Dental Access Research Articles

Traumatic dental injuries and oral health-related quality of life in children and adolescents with special health care needs in Eastern India: A case-control study.

This matched case-control study aimed to investigate the prevalence of traumatic dental injuries (TDI) and its impact on oral health-related quality of life (OHRQoL) in hearing and/or visually impaired children attending government special schools in Eastern India. A two-step cluster analysis was performed to define cases and controls based on the Parental-Caregivers Perceptions Questionnaire (PCP-Q) scores from the 228 parent/guardian responses. The cases included children with a higher negative impact on OHRQoL (89 subjects), whereas the controls were those with a lower negative impact on OHRQoL (139 subjects). Groups were matched for age and gender and researchers were blinded to case/control status. Binary logistic regression was performed. The prevalence of TDI among the study subjects was 24.12%. Compared to subjects in the control group (16.5%), a significantly higher proportion of cases (36%) reported a history of TDI. Children with TDI had considerably higher OHRQoL scores across all P-CPQ sub-scales. Falls were the most common cause of TDI, primarily at home or school and none received treatment. TDI significantly impacts OHRQoL in these children. Lack of treatment highlights the need for caregiver awareness and improved dental access for children with special needs. Further research with larger samples and specialized OHRQoL tools is recommended.

Exploring and enhancing the accessibility of children's oral health resources (called HABIT) for high risk communities

BackgroundWithin the city of Bradford in West Yorkshire, South Asian and Eastern European communities have an increased risk of childhood tooth decay, especially among families with Limited English Proficiency. Tooth decay is preventable, with national guidelines advocating home-based behaviours (toothbrushing with fluoride toothpaste and reducing sugar intake). In England, Health Visitors have opportunities to undertake oral health conversations during universal visits for children aged 0–24 months. The HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing) intervention provides structured oral health conversations, underpinned by complex intervention methodology. A feasibility study found HABIT acceptable to parents, feasible to deliver and led to improvements in home-based behaviours. However, the reach of this original study was limited to those proficient in English. This new study focused on exploring and enhancing the accessibility of the HABIT intervention to parents with Limited English Proficiency.MethodTwenty-four parents participated in interviews and focus groups, with 21 requesting support from interpreters. Community centres and WhatsApp were used to maximise inclusivity. Interviews and focus groups, followed a topic guide and the “Think Aloud” technique, were professionally transcribed, managed in NVivo, and thematically analysed. Team discussions facilitated analytical rigour. Recruitment continued until data saturation.ResultsThree themes were developed: (1) Navigating linguistic barriers; (2) Engagement through visuals; and (3) Addressing oral health challenges. Parents employed diverse strategies to interpret resources, including Google Translate, as well as family and wider community members. Consequently, the HABIT resources were modified to include simple text, subtitles, and translation tools. Parents highlighted the benefits of shorter oral health messages with clear visuals to help understanding, and this strategy was applied across all resources. Challenges surrounding children's resistance to toothbrushing, high sugar intake within their wider families and communities, and limited dental access were all raised. The HABIT resources were updated to address these challenges.ConclusionCollaborative community engagement has enhanced the HABIT resources, enabling access for high-risk communities to preventive oral-health programmes thereby promoting health equity.

Accessing dental services in Slovenia: A quantitative study

This research focuses on patients’ perceptions regarding the accessibility of dental services in Slovenia across four dimensions: financial accessibility, time accessibility, geographical accessibility, and service quality. We observed how specific factors impact accessibility dimensions of dental services in Slovenia, that patients perceive important. A cross-sectional quantitative survey was conducted using proportionate stratified sampling. Data was collected through an online questionnaire, and 599 completed responses were received from patients regarding their experiences and perceptions of accessibility to dental care. A SEM (structural equation model) approach was used to examine the data. The analysis revealed that patients perceive all four dimensions of accessibility: financial, time, geographical, and service quality important and they all constitute the perception of dental accessibility. The findings of this study can assist policymakers in developing a more accessible dental health system by considering the results proposed in our model.

