ArticlePDF AvailableLiterature Review

Abstract

Objective: To summarise the literature on urgent dental care and to identify research priorities on the organisation and delivery of urgent dental services. Basic research design: Scoping review using Andersen's behavioural model of health service utilisation for a framework analysis of the data. Main outcome measures: Gaps in the literature, defined as those factors and interactions identified by Andersen's model as having a contributory role in access to health services that were not evident in the source papers. Results: Fifty-six papers met the inclusion criteria for the review. The factors most often considered were; demographic, socioeconomic, perceived and evaluated need, and health behaviours. Patient outcomes of evaluated health and quality of life following urgent dental care were the least studied variables, with the exception of patient satisfaction. No studies were identified on community values/norms of people accessing urgent dental care, on health economic evaluations or on studies of how urgent dental services mitigate use of other medical services. No studies were identified on urgent need for populations living in water fluoridated areas or on the relationship between service design and efficient or effective access as measured by patient outcomes. Conclusion: Future research on patient outcomes and the comparison of different service models for urgent dental care through measures of equity, effectiveness and efficiency of access are needed to inform future policy and organisation of these services.
Community Dental Health (2017) 34, 19–26 © BASCD 2017
Received 29 July 2016; Accepted 10 October 2016 doi:10.1922/CDH_4038Worsley08
Access to urgent dental care: a scoping review
D.J. Worsley1, P.G. Robinson2 and Z. Marshman1
1School of Clinical Dentistry, Shefeld, UK; 2Bristol School of Oral and Dental Sciences, Bristol, UK
Objective: To summarise the literature on urgent dental care and to identify research priorities on the organisation and delivery of urgent
dental services. Basic research design: Scoping review using Andersen’s behavioural model of health service utilisation for a framework
analysis of the data. Main outcome measures: Gaps in the literature, dened as those factors and interactions identied by Andersen’s
model as having a contributory role in access to health services that were not evident in the source papers. Results: Fifty-six papers met
the inclusion criteria for the review. The factors most often considered were; demographic, socioeconomic, perceived and evaluated need,
and health behaviours. Patient outcomes of evaluated health and quality of life following urgent dental care were the least studied vari-
ables, with the exception of patient satisfaction. No studies were identied on community values/norms of people accessing urgent dental
care, on health economic evaluations or on studies of how urgent dental services mitigate use of other medical services. No studies were
identied on urgent need for populations living in water uoridated areas or on the relationship between service design and efcient or
effective access as measured by patient outcomes. Conclusion: Future research on patient outcomes and the comparison of different service
models for urgent dental care through measures of equity, effectiveness and efciency of access are needed to inform future policy and
organisation of these services.
Key words: health services, dental care, access to care, scoping review
Introduction
Urgent or emergency care is required for dental condi-
tions causing pain, swelling or for injuries resulting in
dental trauma (Austin et al., 2009; Tulip and Palmer,
2008). Timely intervention can relieve symptoms and
mitigate the impacts of oral disease on individuals and
wider society through missed education or absence from
work (Daly et al., 2014; SCDEP, 2013). While severe
dental conditions which may be life threatening, such as
submandibular cellulitis are best treated in a hospital, less
severe urgent conditions are best managed by clinical
interventions such as restorations or extractions, provided
in a dental setting (Anderson et al., 2000; McCormick et
al., 2013; SDCEP, 2013). For people unable to accept
urgent care in a dental clinic, treatment may be provided
under general anaesthesia in a hospital even though the
condition may not be life threatening.
During the nancial year 2014/15 over 3.7 million
people in England received NHS urgent dental care in
a dental setting. People who have an urgent dental
condition may seek care through their dental provider
Correspondence to: Devina J. Worsley, Academic Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, Shefeld,
S10 2TA, UK. Email: djworsley1@shefeld.ac.uk
during working hours, however during out-of-hours and
for people who don’t have a dentist, urgent dental care
in England is provided through the NHS urgent dental
services. An evaluation of an NHS urgent dental service
found that 47% of attendees were reported as not hav-
ing a dentist (Worsley, 2013). Due to the demand for
urgent dental care it is important to elucidate the factors
that facilitate access to urgent care in a dental setting
and how the use of services benets patient outcomes
(Andersen et al., 2014).
Andersen’s behavioural model of health service utilisa-
tion provides a way of understanding how access to urgent
dental care may be facilitated or impeded (Andersen et
al., 2014). It has been widely used in health services
research (Babitsch et al., 2012) and is supported empiri-
cally in relation to dentistry (Baker, 2009; Marshman et
al., 2014). The model describes ve interacting domains
and ve dimensions of access. The three domains of
predisposing, enabling and need may be described at the
contextual and individual levels while domains of health
behaviours and outcomes are described at the individual
level (Andersen et al., 2014) (Figure 1).
Figure 1. Andersen’s behavioural model of health service utilisation
Figure 1. Andersen’s behavioural model of health service utilisation (modified from Andersen et al., 2014)
Table 1. Database search terms
Database
Search terms
Medline via Ovid
(dental care/ OR dental health services/ OR “dental care” OR “dental service*” OR “personal dental
service*” OR “dental access centre*”) AND ((emergencies/ OR “urgent dental” OR “emergency
dental”) OR (“out-of-hours” OR “out of hours” OR “unplanned” OR “unscheduled”))
Web of Science, Scopus
(“Dental care” OR “dental service*” OR “personal dental service*” OR “dental access centre*”)
AND ((“out-of-hours” OR “out of hours” OR unplanned OR unscheduled) OR
(“dental emergenc*” OR “urgent dental” OR “emergency dental”))
OR (whichever better fits the page layout)
Table 1. Database search terms
Database
Search terms
Medline
via Ovid
(dental care/ OR dental health services/ OR
“dental care” OR “dental service*” OR
“personal dental service*” OR “dental access
centre*”) AND ((emergencies/ OR “urgent
dental” OR “emergency dental”) OR (“out-of-
hours” OR “out of hours” OR “unplanned” OR
“unscheduled”))
Web of
Science,
Scopus
(“Dental care” OR “dental service*” OR
“personal dental service*” OR “dental access
centre*”) AND ((“out-of-hours” OR “out of
hours” OR unplanned OR unscheduled) OR
(“dental emergenc*” OR “urgent dental” OR
“emergency dental”))
Figure 2. Flow diagram of search process
Records identified through
database searching (n=1,449)
Additional records identified
through other sources (n=8)
Records remaining after duplicates
removed (n= 860)
Duplicates
removed (n=597)
Records assessed for eligibility
(Title, abstract) (n=860)
Records excluded
(n= 799)
Full-text articles assessed
for eligibility (n=61)
Full text articles
excluded (n=5)
Studies identified for review (n=56)
Need
Environmental
Health indices
Perceived
Evaluated
Predisposing
Demographic
Social
Beliefs
Knowledge
Enabling
Health Policy
Financing
Organisation
Social
Health behaviours
Personal health
practices
Use of health services
Process of health care
Outcomes
Perceived health
Evaluated health
Consumer satisfaction
Quality of Life
20
Predisposing characteristics that might influence
service use include demographic, socioeconomic, health
beliefs and knowledge factors. Enabling conditions
include health policies, the nancing and organisation
of health services, individual resources such as health
insurance, and social factors such as social networks
that enable service use. Need may be indicated by en-
vironmental factors such as water uoridation, population
health indices, and at an individual level, by a person’s
perception of their need (perceived need) or by need
determined by a health professional (evaluated need).
