Geospatial analysis of the urban and rural/remote distribution of dental services in Scotland, Wales and Northern Ireland

Exploring the challenges which influence general dental practitioners' participation as educational supervisors in dental foundation training in the South West of England

Introduction The challenges of recruitment and retention of dentists within the NHS are a major contributory factor in delivering dental access. Availability and geographical location of dental foundation training (DFT) placements is considered to be an important element in recruiting new dental graduates to poorly served areas. A recent decline in the number of dentists applying to act as educational supervisors (ESs) for DFT has been observed, which could have a direct impact on the future sustainability of NHS services.Aims This study aimed to explore the challenges faced by ESs which influence participation in DFT in South West England.Design A cohort study of existing and previous ESs using qualitative methodology.Methods ESs within South West England were invited to participate in semi-structured interviews to explore the challenges of providing DFT. Data underwent inductive thematic analysis.Results In total, 18 ESs were interviewed, with the main challenges identified as workload, financial, recruitment process, feeling valued and the application process.Conclusion An increasing number of challenges are undermining the positive benefits of being an ES. These challenges need to be addressed urgently to avoid further difficulties in recruitment and retention of ESs. Some of these challenges can be addressed at a regional or local level, but factors related to funding, national recruitment and the increasing educational responsibility of the ES need to be addressed at a national level.

Census tract geospatial analysis comparing social determinants of health with tooth loss in California seniors: An ecologic study

OBJECTIVES

Individual-level social determinant of health (SDOH) measures alone may insufficiently explain disparities in edentulism among seniors. Therefore, the authors examined the correlation of census tract-level SDOH and residential racial segregation measures with edentulism in Californian adults aged ≥65 years old.

METHODS

Explanatory variables were obtained from Healthy Places Index (HPI), the National Cancer Institute and diversitydatakids.org. The edentulism outcome variable was obtained from CDC's PLACES small area estimates from the 2018 Behavioral Risk Factor Surveillance System data. Pearson and Spearman rank correlations were estimated. Multiple linear regression and multi-collinearity evaluations were performed. The Global Moran's I statistic assessed partial autocorrelation within census tracts.

RESULTS

Pearson and Spearman correlations were similar, supporting robustness. HPI, an area measure of advantage, strongly negatively correlated with edentulism prevalence [correlation coefficient: -0.87; 95% confidence interval (CI): -0.87, -0.86]. A change of 1.0 in HPI corresponded to an estimated decrease in edentulism prevalence of 5.9% (linear model adjusted R2 = 0.78). Racially segregated census tracts with Hispanics or Blacks alone were positively correlated with edentulism prevalence [0.60, 95% CI: 0.58, 0.62; and 0.33, 95% CI: 0.31, 0.35, respectively]. The converse was seen in census tracts with non-Hispanic Whites alone [-0.57, 95% CI: -0.58, -0.55]. Global Moran's I statistic for edentulism (0.13) and HPI scores (0.19) were significant (both p < .001) indicating geospatial autocorrelation.

CONCLUSIONS

Higher disadvantage and minority racial segregation within census tracts were positively correlated with edentulism prevalence. Future research and policy should consider possible interventions improving SDOH to reduce oral health inequities.

Decomposing Socioeconomic Inequality in Early Childhood Caries Among 3 to 5-Year-Old Children in China

INTRODUCTION AND AIMS

Early childhood caries (ECC) is a widespread oral disease that harms children's health in China. Although previous studies have linked ECC prevalence to socioeconomic status, few have measured the degree of socioeconomic inequality. This study aimed to evaluate the socioeconomic inequality of ECC in children aged 3 to 5 years in China and identify the contributor to the inequality.

METHODS

We extracted data on 3 to 5-year-old children from the fourth National Oral Health Survey. We measured the inequality of ECC by the average household income per capita. We used the average household income per capita to measure the inequality of ECC. To describe inequality both qualitatively and quantitatively, we used the following methods: concentration curve, Erreygers-corrected concentration index, relative index of inequality and slope index of inequality. We also applied a decomposition based on the probit model to identify the factors that contributed to inequality.

RESULTS

The prevalence of ECC in Chinese preschool children was 63.11% (95% CIs: 60.54%, 65.61%). The negative value of the Erreygers-corrected concentration index (-0.0459; 95% CIs: -0.0594, -0.0324), slope index of inequality (-0.0674; 95% CIs: -0.0876, -0.0471) and the positive value of relative index of inequality (0.7484; 95% CIs: 0.6856, 0.8169) all indicated that ECC prevalence was higher among children from low-income families. The main factors contributing to inequality were average household income, parents' educational level and living areas.

CONCLUSION

There is a pro-poor inequality in ECC among 3 to 5-year-old children in China.

CLINICAL RELEVANCE

To improve oral health equality, policymakers should focus more on children from low-income families, with less educated parents and living in rural areas.

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.

