The Association Between Social Deprivation Dental Access and Cervicofacial Infections of Odontogenic Origin in Southeast London

The Association Between Social Deprivation Dental Access and Cervicofacial Infections of Odontogenic Origin in Southeast London | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research The Association Between Social Deprivation Dental Access and Cervicofacial Infections of Odontogenic Origin in Southeast London Oliver Jacob, Alexander Rae, Lucy Stiles, Kathleen Fan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7179514/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Cervicofacial infections of odontogenic origin (CIOO) pose a significant public health issue, often requiring hospital admissions. However, the effects of socioeconomic deprivation and access to primary care dentistry are unclear. Methods This study analysed all CIOO admissions at King’s College Hospital from October 2020 to 2024, focusing on patients within the South East London Integrated Care Board boundary. Infection rates were evaluated against the Index of Multiple Deprivation (IMD) and NHS dental access data at borough and LSOA levels. Statistical analyses included ANOVA, Kruskal-Wallis tests, Spearman’s correlation, and Poisson regression. Results A total of 378 CIOO patients met the inclusion criteria. Infection rates were strongly correlated with higher socioeconomic deprivation (ρ = − 0.94, p < 0.001), with the most deprived areas displaying nearly twice the incidence compared to the least deprived (IRR = 1.95, p < 0.001). In contrast, dental access had no significant association with infection rates (IRR = 1.0, p = 0.915). Conclusions This study shows a consistent link between socioeconomic deprivation and CIOO incidence, emphasising the need for targeted interventions. The lack of correlation with dental access indicates that broader structural factors must improve alongside service provision to reduce the disease burden. Health sciences/Health care/Dentistry/Dental public health/Dental epidemiology Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Between October 2020 and October 2024, a retrospective review was conducted at King’s College Hospital, London, to examine patterns in cervicofacial infections of odontogenic origin (CIOOs). During just one year of this period (October 2023 to October 2024), approximately 750 patients presented to the emergency department with dental pain and facial swelling and were referred to the Oral and Maxillofacial Surgery team, illustrating the high volume of acute dental presentations. Cervicofacial infections of odontogenic origin (CIOO) significantly burden healthcare systems, often resulting in hospital admissions, intensive care unit (ICU) management, and life-threatening complications such as airway compromise and sepsis. 1,2 A well-established connection exists between oral health disparities and socioeconomic status, yet the exact role of access to dental care in mediating these disparities remains unclear. 3,4,5 A national audit of cervicofacial infections indicated that many patients requiring maxillofacial surgical intervention did not initially seek treatment from primary care dental services, frequently arriving at the emergency department with systemic infections that required prompt medical and surgical intervention. 2 Research on geospatial inequalities in CIOO remains limited. 6 Understanding the relative impact of dental service accessibility compared to socioeconomic deprivation on infection rates is critical for designing targeted public health interventions, including commissioning National Health Service (NHS) dentistry. Aims and Objectives This study investigates the relationship between socioeconomic deprivation, dental access, and the incidence of CIOO requiring admission to King’s College Hospital, a large teaching hospital in Southeast London, at both borough and Lower Layer Super Output Area (LSOA) levels. 1. To assess whether hospital admission rates for CIOOs are linked to socioeconomic deprivation. 2. To assess whether geographical areas with limited dental access are associated with higher hospital admission rates for CIOOs. 3. To identify geographic zones where deprivation and poor access overlap, highlighting areas for targeted intervention. Methods Data Collection Electronic records for all patients admitted under the Oral and Maxillofacial Surgery team at King’s College Hospital, London, for the management of cervicofacial infections of odontogenic origin (CIOO) were retrospectively studied over four years, from October 2020 to October 2024. The patients’ residential postcodes were used to map geographical distribution, while their date of admission was used to evaluate the admission trend over time. Patients were excluded from the analysis if their registered address fell outside the boundary of the South East London Integrated Care Board (ICB). The NHS Business Services Authority provided information on the number of unique adult patients in each borough and LSOA within the South East London ICB — which includes the London Boroughs of Bexley, Bromley, Greenwich, Lambeth, Lewisham, and Southwark — who had visited an NHS primary care dentist in the previous 24 months. Dental access data was combined with population estimates published by the Office for National Statistics (ONS) to determine the percentage of the population in each borough and LSOA that had accessed NHS primary care dental services during the study period. 