These three domains inuence health behaviours and
outcomes. Health behaviours include personal health
practices such as oral cleanliness and health service use,
as well as health care provider behaviours such patient/
clinician interaction and treatment processes. The nal
domain, outcomes, includes the individual’s percep-
tions of their health, their health status as evaluated by
a health professional, as well as consumer satisfaction
and quality of life.
Factors and interactions within the model may facili-
tate or impede access, itself considered in dimensions of
potential, realised, effective, efcient or equitable access
(Andersen et al., 2014). Enabling factors contribute to
potential access whereas use of services is realised ac-
cess. Effective access occurs when health outcomes are
improved. Efcient access is the minimisation of the
cost of improving patient outcomes from health service
use. Equity of access is determined by which of the
ve domains is dominant in predicting potential and
realised access. For example, need is directly related to
deprivation (NHS Information Centre, 2011), thus equity
of access might be indicated by socioeconomic and need
variables accounting for most of the variance in use of
urgent dental services.
It is important to understand how factors interact to
facilitate or impede access to urgent dental care to improve
health outcomes for those in need. The known factors
and interactions can be mapped to identify the facilitators
of access and identify the gaps where research is needed.
Scoping reviews are useful in identifying new areas
of research. They synthesise knowledge by collating and
summarising ndings from different study designs and
grey literature to map the research evidence available,
identify gaps in research and to summarise and dis-
seminate research ndings (Arksey and O’Malley, 2005;
Levac et al. 2010). The ve stages of a scoping review
involve: 1, developing a research question 2, identifying
the relevant studies and information, 3, selection of stud-
ies and information, 4, charting data, and 5, collating,
summarising and reporting results.
The aim of this scoping review was to summarise the
literature on urgent dental care and to identify research
priorities on the organisation and delivery of urgent dental
services. The objectives were to:
Identify peer reviewed and grey literature on
urgent dental care
Chart and summarise the information using An-
dersen’s model; mapping the range and nature
of existing research and grey literature on urgent
dental care
Identify the gaps in research and the implications
for future research on urgent dental care.
Methods
Research question
This review aimed to answer the question, ‘What is known
from the literature about the factors and interactions that
facilitate or impede access to urgent dental care?’
Identifying the relevant studies and information
Relevant information was sought from peer reviewed
publications and grey literature. The search strategy
was applied to Medline via Ovid, Web of Science, and
Scopus. Terminology for search terms included MeSH
terms and free text (Table 1). There were no restrictions
on publication years or languages. UK consultants in
dental public health were contacted for unpublished work.
The database searches identied 1,449 records. Eight
records were found from the grey literature. A total of
597 duplicate records were removed (Figure 2).
Selection of studies and information
The inclusion criteria were:
Published abstracts, studies, and literature (e.g.
letters, commentaries, reports) about urgent
dental care
Studies on contextual or individual demographics
and on health related behaviours of potential user
groups or users of urgent dental care
Unpublished (grey) literature about urgent dental care
in the UK including service reviews and evaluations.
The initial exclusion criteria were provision of urgent
dental care:
In emergency or accident and emergency departments
Through general anaesthetic services
From general medical services
Focused on military personnel deployed on
operations.
The inclusion criteria developed by the research team
were discussed to clarify meaning and to ensure they
were applied consistently. Two reviewers screened the
remaining 860 records by title and abstract using the
initial inclusion and exclusion criteria and discussed
any disagreements. Following this screening additional
exclusion criteria were applied for feasibility reasons.
Table 1. Database search terms
Database Search terms
Medline via
Ovid
(dental care/ OR dental health services/
OR “dental care” OR “dental service*”
OR “personal dental service*” OR “dental
access centre*”) AND ((emergencies/ OR
“urgent dental” OR “emergency dental”)
OR (“out-of-hours” OR “out of hours” OR
“unplanned” OR “unscheduled”))
Web of Science,
Scopus
(“Dental care” OR “dental service*” OR
“personal dental service*” OR “dental ac-
cess centre*”) AND ((“out-of-hours” OR
“out of hours” OR unplanned OR unsched-
uled) OR (“dental emergenc*” OR “urgent
dental” OR “emergency dental”))
21
The reasons included the low number of studies pub-
lished before 2000, lack of availability of resources for
translation and it was anticipated the issues determin-
ing access for children were different to adults, such as
provision of public services for children and not adults.
The additional exclusion criteria were applied while
according to the iterative process described for scoping
reviews at the same time not compromising the ability
to answer the research question, (Arksey and O’Malley,
2005; Levac et al., 2010):
Studies and literature dated before 2000
Studies and literature in languages other than
English
Studies focusing specically on urgent dental
care of children.
This resulted in the exclusion of 799 records. Full
copies of the 61 remaining records were obtained. After
assessing for eligibility ve studies were excluded for
the following reasons: two papers described the same
study therefore one was excluded, one described trends
in dental visits to a hospital emergency department, one
was a commentary on provision of care for severe oral
trauma, one described the aetiology and presentation of
oral conditions and one paper could not be located. A
list of included papers can be available on request. The
included papers are listed in online-only Appendix 1.
Charting, collating and summarising the data
Framework analysis was used to chart, manage and ana-
lyse the data (Ritchie and Lewis, 2003). The domains in
Andersen’s model provided the initial conceptual labels
for the coding matrix. Each paper was reviewed, coded
and the data mapped onto the matrix. Interactions be-
tween levels in the Andersen model were described. For
example, the interaction of demographics with realised
access or with perceived and evaluated need for urgent
dental care. The matrix facilitated comparisons of factors
as well as interactions found in different papers. Gaps
in the literature were dened as those factors and interac-
tions that were not evident in the sources. Deviant case
analysis was planned, in which codes that did not map
onto the model would be used to expand or reframe it
(Wicks, 2010). Descriptive summaries of the relevant
papers included; author, journal, year of publication, study
population and country, study design and conclusion.
Results
Descriptive summary of papers
Fifty-six papers were reviewed which included commentar-
ies (n=6), letters (n= 4), service evaluations (n=2), reports
(n=2), review (n=1), audits (n=2) and a design plan for
an urgent dental service. The data collection methods in
these sources included: questionnaires (n= 12), structured
or semi structured interviews (n=7), retrospective (n=5)
and prospective surveys (n=7). Three studies were cross
sectional and there was one systematic review, a case
control study, a descriptive study and a comparison study.
Studies reviewed were from UK (n=24), USA (n=8), Aus-
tralia (n=6), Ireland (n=4), Brazil (n=2), Sweden (n=2),
Finland (n=1), China (n=1) and France (n=1).
Domains and interactions found in Andersen’s model
The data identied in the papers mapped well onto Anders-
en’s model, including factors not originally described in the
model (Table 2). Dental anxiety and/or phobia, pre-existing
medical conditions/medications and disabilities expanded
the predisposing domain. Urban/rural locations found in
the environment domain of Andersen’s 1995 model, but
not featured in the current model (2014), was included as a
predisposing factor (Andersen, 1995). Ethical conduct tted
into processes of care. Outcomes of organisational change
on service providers were included in the outcomes domain.
Predisposing factors
Several studies measured the predisposing variables of age,
gender and socioeconomic status. An additional nine studies
only included persons eligible to receive publically funded
health care or who fell below a measured poverty criterion.
