Unmet needs in dental care: A literature review and document analysis

Background/Context:

Dentistry plays a vital role in protecting the health of the public, by providing oral health care services and treating dental and oral diseases, however the oral health of the population is a growing concern in England. Poor accessibility is likely to exacerbate subjective unmet needs (SUNs) in dental health, which can in turn result in patients presenting later to dental practices with more complex treatment needs or presenting at non-dental services such as Accident and Emergency services or GP practices for dental problems. A greater understanding of the level and distribution of unmet (current and estimated future) needs in dental services is crucial in developing evidence-based policy to target and meet local need most effectively.

In this research, we explore the different types of SUNs that can affect access to NHS dentistry in England based on the categories proposed by Allin and colleagues. More specifically, we asked:

• What are the different perceptions of SUNs?

• Who are affected by experiences of SUNs?

• Are there groups that disproportionately experience SUNs?

Methods:

We examined three different sources of information. First, we reviewed Healthwatch reports and mapped the content of these reports onto different categories of SUNs in order to ascertain the types of need reported by dental service users. Next, we conducted a review of published literature (including grey literature) to understand the range of SUNs that have been identified through research. Finally, we reviewed evidence submissions to the House of Commons Health and Social Care Select Committee on NHS Dentistry to explore up-to-date issues in access to dentistry.

Results:

Overall, we found that most common SUN occurs when people attempt to access care but do not receive it due to factors outside of their control:

• Analysis of the Healthwatch reports demonstrated that although a range of SUNs were evident before the COVID-19 pandemic, reports of these increased in number and range after March 2020, suggesting that the pandemic worsened access to NHS dentistry.

• The literature review showed that published data was largely gathered from populations that have been able to successfully access dental care (i.e. dental patients), whereas there was limited research on those who have been unable to translate their need into a demand for dental care.

• Finally, the analysis of submissions to the House of Commons Health and Social Care Select Committee Inquiry on NHS Dentistry indicated that there remains a significant disparity between the needs of the population and the availability of service to meet this demand.

Concerningly, some groups of people experienced multiple barriers that prevented access to NHS dentistry. These people usually belonged to sub-populations who are either clinically vulnerable or already experience other social disadvantages. This is likely to exacerbate inequalities, when dental needs are not met (regardless of SUN category), this can have a significant negative impact upon the individual experiencing the unmet need and seemed to disproportionately impact those experiencing existing health inequalities or social disadvantages.

Limitations:

While evidence does highlight issues, some of the published literature is now dated and overall there is limited empirical research that explores people’s help seeking intentions and behaviour.

Implications:

The three data sources focused on barriers experienced by those who perceive a need for dentistry and have attempted to pursue access to care, with much less on those who do not, or cannot, seek care. More research is required to understand the impact of unmet needs on populations who are likely to experience health inequalities, the link between unmet needs and dental health outcomes, and unmet needs of those who are unable to translate a need into demand for dental services.