Reflections on ethnic diversity within a dental desert.

The demographics of the dental workforce have changed significantly in recent years, with regard to both gender and ethnicity. Ethnic diversity within dentistry does not align with UK population data, with some groups less well-represented than others, such as those of Black or Afro-Caribbean heritage. Although multiculturalism has developed throughout the UK, it is much less advanced within rural areas. Rural communities have a less ethnically diverse population and this has been identified as a challenge when looking to recruit dentists and other dental care professionals from a Black, Asian or minority ethnic (BAME) background.Recruitment and retention of dentists to rural areas is a major issue and it is vitally important to ensure that all members of the dental profession feel adequately supported and welcome. Addressing the shortage of dental professionals in rural areas is crucial in improving dental access. However, this task becomes more complex when considering the increasing number of BAME students and graduates from a metropolitan background, and a continuing lack of multi-culturalism within rural communities. Identifying and understanding the factors which influence BAME dental professionals' decisions to relocate to rural areas is vital for developing effective strategies to attract and retain diverse talent within these communities.This opinion article considers existing literature, while drawing upon personal experiences as a Black student in the South West of England, in order to explore the barriers to working in rural areas as an individual from a minority ethnic group. Socioeconomic challenges, cultural isolation and limited rural experience are identified as factors that can deter Black and other minority ethnic dentists from living and working in rural areas.

Parental perceptions of an oral health promotion program in early childhood education and care settings: A qualitative study.

Early Childhood Caries is a global health problem. The Bright Smiles Bright Futures (BSBF) program seeks to equip educators, children, and parents with skills and knowledge about oral health promotion habits early in life. The aim of this study was to examine parental perceptions of the BSBF program and identify key facilitators and barriers for its implementation. Twelve mothers of children who participated in the BSBF program in five Early Childhood Education and Care (ECEC) settings in NSW, Australia were recruited in this qualitative study. Data were collected via focus groups and interviews, transcribed verbatim and coded to categorize for inductive thematic analysis. Five major themes emerged: Promoters of the BSBF oral health program, barriers to the BSBF oral health program implementation and participation, online resources, impact of the BSBF oral health program, and strategies for enhancing the BSBF oral health program. While participants reported that the program encouraged their children's toothbrushing, they found issues with the program's materials, ECEC center attendance, and communication about the oral health program with their children. The program improved message retention, attitudes, routines, and family perceptions toward oral health. Participants recommended oral health literacy, changed delivery formats, increased dental access, and inclusion of interactive elements to enhance the program. The findings from this study provide insight to improve parents' experiences and engagement in oral health promotion. This can help to raise awareness of the importance of child oral health among policymakers, healthcare professionals, and the public to inform public health policy discussions.

Access to dental care and caries experience among children with cerebral palsy: a Singapore experience.

Cerebral palsy (CP) is one of the most severe childhood neurodevelopmental disabilities resulting from non-progressive insult to the developing brain. We aimed to report our experience regarding dental visit attendance, caries prevalence and factors affecting dental access in children with CP in Singapore. Patients diagnosed with CP who were born in or after 1994 were included in this study. We reviewed the data of all 151 patients recruited under the CP Registry in Singapore (SingCPR) from September 2017 to May 2020. The SingCPR was launched in September 2017 to assist in future planning of services and resources for CP in Singapore. The mean age of the patients was 7.8 years, with the interquartile range being 3 years and 8 months-10 years and 10 months. Only 41.7% reported a visit to the dentist ever, with 25.4% reporting presence of dental caries. Age was the only statistically significant factor influencing access to dental care. None of the children less than 2 years old ever received any dental care, and 20% of the children with CP aged 2-6 years had received dental care before. Age range with the highest percentage of dental visits was 7-12 years, with up to 44.0% having ever received dental care. We believe the prevalence of dental caries was underreported as many children did not receive any dental care and therefore may have undetected dental caries. Dental care in children with CP should be advocated early for prevention and detection of caries.

Oral cancer incidence rate is associated with access to dental care: City and statewide analyses.