Ethnicity variables were only included in three studies. Very
few sources compared the demographics of people needing or
accessing urgent dental care to the wider population. There
were no studies on community values and cultural norms.
Beliefs and their impact on health behaviours were
investigated in one study and another determined how
changes in a person’s circumstances influence their
health behaviours. One study sought dentists’ attitudes
about changes to urgent dental care provision. People’s
expectations regarding either care or treatment had been
determined (n=4) and one study investigated how knowl-
edge of services related to timeliness of seeking care.
The four additional factors identied that were not
explicitly included in Andersen’s model were: dental
anxiety (n=4), people with pre-existing medical condi-
tions or on medications (n=2), people with disabilities
(n=3) and urban/rural (n=4). All four were deemed to
be predisposing factors and thus the model was modi-
ed to include these factors in this domain. Three were
included under the title ‘predisposing conditions’.
Several interactions were identied, for example,
younger adults used urgent dental services more than
other age groups. Higher deprivation was linked to
greater perceived and evaluated need and increased use
of urgent dental care. People who were more deprived
had more restorations and extracted teeth. A study in the
West Indies including ethnicity variables found ethnicity
of services users for urgent care reected that of the lo-
cal area. A study in the USA found African Americans
were more likely to delay care.
Figure 2. Flow diagram of the search process
Figure 1. Andersen’s behavioural model of health service utilisation (modified from Andersen et al., 2014)
Table 1. Database search terms
Database
Search terms
Medline via Ovid
(dental care/ OR dental health services/ OR “dental care” OR “dental service*” OR “personal dental
service*” OR “dental access centre*”) AND ((emergencies/ OR “urgent dental” OR “emergency
dental”) OR (“out-of-hours” OR “out of hours” OR “unplanned” OR “unscheduled”))
Web of Science, Scopus
(“Dental care” OR “dental service*” OR “personal dental service*” OR “dental access centre*”)
AND ((“out-of-hours” OR “out of hours” OR unplanned OR unscheduled) OR
(“dental emergenc*” OR “urgent dental” OR “emergency dental”))
OR (whichever better fits the page layout)
Table 1. Database search terms
Database
Search terms
Medline
via Ovid
(dental care/ OR dental health services/ OR
“dental care” OR “dental service*” OR
“personal dental service*” OR “dental access
centre*”) AND ((emergencies/ OR “urgent
dental” OR “emergency dental”) OR (“out-of-
hours” OR “out of hours” OR “unplanned” OR
“unscheduled”))
Web of
Science,
Scopus
(“Dental care” OR “dental service*” OR
“personal dental service*” OR “dental access
centre*”) AND ((“out-of-hours” OR “out of
hours” OR unplanned OR unscheduled) OR
(“dental emergenc*” OR “urgent dental” OR
“emergency dental”))
Figure 2. Flow diagram of search process
Records identified through
database searching (n=1,449)
Additional records identified
through other sources (n=8)
Records remaining after duplicates
removed (n= 860)
Duplicates
removed (n=597)
Records assessed for eligibility
(Title, abstract) (n=860)
Records excluded
(n= 799)
Full-text articles assessed
for eligibility (n=61)
Full text articles
excluded (n=5)
Studies identified for review (n=56)
Need
Environmental
Health indices
Perceived
Evaluated
Predisposing
Demographic
Social
Beliefs
Knowledge
Enabling
Health Policy
Financing
Organisation
Social
Health behaviours
Personal health
practices
Use of health services
Process of health care
Outcomes
Perceived health
Evaluated health
Consumer satisfaction
Quality of Life
22
Greater perceptions of importance of oral health
were linked to better self-rated oral health and more
desirable attendance patterns but changes in a person’s
circumstances appeared to change health behaviours.
Expectations inuenced the type of care desired with
some wanting advice and reassurance in the rst instance.
Dental anxiety was linked to a previous traumatic dental
experience, delaying access to urgent dental care and a
desire for sedation services.
Disability was associated with increased deprivation
and poorer oral health. A training need was found for
dentists providing urgent dental care to people who were
medically compromised or who had a disability. People
living in rural areas attended the dentist less frequently
and were more likely to delay seeking urgent dental care
than those living in urban areas.
Enabling factors
Most services providing urgent dental care were publically
funded with some services directed to groups meeting
specied poverty criteria. The effects of policy change
on service use or provision of care had been investigated
(n=5). While simple cost analyses of urgent dental ser-
vices (n=3) had been undertaken, no health economic
evaluations were identied. Fees received by providers
(n=3) and indicators of the affordability of care such as
health insurance had been considered (n=8).
There were few comparisons of service organisations.
Four sources measured variables within different service
models, with one describing patient care pathways.
However, no studies were identied that established the
relationships between service model design and efcient
access measured by patient outcomes of perceived or
evaluated health or quality of life.
One study described how the provision of a dental
clinic in a hospital reduced the demand on the emergency
department for urgent dental care by approximately 50%.
However, gaps were identied in how urgent dental ser-
vices might mitigate use of other health services, such
as general medical services. Distance to services (n=6)
had been considered, but only one study investigated
how people found out about an urgent service.
Several important interactions were found within
enabling factors. Health policies were seen to inu-
ence the availability of healthcare. Service nance and
organisation interacted to inuence the types of care
provided and to whom. The remuneration of dentists
interacted with predisposing factors and attendance such
that reimbursement could facilitate urgent dental care
for those otherwise unable to access it. Individual re-
sources such as health insurance inuenced care seeking
behaviours and type of service used, with those less able
to afford care being less likely to access regular dental
care. Greater distance to services reduced access for
the more deprived.
Need factors
Environmental factors, such as the need for urgent dental
care for populations living in water uoridated areas
do not appear to have been studied. Population health
indices were considered in two sources and one study
evaluated the general health status of patients attending
for urgent dental care.
Studies had investigated; the reasons people sought
care (perceived need), need as evaluated by clinicians and
the presenting oral conditions. The relationship between
perceived and evaluated need had been determined in
studies investigating the psychosocial impacts of oral
disease as predictors for urgent dental care (n=1), the
agreement of the dentists’ that the problem warranted
an urgent appointment (n=1) and the level of agreement
between clinician and patient (n=1).
Andersen’s model - domains
Predisposing Enabling Need Health behaviours Outcomes
Demographic
Age (16)
Gender (11)
Social
Indicators of socioeconomic
status (16)
Ethnicity (3)
Urban/ rural (4)
Beliefs
Beliefs about oral health
and care (1)
Changing perceptions of
oral health and care (1)
Dentists’ attitudes to change
in service provision (1)
Expectations of services (4)
Knowledge
Knowledge of services (1)
Predisposing conditions
Dental anxiety (4)
Pre-existing medical condi-
tions or on
medications (2)
People with disabilities (3)
Health Policy
Policy change (5)
Financing
Cost of service pro-
vision (3)
Provider – fees
received (3)
Indicators of Indi-
vidual wealth (8)
Organisation
Comparison of dif-
ferent urgent dental
services (4)
Care pathways (1)
Use of services fol-
lowing organisational
change (1)
Distance/travel
time (6)
Social network
Sources of
information (1)
Population
indices (2)
Evaluated health
status (1)
Perceived need
Reasons people seek
care (14)
Evaluated need
Evaluated present-
ing oral conditions
or oral health needs
(13)
Subjective oral
health indicators and
psychosocial
impact (1)
Agreement between
clinician/patient
regarding
urgency (1)
Agreement between
dentist and need for
an appointment (1)
Personal health practices
Oral health behaviours (3)
Oral cleanliness (1)
Registration status (9)
Alcohol consumption (1)
Use of health services
For urgent dental care (36)
Month or weekday of
service use (4)
Delay of service use (5)
Follow up care seeking
behaviour (1)
Group not accessing
services (1)
Processes of dental care
Treatments (14)
Treatment protocols or
guidance (7)
Training needs (2)
Sedation (2)
Dentist/patient Communi-
cation (2)
Ethical conduct (1)
Perceived health
Perceived health
following
care (2)
Patient satisfac-
tion (7)
Dentist satisfac-
tion (1)
Quality of Life
Impacts of urgent
dental conditions
(2)
Impacts of a pre-
vious traumatic
experience (2)
Table 2. Factors related to urgent dental care and numbers of primary sources mapped onto Andersen’s model
23
Need for urgent dental care was found across previous
dental attendance patterns. Studies found increased oral
health needs impacts on quality of life with increased treat-
ment needs and increased use of urgent dental services.
