to predict decayed, missing and filled teeth (DMFT).Conclusion: Workforce levels have increased and there has been a corresponding improvement in oral health over two decades. At the same time deprived subgroups continue to experience relatively higher levels of disease. A proportion of the general dental services delivered in Wales has continued to be based on the principle of supply induced demand for care rather than oral health need. Improving oral health in a diverse population like Wales cannot be achieved by increasing dental workforce alone. It is necessary to account for levels of deprivation. USWDI as a predictor of DMFT could be a useful tool to monitor the macro delivery of oral health care for the future in Wales.
Highlights
Reducing social inequality along with oral health inequality in Wales, is a policy objective
This paper aims to explore the relationship between dental workforce, oral health, and deprivation to conclude the need for balancing between service provision for oral healthcare based on oral health need and supply induced demand
Significant correlations were found between deprivation scores: Welsh Index of Multiple Deprivation (WIMD) rank average vs WIMD 10% r=-0.689, p=0.000; WIMD rank average vs WIMD 50% r=-0.0.967, p=0.000; WIMD 10% vs WIMD 50% r=0.733, p= 0.000
Summary
Reducing social inequality along with oral health inequality in Wales, is a policy objective. A proportion of the general dental services delivered in Wales has continued to be based on the principle of supply induced demand for care rather than oral health need. There were unintended consequences resulting from the contract of 2006, where lower socio-economic groups were no longer attractive patients for GDPs, making access for care difficult for this sub-group in the community [21] During this period, the treatment demands from communities continued to satisfy the supply of care provided by GDPs, where GDPs were kept occupied through performing interventions that were not totally based on oral health needs. This paper aims to explore the relationship between dental workforce, oral health, and deprivation to conclude the need for balancing between service provision for oral healthcare based on oral health need and supply induced demand
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