The contract between NHS dentistry and communities and how this varies by neighbourhood types

Introduction There is a growing concern that the NHS's ability to deliver dental care is not keeping pace with population growth. Also, existing capacity may not be evenly distributed, potentially creating dental deserts in some neighbourhoods.Aims This study aims to explore recent trends in NHS general practice dental capacity in England and analyse if these trends vary depending on neighbourhood context.Design This research employs a descriptive analysis of time trends.Materials and methods The study uses data on NHS-contracted capacity in England, measured in units of dental activity (UDAs). These UDAs are geo-located to neighbourhood types using practice postcodes. Changes in the populations of these neighbourhoods provide context for the capacity trends.Results Some trends remain stable over time, albeit at insufficient levels. Rural areas continue to have the lowest capacity for NHS dental treatments. Additionally, areas with previously generous provision are experiencing significant percentage decreases in capacity.Discussion To prevent the formation of dental deserts, two critical issues require attention: firstly, the accessibility of NHS treatment and how it varies across urban/suburban and rural neighbourhoods; secondly, balancing supply and demand by matching the supply of dental care with the demand, conditioned by socio-economic and socio-demographic factors within different neighbourhoods.

Perceptions of orthodontic residents toward the implementation of dental technologies in postgraduate curriculum

BACKGROUND

Dental technologies have increasingly been implemented in orthodontic practice to offer better experiences for orthodontists and patients, however, there is no scientific evidence yet whether which technologies should be implemented into the postgraduate programs.

OBJECTIVES

To investigate perceptions of orthodontic residents toward the confidence and importance of dental technologies, as well as to determine their necessity in postgraduate programs.

MATERIALS AND METHODS

The online questionnaire was designed to collect data from residents from all accredited orthodontic postgraduate programs in Thailand. The questionnaire consisted of four sections, which were (1) demographic data, (2) self-perceived importance of orthodontic technologies, (3) self-perceived confidence toward orthodontic technologies, and (4) the necessity of orthodontic technologies in postgraduate programs. The data were analyzed using descriptive statistics, Spearman correlation, and a chi-square test.

RESULTS

Intraoral scanner was found to be an orthodontic technology with the highest scores for both self-perceived importance (4.37 ± 0.59) and confidence (4.23 ± 0.75), followed by cone-beam computed tomography, digital treatment planning software, and lab-produced aligners. These orthodontic technologies were also considered as mandatory in orthodontic postgraduate programs. CAD/CAM technologies appeared to be least important, and their training may be arranged as short course training. There was no significant influence of training locations on the necessity of all orthodontic technologies (P > 0.05), except CBCT. Self-perceived importance and confidence in all technologies were found to have significant positive correlations (P < 0.05), except teledentistry and in-office aligners.

CONCLUSION

Orthodontic technologies were perceived as important in clinical workflow. Intraoral Scanners, CBCT, digital treatment planning software, lab-produced aligners, and digital modeling software appeared to be necessary for clinical practice and should be considered for orthodontic postgraduate programs, while other technologies may be arranged as short course training. Further research should investigate how to arrange and organize training sessions in orthodontic postgraduate programs.

Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries

BACKGROUND

Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project "ROUTE-HWF" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies).

METHODS

We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes.

RESULTS

Two-hundred and forty studies were included (n=116, 48% Australia/New Zealand; n=105, 44% North America; n=20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=171, 71%), characteristics (n=95, 40%), contributing factors (n=112, 47%), and approaches to mitigate medical deserts (n=87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n=55, 23%) and lifestyle-related factors (n=33, 14%) of the HWF as well as sociodemographic characteristics (n=79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n=67, 28%), HWF distribution (n=3, 1%), support/infrastructure (n=8, 3%) and innovative models of care (n=7, 3%).

CONCLUSION

Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.

The dental workforce recruitment and retention crisis in the UK

The precarious state of NHS dentistry is widely acknowledged, yet there is limited progress in addressing the underlying issues. Further delays will undoubtedly impact patient care, leading to oral health deterioration and unnecessary suffering. This will predominantly affect the most vulnerable in society, resulting in greater oral health inequalities.The underlying issues contributing to the current NHS dental crisis are many, and they include: prolonged delays in contract reform; long-term underinvestment; private sector growth; and fewer dentists working full-time and/or in the NHS. In England, an NHS dental contract that fails to promote prevention or equality of access continues to have a deep and pernicious impact on the future of NHS dentistry. The devastating impact of the COVID-19 pandemic on access cannot be underestimated and neither should the effect of Brexit on the availability of workforce.The recruitment and retention of dentists, and other members of the dental team, is undoubtedly a major issue in terms of capacity and access to NHS dental care. These problems, seen across the UK, are a particular issue in England, with acute challenges within rural and coastal areas.There is an urgent necessity to develop coherent, multifaceted strategies, aided by the collection of clear and accurate workforce data, to tackle these issues.

Recruitment and retention in dentistry in the UK: a scoping review to explore the challenges across the UK, with a particular interest in rural and coastal areas

Introduction There is currently reduced access to NHS dental services in the UK, particularly in England, with rural and coastal areas significantly affected. Recruitment and retention in dentistry has been highlighted as an issue contributing to the problem.Objectives To explore what is known or unknown about recruitment and retention of the dental workforce in the UK, with a particular focus on rural and coastal areas. We were keen to gain information relating to factors affecting recruitment and retention, geographical distribution of the workforce, anticipated challenges, strategies or proposals to assist workforce planning and the extent of empirical research.Methods Searches for peer-reviewed literature and reports were undertaken and included when they met the eligibility criteria. Data were extracted and the findings narratively synthesised.Discussion The findings suggested wide ranging recruitment and retention issues of the dental workforce in the UK. Most issues were associated with NHS dentists, followed by dental nurses across both the NHS and private sectors. The worst affected parts of the country were rural and coastal areas.Conclusion It appears from the evidence that there are many dental professionals discussing recruitment and retention issues, followed by stakeholders. However, there is limited research and data to initiate change.