7 The proportion of the local population attending an NHS dentist served as an indicator of dental access. The mean percentage of dental access was calculated for each LSOA within the South East London ICB, with each LSOA assigned an NHS dental access decile, where 1 indicates the lowest access and 10 represents the highest access at the South East London ICB level. Deprivation was measured using the 2019 Index of Multiple Deprivation (IMD), which serves as the official measure of relative area-level deprivation in England and takes into account factors beyond poverty. 8 The IMD incorporates seven domains: barriers to housing and services, crime, education, employment, health, income, and living environment. There are 32,844 Lower Layer Super Output Areas (LSOAs) in England, each assigned a ranked IMD score, where 1 indicates the most deprived area and 32,844 denotes the least deprived. 7 This study analysed the IMD deciles: Decile 1 represent the most deprived, while decile 10 signify the least deprived. 9 The South East London ICB was organised into boroughs and LSOAs based on the boundaries established in 2021. LSOAs are stable geographical areas created to enhance the reporting of small-area statistics in England. Each LSOA and borough was assigned an IMD decile based on national level data. Population estimates at the borough and LSOA levels were used to standardise the prevalence of admission rates for odontogenic infections, ensuring that variations in population size within the studied areas were considered. Each admission record was assigned to a borough and LSOA. Statistical Analyses Data was analysed using descriptive and inferential statistical methods to examine temporal trends, intergroup differences, and associations between severe odontogenic infection rates, dental access, and socioeconomic deprivation across six London boroughs. One-way ANOVA was used to compare infection rates and dental access across boroughs, with post hoc Tukey’s HSD tests applied as necessary. Differences in average IMD decile across boroughs were assessed using the Kruskal-Wallis rank sum test, followed by Dunn’s post hoc tests with Bonferroni correction. Associations between infection rates, socioeconomic deprivation, and dental access were evaluated using Spearman’s rank correlation and Poisson regression models, incorporating a log-offset for population size. To facilitate interpretation of regression coefficients, IMD deciles were reverse coded in the model such that higher values represented greater deprivation; however, all results are reported using the standard IMD scale (1 = most deprived, 10 = least deprived). A significance threshold of p < 0.05 was adopted for all analyses. All statistical analyses were conducted using R Version 2024.04.2+764. Ethical Approval The review board of King’s College Hospital, London, exempted the study from requiring ethical approval. The stud Results Descriptive statistics Between 2020 and 2024, a total of 378 patients living within the South East London ICB area who were admitted to King’s College Hospital for cervicofacial infections of odontogenic origin (CIOO) were recorded (Figure 1). Of these patients, 64% were female, with a mean age of 36 years (range18-92). The incidence of CIOO has steadily increased since 2020, reaching a peak in 2023 before declining in 2024. Rates of infection varied significantly by borough; for instance, Southwark showed sharp fluctuations, while Bexley and Lewisham demonstrated a more gradual upward trend in infection rates over time (Figure 2). A one-way ANOVA test found no statistically significant difference in infection rates across the boroughs (F(5, 24) = 1.11, p=0.383). Access to dental care, measured as the percentage of adults in each borough who visited a primary care NHS dentist annually, remained stable from 2015 to 2019 before a notable decrease occurred across all six boroughs from 2020 to 2022. Although there has been some improvement starting in 2022, NHS dental access has yet to recover to pre-2020 levels, indicating a general decline in access throughout all six boroughs since 2015. A one-way ANOVA revealed a statistically significant difference in dental access among the boroughs (F(5, 54) = 17.41, p<0.001), with post-hoc Tukey’s HSD analysis showing that Bexley and Bromley had significantly lower dental access compared to other boroughs (p<0.01) (Figure 3). Relationship between socioeconomic deprivation and cervicofacial infections requiring hospital admission To assess the relationship between socioeconomic deprivation and infection rates, Spearman’s rank correlation was used to evaluate the monotonic association between the IMD decile and infection rate. A strong, statistically significant negative correlation was observed (Spearman’s ρ = –0.94, p < 0.001), indicating that infection rates consistently increased with higher levels of deprivation (Figure 3). The link between socioeconomic deprivation and increasing CIOOs was supported by regression analysis, which included a log offset for population size to account for differences in population among deciles. The results indicated that each one-point decrease in the IMD decile (i.e., increasing deprivation) was associated with a 13% increase in infection rates (IRR = 1.13, 95% CI [1.08, 1.18], p < 0.001) (Figure 4). The model fit was deemed acceptable (residual deviance = 11.37 on 8 degrees of freedom). A similar