Access to dental care may affect diagnosis of oral squamous cell carcinoma (OSCC). We tested whether the incidence rate of OSCC is higher in regions with less dental care access in the city of Chicago and state of Illinois. Ecological cohort. Population, outpatients, and inpatients. We extracted 5-year averages of the state-wide county-level and city-level OSCC incidence rates from 2015 to 2019 from the Illinois Department of Public Health. Dental care access information was also collected for each county for the same period, as well as the percentage of people that had ≥1 visit to a dentist in the previous year in Chicago. Multivariate Poisson regression was used to investigate the relationship between county-level access to dental care (and city-level dentist visits) and OSCC incidence rate, controlling for confounders, with additional flexible semiparametric models for confirmatory sensitivity analysis. In Illinois, higher 5-year incidence rate of OSCC was significantly associated with low access to dental care by county (IRR = 0.96, 95% CI 0.91, 0.98). Southern/southwestern counties had higher incidence rates of OSCC (15.5%-28.4%) and the lowest rates of dental care access (47.5%-69.2%) compared to northern counties (10.3%-15% and 55.4%-80.6%, respectively). In Chicago, people with more dentist visits had a reduced chance of being diagnosed with OSCC (IRR = 0.97, 95% CI 0.91, 0.99), consistent with state-wide analyses. OSCC incidence rate is closely associated with poor local dental healthcare access in a major state and urban city. Increasing dental access could improve cancer outcomes via improved oral health and earlier detection.

Developing oral health services for people experiencing severe and multiple disadvantage: a case study from Southwest England.

People experiencing severe and multiple disadvantage (SMD) have disproportionately high levels of dental disease and tooth loss but have limited access to dental care. This paper presents an evidence-based case study of co-designing, implementing, evaluating and refining a community dental clinic for people experiencing SMD in the Southwest of England. It shares challenges, lessons, and solutions. Tailored interventions that coordinate flexible and responsive care are important for facilitating dental access for individuals experiencing SMD. Participatory approaches can deliver a range of impacts both on research and service development. No single fixed model of co-design can be applied in service development, and the choice will vary depending on local context, available resources and joint decision making. Through co-design, vulnerable populations such as those with SMD can shape dental services that are more acceptable, appropriate and responsive to their needs. This approach can also ensure long-term sustainability by bridging treatment pathway development and commissioning.

Utilization of dental care and dentate status in diabetic and nondiabetic patients across US states: An analysis using the 2020 Behavioral Risk Factor Surveillance System.

This study examines the differences, by state, in dental care utilization and tooth retention between adults with and without diabetes mellitus (DM). We conducted a secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System, an annual, state-based, random telephone survey of noninstitutionalized US civilian adults. The predictor variable was DM status. The outcome variables were time since the last dental appointment and tooth loss. We utilized multiple multinomial logistic regression models followed by postestimation procedures to determine state-level adjusted proportions for dental visits within the last year and complete teeth retention among DM and non-DM adults. Among adults with DM, 60.0% reported dentist visits within a year of survey participation, while 53.6% had complete tooth retention. As education and income levels increased, dental attendance and tooth retention increased among adults with DM. Most Southern states had a higher prevalence of DM, a lower proportion of dentist visits, and worse tooth retention among DM adults. Nationally, DM individuals were 4.3 percentage points less likely to visit a dentist and were 7 percent less likely to have complete teeth retention than non-DM adults. Compared with the national average, 25/50 states had greater disparities in dental visits between DM and non-DM adults, and 27/50 states had greater disparities in tooth loss between DM and non-DM adults. State-level variations indicate geographical and dental coverage influences on DM and dental outcomes. There is a need for state-specific interventions to improve dental access and outcomes for adults with DM.

Role of teledentistry in enabling improved oral care outcomes.