Pain and/or swelling were the most common presenting
symptoms, which related to evaluated need and service use,
with most attendances being due to the consequences of
dental caries. Self-reported oral health indicators predicted
how soon a person needed to be seen. Need was related
to higher deprivation, less regular dental service use and
poorer oral health outcomes, such as more tooth extractions.
Health behaviour factors
Health behaviours had been comprehensively studied.
The personal health practices most often considered
were patients’ dental registration status (n=9), oral health
behaviours in the relationship to personal circumstances
such as, whether people were recorded as being employed,
unemployed or homeless (n=3), oral cleanliness (n=1) and
alcohol consumption (n=1).
Most sources related directly to people seeking ur-
gent dental care. Three sources determined if the use of
services (realised access) was equitable, by comparing
the demographics of service users to the population, but
use by vulnerable groups had not been ascertained. The
reasons and how long people delayed seeking urgent care
had been studied ve times, with one study nding some
people not accessing dental care, even when in pain. Fol-
low up care seeking behaviours by patients attending for
urgent or non-urgent dental care had been investigated
in one study. Rate of service use by calendar month or
weekday had been determined (n=3).
People attending for urgent care had sub-optimal service
use, often returning and needing more extractions. Stud-
ies of predictors of care seeking behaviours of individuals
identied symptoms, fear, knowledge of services, changes
in circumstances, costs, whether having a disability or not
and living in urban or rural areas. However, none of those
studies were theoretically informed. Realised access to
urgent care was related to deprivation, greater need and
high patient satisfaction. Service use related to calendar
month and weekday.
The most frequent process of care considered was the
volume and type of treatments provided (n=14). One study
looked specically at dentist/patient communication, nding
people wanted advice and reassurance as much as relief
from symptoms. Protocols or guidance regarding urgent
dental care were considered in seven papers (antibiotic
use n=4, oral condition and timeliness of care n=2 and an
evidence based protocol for urgent dental care n=1) and
one source considered ethical conduct in relation to urgent
dental care. The training need for dentists treating medi-
cally compromised and special care patients (n=2) and the
desire for sedation by people who were dentally anxious
(n=2) had been investigated. Treatments provided were
dependent on health setting, evaluated need, protocols or
guidelines with greater antibiotic use in hospital or general
medical services. Ethical conduct which was not explicit
in the model was included under processes of care.
Outcomes
Patient outcomes following urgent dental care, with the
exception of consumer satisfaction, were the least studied
domain. Two studies found urgent dental conditions re-
duced quality of life (inability to sleep and eat), with more
severe symptoms prompting access. Effective access, that
is, improvements in health following treatment had been
demonstrated in relation to perceived health (n=2) one day
after treatment. No studies were identied investigating
effective access in relation to evaluated health or quality
of life following advice from telephone triage services or
treatment for urgent care.
Patient satisfaction was the most studied outcome
(n=7), investigated twice in relation to telephone triage
services. Service use for urgent dental care interacted with
high patient satisfaction. Difculty in accessing services
reduced satisfaction. Dentists’ satisfaction with service
provision was included as an outcome in one study and
this mapped onto the model alongside patient satisfaction.
Dimensions of access
There were limited studies on the dimensions of access as
described by Andersen (n=6). No sources had investigated
which population groups their services may or may not
potentially reach. Three sources determined if the use of
services (realised access) was equitable, by comparing the
demographics of service users to the population, but use
by vulnerable groups had not been ascertained. Realised
access to urgent care was related to deprivation, greater
need and high patient satisfaction. Only two studies had
investigated the effectiveness of access that is, improvements
in health following treatment by measuring perceived health
outcomes, but effectiveness of access on evaluated health
and quality of life had not been studied. The relative ef-
ciency of services (efcient access) had been determined
in one study comparing the costs of a service before and
during a pilot. No studies were identied that had compared
different service delivery models for urgent care.
The gaps in research on urgent dental care are sum-
marised in Figure 3 and Table 3.
Figure 3. Gaps in interactions related to urgent dental care mapped onto Andersen’s model
Table 2. Factors related to urgent dental care and their numbers of primary sources mapped onto Andersen’s model
Andersen’s model - domains
Predisposing
Enabling
Need
Health behaviours
Outcomes
Demographic
Age (16)
Gender (11)
Social
Indicators of socioeconomic
status (16)
Ethnicity (3)
Urban/ rural (4)
Beliefs
Beliefs about oral health
and care (1)
Changing perceptions of oral
health and care (1)
Dentists’ attitudes to change
in service provision (1)
Expectations of services (4)
Knowledge of services (1)
Predisposing conditions
Dental anxiety (4)
Pre-existing medical
conditions or on
medications (2)
People with disabilities (3)
Health Policy
Policy change (5)
Financing
Cost of service
provision (3)
Provider fees
received (3)
Indicators of
Individual wealth (8)
Organisation
Comparison of
different urgent dental
services (4)
Care pathways (1)
Use of services
following
organisational
change (1)
Distance/travel
time (6)
Social network
Sources of
information (1)
Population
indices (2)
Evaluated health
status (1)
Perceived need
Reasons people seek
care (14)
Evaluated need
Evaluated
presenting oral
conditions or oral
health needs (13)
Subjective oral
health indicators and
psychosocial
impact (1)
Agreement between
clinician/patient
regarding
urgency (1)
Agreement between
dentist and need for
an appointment (1)
Personal health practices
Oral health behaviours (3)
Oral cleanliness (1)
Registration status (9)
Alcohol consumption (1)
Use of health services
For urgent dental care (36)
Month or weekday of service
use (4)
Delay of service use (5)
Follow up care seeking
behaviour (1)
Group not accessing
services (1)
Processes of dental care
Treatments (14)
Treatment protocols or
guidance (7)
Training needs (2)
Sedation (2)
Dentist/patient
Communication (2)
Ethical conduct (1)
Perceived
health
Perceived
health
following
care (2)
Patient
satisfaction (7)
Dentist
satisfaction (1)
Quality of Life
Impacts of
urgent dental
conditions (2)
Impacts of a
previous
traumatic
experience (2)
Figure 3. Gaps (- - -) in interactions related to urgent dental care mapped onto Andersen’s model
Table 3. Quantitative content analysis of the gaps in research on urgent dental care
Predisposing
Enabling
Need
Outcomes
No identified
studies on
community values
and cultural
norms of
population groups
accessing urgent
dental care.
