The Dental Health of Looked After Children in the UK and Dental Care Pathways: A Scoping Review.

BACKGROUND: There has been a 37% increase in the number of Looked After Children (LAC) in England over the past decade. Although LAC have more health and social problems than their peers, little is known about their dental needs, barriers to dental care, and pathways used to access it. OBJECTIVES: This scoping review assessed the evidence on the dental health needs of LAC in the UK and their different dental care pathways. METHODS: Embase, MedLine(R), Scopus, Web of Science, PubMed and CINAHL, grey literature databases and third-sector organisation websites were searched up to February 2022. Included studies were any study type involving UK resident LAC aged 0-18 with no limits placed on time in care/placement. Thematic analysis identified access barriers and dental care pathways. RESULTS: Twenty-eight articles were included (nine publications, 11 abstracts and 8 grey literature). Oral health surveys, population linkages studies and service evaluations described the poor oral health of LAC and their unmet needs. Barriers included the lack of dental care and irregular attendance; the lack of integrated working between health and social care teams, lack of self-care and oral health promotion, and psychological issues complicating dental treatment. Four dental care pathway models were identified: care navigation, facilitated access, nurse-led triage and referral, and signposting to local dentist with multi-agency information sharing. CONCLUSION: LAC are a vulnerable group with barriers to care suggesting the need for integrated working between health and social care teams, specialist services and an evaluation of pathways to identify best practice.

A Critical Analysis of Underrepresentation of Racialised Minorities in the UK Dental Workforce.

This article analyses the underrepresentation of racialised minorities across the three stages of the dental workforce pipeline through the critical lens of power. The reformist view of power was used, which focuses on concealment caused by systemic biases. We observed adequate representation of racialised minorities in the first two stages of the pipeline; entry to dental schools and completion of dental education. However, the categorisation of diverse groups into a single 'BAME' category conceals the underrepresentation of Black people and those who experience intersectional forms of discrimination rooted in race, gender and class. We observed all racialised minorities to be underrepresented in the third stage of the pipeline; career development and progression. The data suggest that institutional processes are more likely to recruit and promote White1 people, and racialised minorities are more likely to be exposed to bullying and inequitable disciplinary processes. Consistently across dental institutions, as the level of seniority increases, the representation of racialised minorities decreases. Thus, senior decision-making and agenda-setting spaces in UK dentistry are overwhelmingly White. Multiple actions are suggested; including collation of comprehensive, inclusive data, widening participation and representation initiatives to help re-distribute the power dynamics towards racialised minorities and ensure equality of representation across the dental pipeline, including in senior spaces. We hope this will work towards putting some of the systemic problems that we see in dentistry; such as differential staff and student experiences, inequitable recruitment, promotions and disciplinary proceedings, and colonial dental curricula and research on the institutional agenda.

Ethnic disparities in the oral health of three- to four-year-old children in East London.

AIM: To report ethnic differences related to caries experience among three- to four-year-old children living in three of the most deprived boroughs in the UK in Inner North East London: Tower Hamlets, Hackney and Newham. METHODS: This cross-sectional survey used a cluster sampling study design following the British Association for the Study of Community Dentistry protocol. Twenty nurseries from each borough were randomly selected and all three- to four-year-old children in selected nurseries were invited to participate (n = 2,434). Calibrated dentists examined children. Demographic information was obtained from schools. RESULTS: One thousand, two hundred and eighty-five children were examined in 60 nurseries (response rate = 52.8%). Twenty-four percent of three- to four-year-old children had caries experience (mean dmft = 0.92). Few children (2.1%) had filled teeth. Children living in Hackney had significantly lower dmft scores (mean = 0.63) than children living in Newham (mean = 1.06) and Tower Hamlets (mean = 1.06). White European (mean = 1.91), Bangladeshi (mean = 1.05) and Pakistani (mean = 1.11) children had a significantly higher number of untreated carious teeth than White British children (mean = 0.56). CONCLUSION: Preschool children from a White Eastern European, Bangladeshi and Pakistani background are likely to experience significantly poorer oral health than their White British counterparts. These findings have profound implications for commissioning dental services and oral health promotion.

Predictors of dental care utilization among working poor Canadians.

OBJECTIVE: This study used the Gelberg-Andersen Behavioral Model for Vulnerable Populations to identify predictors of dental care utilization by working poor Canadians. METHODS: A cross-sectional stratified sampling study design and telephone survey methodology was used to collect data from a nationally representative sample of 1049 working poor individuals aged 18 to 64 years. Working poor persons worked > or = 20 h a week, were not full-time students and had annual family incomes <$34,300. A pretested questionnaire included sociodemographic items, self-reported oral health measures and two dental care utilization outcomes: time since their last dental visit and the usual reason for dental visits. RESULTS: Hierarchical stepwise logistic analyses identified independent predictors associated with visiting the dentist >1 year ago: male gender (OR = 1.63; P = 0.005), aged 25-34 years (OR = 2.05; P = 0.02), paying for dental care with cash or credit (OR = 2.31; P < 0.001), past welfare recipients (OR = 1.65; P = 0.03), <21 teeth (OR = 4.23; P < 0.001) and having a perceived need for dental treatment (OR=2.78; P < 0.001). Sacrificing goods or services to pay for dental treatment was associated with visiting the dentist within the past year. The predictors of visiting the dentist only when in pain/trouble were lone parent status (OR = 4.04; P < 0.001), immigrant status (OR = 1.72; P = 0.006), paying for dental care with cash or credit (OR = 2.71; P < 0.001), a history of an inability to afford dental care (OR = 1.62; P = 0.01), a satisfactory/poor/very poor self-rated oral health (OR = 2.10; P < 0.001), number of teeth <21 (OR = 2.58; P < 0.001) and having a perceived need for dental treatment (OR = 2.99; P < 0.001). CONCLUSIONS: This study identified predisposing and enabling vulnerabilities that jeopardize the dental care-seeking practices of working poor persons. Dental care utilization was associated with relinquishing spending on other goods and services, which suggests that dental care utilization is a competing financial demand for economically constrained adults.