Nowadays, the link between oral health and general health is clearly understood and supported by many global bodies, including the World Health Organisation. Yet, oral diseases remain prevalent worldwide, necessitating a practical approach. This opinion paper seeks to clarify the role of teledentistry as an adjunct for improving oral health when access to oral care services is one of the major concerns.While prevention is the best option, many people lack regular oral care access, missing vital maintenance for mouth and body health. Limited evidence-based education further hinders effective oral hygiene routines. This holds true for remote/rural populations, low socioeconomic groups and individuals with physical/mental disabilities which could make visiting a dental practice more difficult.We examined recent teledentistry publications, highlighting outcomes and suggesting evidence-backed oral health guidance via tailored teledentistry models. Two virtual roundtables were conducted with a global working group experienced in teledentistry and dental access barriers. This panel was made up of representatives from the UK, Belgium, Vietnam, Indonesia, Bangladesh, Ghana and Tunisia.We conclude that teledentistry effectively aids dental referrals, early disease detection, treatment planning, compliance and viability, particularly in regions with limited dental access. The advantage of teledentistry lies in expanding the reach of care. Telehealth and teledentistry are value-driven, yet larger, standardised research is needed to fully harness the potential of teledentistry in bridging underserved populations with oral care experts, ultimately fostering optimal oral health. Education on the capabilities and benefits of teledentistry should become part of the curriculum of future dental professionals and broadly leveraged on continuing education platforms.

Access to Dental Care for Children and Young People in Care and Care Leavers: A Global Scoping Review.

This scoping review aimed to explore three research questions: 1. What is the dental care access for children and young people (CYP) in care and care leavers? 2. What factors influence CYP in care and care leavers' access to dental care? 3. What pathways have been developed to improve access to oral health care for CYP in care and care leavers? Five databases (Ovid MEDLINE, Ovid Embase, CINAHL, SocINDEX and Dentistry and Oral Sciences Source) and grey literature sources were systematically searched. Articles relating to CYP in care or care leavers aged 0-25 years old, published up to January 2023 were included. Abstracts, posters and publications not in the English language were excluded. The data relating to dental care access were analysed using thematic analysis. The search identified 942 articles, of which 247 were excluded as duplicates. A review of the titles and abstracts yielded 149 studies. Thirty-eight were eligible for inclusion in the review: thirty-three peer-reviewed articles, one PhD thesis and four grey literature sources. All papers were published from very high or medium Human Development Index countries. The studies indicate that despite having higher treatment needs, CYP in care and care leavers experience greater difficulty in accessing dental services than those not care-experienced. Organisational, psycho-social and logistical factors influence their access to dental care. Their experience of dental care may be impacted by adverse childhood events. Pathways to dental care have been developed, but little is known of their impact on access. There are very few studies that include care leavers. The voices of care-experienced CYP are missing from dental access research. care-experienced CYP are disadvantaged in their access to dental care, and there are significant barriers to their treatment needs being met.

Barriers to Accessing Primary Dental Care in Adults with Alcohol Dependence: A Qualitative Study.

People with alcohol dependence (AD) frequently experience oral health problems, but their dental attendance is poor, with limited evidence to the reasons why from their perspective. To explore perceived barriers, motivators, and facilitators to accessing primary dental care in people with AD. Qualitative study consisting of remote one-to-one and group semistructured interviews with a convenience sample of adults with lived experience of AD in northern England. Data were audio-recorded, transcribed, and coded. A reflexive thematic analysis method was used; use of COM-B model informed data interpretation. Twenty adults with lived experience of AD participated in 18 one-to-one interviews and 1 group interview (of 3 participants). Barriers to access were fear and physical, social, and environmental factors (physical effects of AD, financial barriers, nonprioritization of oral health). Motivators to access were pain and prioritization of oral health. Facilitators to access were patterns of alcohol use (i.e., sobriety) and dental service provision within recovery services. Fear of "the dentist" is a major barrier to accessing dental care, and pain is the primary motivator, among people with AD, although neither are unique to this population. Fear and physical, social, and environmental barriers to access contribute to problem-oriented attendance, which negatively affect oral health outcomes. Opportunity to facilitate attendance increases when a person is in remission from AD through their physical capabilities improving. Increasing capability and opportunity can influence attendance beyond the automatic motivation of pain. Provision of dental care within recovery services could facilitate access to care. Understanding the "web of causation" is key to developing any intervention to improve dental access in people with AD. Further research is needed from the perspective of other adult populations with lived experience of AD, as well as of dental professionals, to gain deeper insight into barriers, facilitators, and possible solutions. The results of this study can help dental professionals understand factors affecting access to primary care in people with alcohol dependence to provide knowledge that may reduce stigma surrounding the disease. Results also demonstrate areas for intervention development for public policy.