No identified studies on health
economic evaluations of services
providing urgent dental care.
No identified studies on how
use of dental services for urgent
dental care mitigates use of other
medical health services such as
general medical services.
No identified
environmental
studies e.g. the
impact on need
for urgent dental
care for
populations
living in water
fluoridated areas.
No identified studies on perceived health outcomes
following telephone helpline advice only.
No identified studies on the relationships between
service model design for urgent dental care and
efficiency of access measured by patient outcomes of
perceived or evaluated health or quality of life.
No identified studies on the relationships of service
model design and effectiveness of access measured by
patient outcomes of evaluated health or quality of life.
Need
Fluoridated water
Evaluated need
Predisposing
Social
cultural values
and norms
Enabling
Financing
Organisation
Health behaviours
Use of health services
Process of health care
Outcomes
Evaluated health
Quality of Life
24
Discussion
The aim of this scoping review was to summarise the litera-
ture on urgent dental care to identify research priorities on
the organisation and delivery of urgent dental services. The
data identied in the papers mapped well onto Andersen’s
model including factors not originally described in relation
to the model. The factors, most often considered in the
literature relating to urgent dental care were demographic
and socioeconomic factors, perceived and evaluated need and
health behaviour factors. Patient outcomes following service
use were the least studied variables with the exception of
patient satisfaction. No studies on the relationship between
service design and efcient or effective access as measured
by evaluated health and quality of life were identied. No
studies on health economic evaluations of services or on
how services providing urgent dental care mitigate use of
other medical services were found. There were no identi-
ed studies on the impact on need for urgent dental care
for populations living in water uoridated areas however,
a study by Elmer et al. (2014) found that there were lower
hospital admission rates for children living in areas with
uoridated water for tooth removal under general anaesthesia
when compared to children living in non-uoridated areas
– a nding supported by a national report (PHE, 2014).
No studies on the community values and norms of people
accessing urgent dental care were identied.
Use of services for urgent dental care was related to
deprivation with increasing need as deprivation increased
(Landes, 2015; Oliver, 2015; Rocha et al., 2013; Tramini
et al., 2010; Worsley, 2013). The services were found to
make access to dental treatment easier for the unemployed,
manual workers, and people who are generally disadvan-
taged’ (Tramini et al., 2010, p70). However, few sources
compared the demographics of service users to the wider
population. In addition, there may be potential barriers
to healthcare for different ethnic minorities (Scheppers et
al., 2005). To determine equity of access it is important
to compare demographics of service users to the wider
population to nd out if people with the greatest need are
accessing services.
Timely access to urgent dental care may reduce
inappropriate attendance at general medical services
and hospital emergency departments as well reduce the
impacts of urgent dental conditions and improve patient
outcomes. Access to services may be direct such as
walk-in clinics or though telephone triage helplines. The
use of telephone triage helplines facilitated the provi-
sion of advice to people with perceived urgent need
(Anderson, 2004; Halling and Ordell, 2000) and may
prioritise access to those needing treatment (McGuire
et al., 2008; Topping, 2005; Worsley, 2013). This may
result in a more efcient use of resources however, only
simple cost analyses of urgent dental services had been
undertaken (Oliver, 2015; Topping, 2005; Worsley, 2013).
Health economic evaluations are needed to determine
efciency of access by comparing the relative efciency
of different service models providing urgent dental care
and determining how they mitigate inappropriate use of
other medical services.
Outcome measures are an important indicator of both
efcient and effective access. However, no studies on
evaluated health or on quality of life following advice
or treatment have been identied nor costs in relation to
these indicators. Access to urgent dental care resulted
in improved perceived health one day after treatment
(Anderson et al., 2005), but perceived health benets of
reassurance and advice from telephone triage helplines
has not been ascertained. Research is needed to nd
out how urgent dental care addresses the needs of the
patients, how it improves patient health outcomes and
impacts their future health behaviours, such as follow
on care seeking behaviours.
The limitations of this review are the exclusion of
papers published before 2000, exclusion of papers in
languages other than English, exclusion of studies only
including children and in limiting grey literature sources
to the UK only. Few papers on urgent dental care were
identied prior to 2000 and translation facilities were
not available. As a result, some relevant studies may
have been omitted.
Table 3. Quantitative content analysis of the gaps in research on urgent dental care
Predisposing Enabling Need Outcomes
No identied stud-
ies on community
values and cultural
norms of population
groups accessing
urgent dental care.
No identied studies on
health economic evalua-
tions of services provid-
ing urgent dental care.
No identied studies
on how use of dental
services for urgent dental
care mitigates use of
other medical health
services such as general
medical services.
No identied envi-
ronmental studies
e.g. the impact on
need for urgent den-
tal care for popula-
tions living in water
uoridated areas.
No identied studies on per-
ceived health outcomes follow-
ing telephone helpline advice
only.
No identied studies on the
relationships between service
model design for urgent dental
care and efciency of access
measured by patient outcomes
of perceived or evaluated health
or quality of life.
No identied studies on the
relationships of service model
design and effectiveness of
access measured by patient
outcomes of evaluated health or
quality of life
25
A strength of this review was the use of a theoretical
model to guide the analysis. In particular, the model helped
identify important gaps in the literature. Moreover, the
observation that sources mapped readily onto the frame-
work adds further support to the use of Andersen’s model
to study access to dental care. However, a limitation of
the model was that it was not always clear into which of
the ve domains of Andersen’s model unspecied factors
best tted. Some of these factors may have tted into one
or more domains. For example, if a person’s disability,
medical condition or their dental anxiety contributed to
poorer oral health, these conditions would be predisposing
factors, but if their poorer oral health was due to factors
impeding access to services this would be in the enabling
domain. Dental anxiety might also be listed under the
domain of health behaviour if previous experiences deter-
mined use of services. Choosing to live in an urban or
rural area may be described as predisposing, however if
access to health services is impeded due to location this
would be described in the enabling domain.
The few studies undertaken to determine the relative
benets of different service models providing urgent den-
tal care in England had preceded the reconguration of
dental services in 2006 and the introduction of telephone
triage helplines for urgent dental care. NHS England
now has a statutory duty to ensure provision of urgent
and emergency dental care for people without a dentist
or unable to access a dentist (Department of Health,
2005). This duty is met using a range of service designs
(Oliver, 2015). However, little is known of their relative
benets. Evaluations have tended to focus on a single
service (Worsley, 2013) rather than compare competing
congurations. Gaps in evidence to support the design
of urgent care networks were also found in a review of
delivery of urgent medical care (Turner et al., 2015).
Measures of access to urgent dental care are important
for health policy and health reform at national and local
levels (Andersen et al., 2014). Future research on the
comparison of different service models for urgent dental
care through measures of equity, effectiveness and ef-
ciency of access are needed to inform future policy and
organisation of these services.
Conclusion
The scoping review found gaps in the literature on
urgent dental care. Future research on patient health
outcomes and quality of life following urgent dental care
and comparison of different service models for urgent
dental care through measures of equity, effectiveness and
efciency of access are needed to inform future policy
and organisation of these services.
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28
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... Economic studies show that income, complementary health insurance and socioeconomic status (including educational level, income category and deprivation) all affect access to dental care [4][5][6][7][8][9][10]. Dental pain, fear of dental care, oral health knowledge and dental service trajectories have also been related to dental service utilization [4,7,10]. ...