Aboriginal Health Practitioners obtaining, possessing and administering fluoride varnish: self-determination driven regulation amendment for integrated oral health care for Aboriginal children.

Self-determination informed policies are key to improved outcomes for Aboriginal health. Aboriginal leadership must be reflected throughout any public health reform process that affects Aboriginal communities. This paper presents a body of oral health policy work, undertaken under Loddon Mallee Aboriginal Reference Group's (LMARG's) leadership, as an exemplar of a self-determination informed change, that led to an amendment of an Australian state (Victoria) regulation - The Drugs, Poisons and Controlled Substances Amendment (Registered Aboriginal and Torres Strait Islander Health Practitioners [AHPs]) Regulations 2022. A summary of activities undertaken by LMARG, from advocacy to leading the submission, to amend the regulation, is provided. The amendment, now in place, authorises registered AHPs to obtain, possess, and administer fluoride varnish (FV) as a part of health services they provide. FV is a concentrated form of fluoride applied to tooth surfaces to prevent tooth decay. The practical implication of this amendment is delivery of a culturally appropriate integrated oral health promotion FV model that addresses mainstream dental access barriers commonly experienced by Aboriginal people. The model aims at upskilling an Aboriginal workforce to facilitate timely FV application to Aboriginal children.

História de dor e atendimento odontológico em indivíduos com Transtorno do Espectro Autista durante a pandemia de Covid-19 sob a perspectiva dos cuidadores

ABSTRACT Objective: Assess the history of pain and dental care before and during the COVID-19 pandemic, as well as the resolution of the dental problems in individuals with ASD from the perspective of caregivers. Methods: Caregivers from three associations of individuals with ASD in the state of Rio Grande do Sul were invited to answer an online questionnaire. They answered questions distributed into three sections: I) identification data of the patient with ASD and his caregiver; II) perception of dental access before the pandemic (until March/2020) and III) perception of dental access during the pandemic (March/2020 until 2022). Data were tabulated into a Microsoft Excel spreadsheet and analyzed using descriptive statistics. Results: Of the 473 caregivers for individuals with ASD in the contacted groups, 72 (15.2%) responded to the survey and were included in this study. Before the COVID-19 pandemic, individuals with ASD had experienced dental pain (23.7%). Twelve of these (70.6%) allowed dental care, according to the caregivers’ reports. Regarding the experience of pain during the pandemic, 20 individuals with ASD (27.8%) felt pain, and 17 of them had also experienced pain before the pandemic. Conclusion: The difficulty of dental access faced by families and individuals with ASD is a reality, and the persistence of dental pain history was similar before and during the COVID-19 pandemic. The preference for services in the public sector prevailed; however, the majority did not find a resolution to their issues, emphasizing the need for improvements in oral health care for this population.

Dental practice workforce challenges in rural England: survey into recruitment and retention in Devon and Cornwall.

Introduction Devon and Cornwall have been identified as 'dental deserts' with limited NHS dental access and high levels of oral health inequality. Challenges around recruitment and retention of the dental workforce have been acknowledged as an important contributory factor.Aims The aim of this research was to explore the experiences of dental practices within Devon and Cornwall in relation to recruitment and retention of the dental workforce.Method A self-administered, online questionnaire was used to explore various aspects of workforce recruitment and retention. The questionnaire included categorical rating scale and free-text question formats providing quantitative and qualitative data.Results In total, 106 dental practices responded to the survey, providing a response rate of 36%. The vast majority of respondents (94%) considered recruitment and retention to be a major barrier to delivering NHS services. Additionally, 77% of practices had a current staff vacancy, 57% had a dentist vacancy and 48% had a vacancy for dental nurses. Thematic analysis led to identification of four main themes which were considered to influence recruitment and retention: NHS system; economic challenges; logistics; and support networks.Conclusion A large number of dental practices in Devon and Cornwall are failing to operate at capacity due to workforce shortages, which is affecting access to services in both NHS and private practices. Recruitment and retention of dentists and dental nurses appears to be the most challenging factor, with NHS practices affected more than the private sector.

A two-arm, randomised feasibility trial using link workers to improve dental visiting in people with severe mental illness: a protocol paper

BackgroundPeople with severe mental illness (e.g. psychosis, bipolar disorder) experience poor oral health compared to the general population as shown by more decayed, missing and filled teeth and a higher prevalence of periodontal disease. Attending dental services allows treatment of oral health problems and support for prevention. However, people with severe mental illness face multiple barriers to attending routine dental appointments and often struggle to access care. Link work interventions use non-clinical support staff to afford vulnerable populations the capacity, opportunity, and motivation to navigate use of services. The authors have co-developed with service users a link work intervention for supporting people with severe mental illness to access routine dental appointments. The Mouth Matters in Mental Health Study aims to explore the feasibility and acceptability of this intervention within the context of a feasibility randomised controlled trial (RCT) measuring outcomes related to the recruitment of participants, completion of assessments, and adherence to the intervention. The trial will closely monitor the safety of the intervention and trial procedures.MethodsA feasibility RCT with 1:1 allocation to two arms: treatment as usual (control) or treatment as usual plus a link work intervention (treatment). The intervention consists of six sessions with a link worker over 9 months. Participants will be adults with severe mental illness receiving clinical input from secondary care mental health service and who have not attended a planned dental appointment in the past 3 years. Assessments will take place at baseline and after 9 months. The target recruitment total is 84 participants from across three NHS Trusts. A subset of participants and key stakeholders will complete qualitative interviews to explore the acceptability of the intervention and trial procedures.DiscussionThe link work intervention aims to improve dental access and reduce oral health inequalities in people with severe mental illness. There is a dearth of research relating to interventions that attempt to improve oral health outcomes in people with mental illness and the collected feasibility data will offer insights into this important area.Trial registrationThe trial was preregistered on ISRCTN (ISRCTN13650779) and ClinicalTrials.gov (NCT05545228).

The impact of restricted access on the need and demand for specialist dental services - A consideration for future needs assessments.

The COVID-19 pandemic forced NHS Dental Services to adapt quickly and implement measures which would safeguard essential care provision, whilst mitigating COVID-19 transmission risks. However, these changes impacted on both dental access, and onward referrals for specialist care. A longitudinal study design is used to offer descriptive analysis of referrals sent across three referral groups (orthodontics, paediatric dentistry, suspected cancers) across three time-matched periods (1st July to 31st December in 2019, 2020 and 2021). Anonymised data, extracted from an electronic referral management system (eRMS), are considered. Number of referrals, reasons for referral, Indices of Multiple Deprivation for each referral are discussed. Referrals reduced from 2019 to 2020. Proportionally, the greatest reduction in onward referral was observed amongst individuals from the lowest socioeconomic positions, across all groups. Although mandated to conduct only 62.5% of the 2019 activity, the 2021 referrals exceeded 2019 figures. Proportions referred from the lowest socioeconomic position were still slightly lower across all three groups. Referrals from the lowest socioeconomic groups decreased in 2020, followed by a rebound in 2021, despite a reduction in mandated clinical activity. There are potential implications for future oral health needs assessments that should be considered when developing interventions to enhance access for vulnerable populations as we emerge from the COVID-19 pandemic.