... Dental pain, fear of dental care, oral health knowledge and dental service trajectories have also been related to dental service utilization [4,7,10]. Perceptions of need for dental treatment have been associated with a low socioeconomic status [4][5][6]11] and non-utilization of dental services [4,6]. ...
... As a result, users seeking to maintain good dental health via regular check-ups are more likely to have lower expenditure than occasional users. According to Grembowski et al. [20] and Worsley et al. [5], people with good dental health go to the dentist for check-ups, while people with poor dental health status tend to see dentists to deal with the worst problems, and this second category could benefit from more information about dental service's usefulness. The available data comprised little information on different oral health variables, so it was not possible to analyze expenditure in relation to specific types of dental care, differentiating surgery, prevention, conservative care, and so on. ...
Article
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(1) Background: This study investigated how individual enabling resources influence (i) their probability of using dental services and (ii) consumers’ expenditure on dental treatment. (2) Methods: Data were derived from a self-administered national health survey questionnaire and from expenditure data from national health insurance. Multiple linear regression methods were used to analyze entry into the dental health system (yes/no) and, independently, the individual expenditure of dental care users. (3) Results: People with the highest incomes were more likely to use dental service (aOR = 1.59; 95% CI = 1.28, 1.97), as were those with complementary health insurance and the lowest deprivation scores. For people using dental services, good dental health status was associated with less expenditure (−70.81 EUR; 95% CI = −116.53, −25.08). For dental service users, the highest deprivation score was associated with EUR +43.61 dental expenditure (95% CI = −0.15; 87.39). (4) Conclusion: Socioeconomic determinants that were especially important for entry into the dental health service system were relatively insignificant for ongoing service utilization. These results are consistent with our hypothesis of a dental care utilization process in two steps. Public policies in countries with private fees for dentistry should improve the clarity of dental fees and insurance payments.
... The National Health Service (NHS) England defines emergency dental care as care for patients who require dental treatment immediately to prevent risk of health complications . Dental treatment which can cause risk to life include submandibular cellulitis and may need to be treated in a hospital (Worsley et al., 2017). Urgent dental care is for those patients who need to be seen quickly but the condition is not threatening to general health. ...
... There is limited data about the number of dental emergencies for paediatric patients. However according to Worsley et al., in 2017Worsley et al., in , between 2014Worsley et al., in and 2015.7 million people in England received urgent dental care by NHS dentists (Worsley et al., 2017). A study carried out in the West midlands in 2019 found that 7.7% of all dental treatments courses delivered by NHS dentist was for emergency dental care (Woodman et al., 2019). ...
... There is limited data about the number of dental emergencies for paediatric patients. However according to Worsley et al., in 2017Worsley et al., in , between 2014Worsley et al., in and 2015.7 million people in England received urgent dental care by NHS dentists (Worsley et al., 2017). A study carried out in the West midlands in 2019 found that 7.7% of all dental treatments courses delivered by NHS dentist was for emergency dental care (Woodman et al., 2019). ...
Conference Paper
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Background: Osteogenesis Imperfecta (OI) is a genetic condition resulting from a mutation in the genes involved in the modification or biosynthesis of collagen. The study involved two parts and took place in the OI department at Great Ormond Street Hospital (GOSH). Aims: To investigate the oral health related quality of life of children aged eight to sixteen-years-old with OI. Service Evaluation: Methodology: Five questions designed to assess if children with OI are receiving adequate dental care. Results: 86 participants (43% female, 57% males, mean age 8.31) 78 (91%) of children were receiving some form of dental care. 49 (57%) of participants reported one or more dental concerns. 27/41 (66%) of the mixed dentition group reported at least one type of concern; most frequently appearance [18/41 (44%)]. Conclusions: Dental concerns in children with OI are present. It is important to have ongoing dental care to address concerns. Questionnaire: Methodology: Ethical approval and consent were obtained The Child Oral-Health Impact Profile – Short Form (COHIP-SF) was used, with demographic and qualitative data Children aged 8 – 16 years participated between January – October 2019 Statistical analysis with parametric and non-parametric tests Results 106 children participated (44 female, 62 male, mean age 11.93 years) COHIP-SF Data A higher COHIP-SF score indicates better OHRQoL (maximum score, 76). The median score was 59. Children reporting mild OI had higher median score (62) than those reporting severe OI (55) [P=0.087]. When comparing mixed (<12 years, n=46) vs permanent dentition (>=12, n=60), no statistically significant difference in OHRQoL was seen [P= 0.977]. The 3 COHIP-SF domains are Oral Health, Functional and Socio-Emotional Well-Being. There was no significant difference between severities for each domain. Perceived severity was not associated with significantly lower OHRQoL scores for females [P=0.125] or males [P=0.406]. Limited data on the presence of Dentinogenesis Imperfecta did not impact overall score [P=0.109] but was significant in the Oral Health domain [P=0.033]. Qualitative Data Common themes were the need for braces (straightness/ gaps between teeth), discolouration, pain and function. Conclusions: This study confirmed that children with OI have dental concerns, including oral health, functional and socio-emotional well-being. This was related to severity of OI. Compared to the general child population, children with OI had similar OHRQoL scores.
... 3 4 Failure of initial treatment to relieve dental pain and infection can result in patient reattending for further treatment, including to emergency medical care. 5 Thus, ensuring high-quality care for people with acute dental problems is critical for both patient safety and service efficiency. Outcomes to evaluate the care provided for people with acute dental pain and/or infection are important. ...
... 7 14 15 While a plethora of drug trials for the treatment of dental pain or infection have been published, there is little research on patient outcomes following urgent dental care for acute dental pain or infection. 5 A rise in the number of trials to evaluate dental antibiotic stewardship and opioid stewardship interventions is anticipated, with a focus on optimising care and judicious use of medicines for adults (where more than 90% of dental prescribing occurs). 16 To evaluate the effectiveness of these sorts of interventions and to enable improvements in the quality of urgent dental care, this study aimed to identify outcomes from the peer-reviewed literature for evaluating care for adults with acute dental pain and/or infection. ...
Article
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Objective To identify outcomes reported in peer-reviewed literature for evaluating the care of adults with acute dental pain or infection. Design Systematic narrative review. Setting/participants Primary research studies published in peer-reviewed literature and reporting care for adults with acute dental pain or infection across healthcare settings. Reports not in English language were excluded. Study selection Seven databases (CINAHL Plus, Dentistry and Oral Sciences Source, EMBASE, MEDLINE, PsycINFO, Scopus, Web of Science) were searched from inception to December 2020. Risk of bias assessment used the Critical Appraisal Skills Programme checklist for randomised controlled trials and Quality Assessment Tool for Studies of Diverse Design for other study types. Outcomes Narrative synthesis included all outcomes of care for adults with acute dental pain or infection. Excluded were outcomes about pain management to facilitate treatment, prophylaxis of postsurgical pain/infection or traumatic injuries. Results Searches identified 19 438 records, and 27 studies (dating from 1993 to 2020) were selected for inclusion. Across dental, pharmacy, hospital emergency and rural clinic settings, the studies were undertaken in high-income (n=20) and low/middle-income (n=7) countries. Two clinical outcome categories were identified: signs and symptoms of pain/infection and complications following treatment (including adverse drug reactions and reattendance for the same problem). Patient-reported outcomes included satisfaction with the care. Data collection methods included patient diaries, interviews and in-person reviews. Discussion A heterogeneous range of study types and qualities were included: one study, published in 1947, was excluded only due to lacking outcome details. Studies from dentistry reported just clinical outcomes; across wider healthcare more outcomes were included. Conclusions A combination of clinical and patient-reported outcomes are recommended to evaluate care for adults with acute dental pain or infection. Further research is recommended to develop core outcomes aligned with the international consensus on oral health outcomes. PROSPERO registration number CRD42020210183.
... One of the three components of the Basic Package of Oral Health Care proposed by the WHO [8] is oral urgent treatment (OUT). Although many domains mentioned above could be used for OUT management, the relationship between service design, effective access and its impact on treatment management is yet to be assessed in a community setting [9]. Additionally, the use of oral disease risk assessment tools could help healthcare professionals to predict periodontitis progression and tooth loss in various populations [10,11]. ...
... A recent review [22] identified some basic principles associated with improved access to healthcare services: matching supply to demand, immediate engagement of patient's needs, patient preference on the timing and nature of care, need-tailored care, surge contingencies, and continuous assessment of changing circumstances. The use of risk assessment tools, especially for OUT, could facilitate the implementation of each one of these principles, enhance the effectiveness of primary OHC services, and have a broader impact, since timely access to urgent dental care decreases inappropriate attendance at general medical services and hospital emergency departments [9]. ...
Article
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Background The World Health Organization has advocated for the integration of dental care into the primary healthcare (PHC) setting, including oral urgent treatment (OUT). However, the knowledge necessary for OUT implementation in this setting is still limited. Thus, this study aimed to describe the impact of the implementation of oral disease risk assessment tools for oral health management in PHC. Methods This was a cross-sectional study that included individuals served by a single public PHC unit, with integrated oral healthcare teams, located in the south region of the city of São Paulo, Brazil, between April of 2015 and March of 2017. Data were collected from dental records. Three co-primary endpoints: same day treatment offered, first future appointment scheduled fulfilled, and treatment plan completed were compared before and after the implementation of oral disease risk assessment for OUT. Results A total of 1214 individuals that sought OUT, 599 before and 615 after the implementation of oral disease risk assessment for OUT were included in the study. All three co-primary endpoints had significant changes after the implementation of oral disease risk assessment for OUT. Individuals were significantly more likely to be offered same day treatment after (39.9%; 95% CI:36.0–43.9%) than before (9.4%; 95% CI: 7.2–12.0%), to fulfill their first future appointment scheduled after (34.9%; 95% CI:31.1–38.8%) than before (20.7%; 95% CI: 17.5–24.2%), and to have their treatment plan completed after (14.3%; 95% CI:11.6–17.4%) than before (10.0%; 95% CI: 7.7–12.7%) the intervention. Conclusions This study provided evidence of the positive impact oral disease risk assessment tools could have in the organization of OUT in PHC settings.
... The studies were grouped according to the age of the participants, and studies with participants aged 20 years or more were grouped into adults and old adults. The results were categorized according to the components of the behavioral model, similar to the methodology used by Worsley et al., which evaluated access to dental emergency services [15]. Among enabling factors were the specific aspects of the Brazilian model, which are related to organization and financing that have an influence on the universal and comprehensive access to care in the network. ...
Article
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Part of the oral health care in the care network encompasses users in emergency cases. This study proposed mapping the determinants of the use of dental care services within the health care network to address dental emergencies within the Brazilian Unified Health System (UHS) and to verify the main gaps in the research in this area. This is a scoping review that took place in 2018 using Andersen’s behavioral model as a reference. A total of 16 studies, out of 3786 original articles identified, were included and reviewed. Two reviewers independently conducted the selection process and the decision was consensually made. The mapping of the determinants revealed a greater number of enabling factors and a larger gap in the results. Greater use of the emergency service was registered by people in pain, women, adults, those from an urban area, people with a lower income, and those with less education. In future studies, primary surveys are recommended, which include all ages, and analyze different groups of needs and users that take into account the country’s northern region and the different subjects pointed out by this review.
Article
The option to use emergency dental services is dependent upon the social, epidemiological and organizational conditions of the health services. In order to evaluate the specific emergency indicators in the care network for understanding access and performance, a time series study of emergency dental care according to the codes of care by health facilities in Brazil from 2008 to 2015 was carried out. Health services were grouped into primary and secondary care points and total services. Secondary services were subdivided into specialized and hospital services. The primary care group accounted for 72.75% of the emergency care and the mean of the standardized rate of total emergencies was 0.04 visits per inhabitant. The trend for total services was stable, though there was growth in primary health care services (5.58%/year). The results highlight the participation of primary health care services in the care of dental emergencies, followed by specialized and hospital services, which is in line with the assumption of the inverse relationship between the capacity of emergency dental care service and its technological density.
Article
Objectives Our aim was to describe the nature and determinants of the changes in unmet treatment need between the years 2000 and 2011 after a major oral healthcare reform and a wider supply of subsidized care. Methods The study used a longitudinal sample (n = 3838) of adults who had participated in both the Health 2000 and 2011 surveys (BRIF 8901). Those reporting self‐assessed treatment need without having visited a dentist in the previous 12 months were categorized as having unmet treatment need. Two logistic regression models were applied to determine the effects of predisposing and enabling factors on change in unmet treatment need. Model 1 was conducted among those who reported unmet treatment need in 2000 and evaluated the determinants for improvement. Model 2 was conducted among those who did not have unmet treatment need in 2000 to evaluate the risk factors for having unmet treatment need by 2011. Results Unmet treatment need was reported by 25% of the participants in 2000 and by 20% in 2011. Those with unmet treatment need in 2000 were less likely to report improvement by 2011 if they had poor subjective oral health, basic or intermediate education level, or poor perceived economic situation in 2000. Those who did not have unmet treatment need in 2000 were more likely to have it in 2011 if they were males or from northern Finland and less likely to if they came from central Finland or were older. Conclusions The wider supply of subsidized oral health care during the study years did not lead to complete elimination of treatment need. The determinants of unmet treatment need, such as low or intermediate education level and perceived economic difficulties, should be used in targeting the services at those with treatment need to achieve better oral health outcomes.
Preprint
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Part of the oral health care in the care network encompasses users in cases of emergency. This study proposed to map the determinants of the use of dental care services within the health care network to address dental emergencies of the Brazilian Unified Health System (UHS) and to verify the main gaps in the research in this area. This is a scoping review that took place in 2018 using Andersen’s behavioral model as a reference. A total of 16 studies, out of 3786 original articles identified, were included and reviewed. Two reviewers independently conducted the selection process and the decision was consensually taken. The mapping of the determinants revealed a greater number of enabling factors and a larger gap in results. Greater use of the emergency service was registered by people in pain, women, adults, from an urban area, with a lower income, and less education. In future studies, primary surveys are recommended, which include all ages, analyzing different groups of needs and users that take into account the country’s northern region and the different subjects pointed out in this review.