GIS-Based Study of Dental Accessibility and Caries in 3-Year-Old Japanese Children

This study aimed to reveal the geographic accessibility of dental clinics for most municipalities in Japan in 2015 and to explore the association between dental accessibility and dental caries status in 3-year-old children. We computed the accessibility index and accessibility index rate for the population outside a 1-km radius of dental clinics using a geographic information system. We also used spatial autocorrelation analysis (Moran's I statistic) to examine the spatial clustering patterns of dental accessibility in Japanese municipalities. In addition, we adjusted the prevalence of dental caries for most municipalities using empirical Bayesian estimation. Finally, we applied multiple linear regression to scrutinise the associations between dental caries status, including the prevalence of dental caries and decayed and filled teeth (dft), and dental accessibility, with adjustments made for other sociodemographic variables. The distribution of dental accessibility in Japanese municipalities is relatively unequal. Dental accessibility is decent in the 3 metropolitan areas around Tokyo, Osaka, and Nagoya but poor in the Tohoku and Kyushu regions. In addition, dental accessibility is significantly related to the prevalence of dental caries and dft after adjusting for other sociodemographic variables (P < .005). This study suggests that dental accessibility is considerably connected to the dental caries status of 3-year-old children after excluding financial burden. Preschool children in areas with poor dental accessibility are likely to have poor dental caries status. We also verified the inequality of dental accessibility amongst Japanese municipalities. For the future development of primary oral health care, more attention should be paid to people with a disadvantage in terms of dental accessibility.

Geospatial Analysis of Dental Access and Workforce Distribution in Kenya.

One of the major factors affecting access to quality oral healthcare in low- and middle-income countries is the under-supply of the dental workforce. The aim of this study was to use Geographical Information System (GIS) to analyse the distribution and accessibility of the dental workforce and facilities across the Kenyan counties. This was a cross-sectional study targeting dental professionals and their practices in Kenya in 2013. Using QGIS 3.16, these data were overlaid with data on population size and urbanization levels. For access measurement, buffers were drawn around each clinic at distances of 2.5, 5, 10 and 20 km, and the population within each determined. Nine hundred six dental professionals in 337 dental clinic locations were included in the study. Dentists, community oral health officers (equivalent to dental therapists) and dental technologists comprised 72%, 15% and 12%, respectively. Nairobi county with 100% urbanization and >4000 people/km2 had 43% of the workforce and a dentist to population ratio of 1:9,018. Wajir with an urbanization level of 15% and 12 people/km2 had no dental facility. Overall, 11%, 19%, 35% and 58% of the Kenyan population were within 2.5, 5, 10 and 20 km radius of a dental clinic respectively. Maldistribution of dental workforce in Kenya persists, particularly in less urbanized and sparsely populated areas. GIS map production give health planners a better visual picture of areas that are most in need of health care services based on population profiles.

Understanding the impact of COVID-19 on dental antibiotic prescribing across England: 'it was a minefield'

Introduction The COVID-19 pandemic impacted significantly on dental service delivery across England.Objective To explore how and why the pandemic affected antibiotic prescribing by primary care dentists.Methods Mixed-methods study: secondary analysis of routinely collected NHS dental antibiotic prescribing data from before and during the pandemic; and an online survey of dentists (NHS and private) across England's regions.Results Dental antibiotic prescribing increased 22% in the pandemic's first year, with regional variation from a 12.1% increase in London to 29.1% in East of England. Of 159 dentists surveyed, 60% had prescribed 'many more' antibiotics. Some urgent dental centres required antibiotics before accepting referrals, irrespective of clinical appropriateness. Diagnosing remotely was hard. Antibiotics were used to delay aerosol generating procedures and fill gaps in services. Widespread frustration existed.Discussion Maintaining access to urgent dental care during a future pandemic would include availability of high-grade personal protective equipment for dental teams. Everyone must understand the impact of restricted dental access on antibiotic overprescribing and hence antibiotic resistance.Conclusion Reduced dental access and changes in dental service delivery because of the pandemic increased antibiotic prescribing. Ensuring uninterrupted access for all to effective urgent dental care is an important element of global efforts to tackle antibiotic resistance.