Technical Report
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Abstract Background In 2013 NHS England set out their strategy for development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care,and the gaps in evidence which need to be addressed can support this process. Objective The purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis. Methods We have conducted a rapid framework based evidence synthesis approach. Five separate reviews were conducted linked to themes in the NHS England review. A general and five theme specific database searches were conducted for the years 1995 -2014. Relevant systematic reviews and additional primary research papers were included with narrative assessment of evidence quality was conducted for each review. Results The review was completed in six months. In total 45 systematic reviews and 102 primary research studies have been included across all 5 reviews. The key findings for each reviews were 1) Demand - there is little empirical evidence to explain increases in demand for urgent care, 2) Telephone triage - Overall, these services provide , appropriate and safe decision making with high patient satisfaction but required clinical skill mix and effectiveness in a system is unclear , 3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital. 4) ED–The evidence on co-location of GP services with ED indicates there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed. 5) There is no empirical evidence to support the design and development of urgent care networks. Limitations Although there is a large body of evidence on relevant interventions much of it is weak with only very small numbers of randomised controlled trials identified. Evidence is dominated by single site studies many of which were uncontrolled. Conclusions The evidence gaps of most relevance to the delivery of services are 1) more detailed understanding and mapping of the characteristics of demand to inform service planning, 2) assessment of the current state of urgent care network development and evaluation of effectiveness of different models, and 3) Expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning
Article
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Statement of the problem: Research on oral health behaviours and dental care service uptake of drug users and those in recovery remains scant. Purpose of the study: The research aimed to explore and describe perspectives of drug users on their oral health behaviours, awareness of oral health complications caused by alcohol, cigarette and drug use, dental service uptake and opinions on improved dental service for active and recovering addicts. Materials and methods: Two focus groups with a purposeful sample of participants (n=15) were conducted in two treatment and rehabilitation settings. The semi-structured guide consisted of open questioning relating to dental access and uptake, oral health, awareness of oral cancers, nutrition and substance consumption on oral health, and opinions around optimum oral health and dental service provision for active drug users and those in recovery. Thematic analysis of narratives was conducted. Results: Participants described barriers to access and uptake, poor levels of preventative dental care, DIY dentistry in the event of dental emergencies, substance use to self-medicate for dental pain, mixed awareness of the effects of sugary products and substance use on oral health and cancers, and emphasised the importance of preventative dental care and dental aesthetics when in recovery. Conclusions: Findings illustrate a profile of oral health behaviours in Irish drug users, with information useful for private and public practice, and in the further development of street, community and treatment setting oral health interventions.
Article
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This study explored the association between area-level primary dental care performance and area-level demographics, dental treatment need, and health care service indicators. An ecological cross-sectional study was performed in Belo Horizonte, Brazil, in 2010. The 142 primary health care (PHC) units were grouped based on the following variables: access to individual dental treatment, frequency of dental emergencies, and frequency of individual preventive procedures. The independent variables analyzed were demographic variables, dental treatment need, and health care service indicators. The data were obtained from the information systems of the Brazilian Ministry of Health and the city of Belo Horizonte. We explored the associations between membership in a specific PHC cluster type and the independent variables using multinomial logistic regression with a significance level of 5%. Variables such as the high/very high vulnerability of population, rate of completed treatment, and rate of referrals of users to secondary care were independently associated with the clusters (P < 0.05). The performance of primary dental care services was associated with patient demographics, dental treatment need, and referrals. The results of this study have implications for the planning of public policies.
Article
Background: Contemporary evidence for the effectiveness of water fluoridation schemes in the U.K. is sparse. The utility of routinely collected data in providing evidence warrants further research. Objectives: To examine inpatient hospital episodes statistics for dental extractions as an alternative population marker for the effectiveness of water fluoridation by comparing hospital admissions between two major strategic health authority (SHA) areas, the West Midlands SHA-largely fluoridated--and the North West SHA--largely unfluoridated. Method: Hospital episodes statistics (HES) were interrogated to provide data on admissions for simple and surgical dental extractions, which had a primary diagnostic code of either dental caries or diseases of pulp and periapical tissues for financial years 2006/7, 2007/8 and 2008/9. Data was aggregated by SHA area and quinary age group. Directly standardised rates (DSR) of admissions purchased for each primary care trust (PCT) were calculated and ranked by index of multiple deprivation (IMD). Results: A significant difference in DSRs of admission between PCTs in the West Midlands and North West was observed (Mann-Whitney U test [p <0.0001]) irrespective of IMD ranking. The difference in rates between the two most deprived PCTs was 27-fold. Conclusions: After ranking by IMD, DSRs of hospital admissions for the extraction of decayed or pulpally/periapically involved teeth is lower in areas with a fluoridated water supply. The analysis of routinely collected HES data may help identify the impact of water fluoridation schemes.
Article
Prisoners have worse oral health and greater unmet dental treatment needs than the general population. However, little is known about the impact of the mouth, or attitudes such as dental indifference and consequent patterns of dental service use in this disadvantaged group. The aim was to determine whether dental indifference was associated with the oral health-related quality of life (OHQoL) of prisoners using Andersen's behavioural model of service utilization as the theoretical framework. The sample was male prisoners aged 20-35 years attending three prisons in the north of England. Participants took part in interviews and oral examinations. The variables were selected to populate Andersen's model including: predisposing characteristics (socioeconomic status), enabling resources (dental indifference and dental attendance patterns before prison), perceived need (perceived treatment need, satisfaction with appearance of teeth, global rating of oral health), evaluated need (number of decayed teeth), health behaviours (use of dental services while in prison) and health outcomes (OHQoL). Structural equation modelling was used to estimate direct and indirect pathways between variables. Of the 700 men approached, 659 completed the interview and clinical examination. Worse OHQoL was associated with less dental indifference (i.e. greater interest in oral health), previous regular use of dental services, perceived need for treatment and use of prison dental services. The number of decayed teeth and predisposing factors such as qualifications and employment did not predict OHQoL. Dental indifference was related to the OHQoL of prisoners in addition to previous regular use of dental services, a perceived need for treatment and use of dental services while in prison. Dental services in prisons might incorporate methods to address dental indifference in their attempts to improve oral health. The findings also have general implications for the assessment of population oral health needs.
Article
AimThe aim of this study is to investigate the prevalence of medical conditions and medications used by patients accessing emergency dental care at Manchester Dental Hospital. Materials and methodsThe records of 400 randomly selected adult patients seeking emergency dental treatment at Manchester Dental Hospital from October 2011 to July 2012 were reviewed. ResultsFrom the 400 patients reviewed, 137 (34%) patients had a medically compromising condition. The most commonly presenting conditions were cardiovascular disorders, respiratory disorders, diabetes/endocrine disorders and psychiatric disorders. Twenty-nine per cent were taking prescribed medication. Conclusions Over a third of patients presenting to our emergency dental service had one or more medically compromising conditions. It is vital that dentists have an adequate knowledge about these conditions and how treatment may need to be modified in these patients. A detailed medical history is essential for all patients.
Article
Little detail is known about the geographical catchment areas covered by dental hospitals, with no previous Australian studies of this kind. The aim of this study was to assess the geographical distribution of public dental emergency patients and their socioeconomic status to define catchment zones for a dental hospital. All patients requesting emergency dental care at the Royal Dental Hospital Melbourne, meeting the inclusion criteria, in calendar years 2006 and 2010 were included in the sample. Geographic information systems tools were used to locate and link each patient address to the socioeconomic data. For both 2006 and 2010 95% of the patients were living within 50km of the hospital. In 2006, most of the patients seeking care lived within a 15km radius of the dental hospital whilst in 2010 that distance increased somewhat. Patients from areas with similar socioeconomic status living more than 10km away from the hospital had poorer access to dental emergency treatment. The hospital had a surprisingly large catchment zone that overlapped those of smaller community-based clinics.