model was used to further examine this pattern by employing a binary grouping of deprivation: the most deprived half (IMD deciles 1–5) compared to the least deprived half (deciles 6–10). Infection rates were significantly higher in the more deprived group, with an incidence rate nearly double that of the less deprived group (IRR = 1.95, 95% CI [1.53, 2.51], p < 0.001). Average IMD decile per borough Average IMD decile scores were initially examined to investigate differences in socioeconomic deprivation across the boroughs. Greenwich, Lambeth, Lewisham, and Southwark all had a mean IMD decile of four, placing them in the more deprived half of the national distribution. Conversely, Bromley and Bexley had mean IMD deciles of 7, indicating they fall within the less deprived half (Figure 4). These patterns were statistically confirmed by a Kruskal-Wallis rank sum test, which identified significant differences in deprivation levels among the six boroughs ( χ² (5) = 106.97, p < 0.001). Post hoc pairwise comparisons using Dunn’s test with Bonferroni correction verified that Bexley and Bromley were significantly less deprived than Greenwich, Lambeth, Lewisham, and Southwark ( adjusted p < 0.001 for most comparisons) (Figure 5). Relationship between dental access and infections A Spearman’s rank correlation was performed to evaluate the relationship between dental access decile and infection rate. The results indicated no significant association between the two variables (ρ=0.006, p =1). This implies that infection rates do not demonstrate a monotonic relationship with levels of dental access. Additionally, regression analysis showed no significant association between dental access level and infection rates (IRR 1.0, 95% CI [0.97, 1.04], p = 0.915). Discussion Key Considerations and Implications The most significant finding of this study is the strong association between socioeconomic deprivation and the incidence of cervicofacial infections of odontogenic origin requiring hospital admission. This consistent and statistically significant relationship highlights the disproportionate burden of advanced dental disease in more deprived communities, reinforcing the role of socioeconomic factors as key determinants of oral health outcomes. 5 Notably, boroughs such as Southwark, Lambeth, Greenwich, and Lewisham have an average IMD decile below 5 , indicating higher levels of deprivation. These areas should be prioritised in targeted public health strategies to address deprivation-related barriers to early dental intervention and prevention. This finding adds weight to the well-established link between deprivation and adverse health outcomes, including reduced life expectancy and fewer years of good health. 9 Interestingly, no association was found between NHS primary care dental access rates and incidence of CIOOs requiring hospital admission, suggesting that the availability of services alone may be insufficient to mitigate severe disease in high-risk populations. A range of non-structural barriers to care, including health-seeking behaviours, financial concerns, perceptions of dental care, and broader health literacy challenges, may explain this. 10,11,12 Individuals in deprived areas may delay seeking care until infection becomes severe, due to factors such as mistrust of healthcare providers, prioritisation of other immediate needs, or lack of awareness of early warning signs of oral disease. 13,14,10 In this context, CIOOs can be seen as sentinel events indicating failure across multiple points in the care pathway. However, the study’s sole reliance on NHS dental access data means we may not have fully captured dental access, especially in areas with higher uptake of private dental care. This potential underestimation introduces a source of misclassification that may obscure a real but unmeasured relationship. Additionally, we could not assess the relationship between dental access and patients who attended hospital for management of a CIOO but did not require admission. As such, the true association between dental access and CIOOs remains unclear. Strengths and Limitations The inclusion of a large dataset spanning four years and comprising 378 admissions allows for meaningful analysis of trends in cervicofacial infections. The use of LSOA data provides high-resolution geospatial insights, enabling precise mapping of infection rates in relation to both deprivation and dental access. Additionally, the study employs validated national metrics, such as the Index of Multiple Deprivation (IMD) and NHS dental access data, and adjusts for population size, enhancing the reliability and comparability of findings across boroughs and deprivation deciles. Importantly, the analysis is grounded in real-world clinical data from a major NHS teaching hospital, improving its relevance to public health policy and service planning. Nonetheless, there are limitations to consider. The retrospective observational design precludes causal inference and is subject to potential selection bias and limits control over confounding factors. The reliance on NHS dental access data excludes patients using private dental services, potentially underestimating true access in more affluent areas. Other unmeasured influences, such as oral hygiene practices, comorbidities, and health literacy, may also affect infection risk. 5,15,16 The overlap with the COVID-19 pandemic introduces temporal confounding due to disruptions in healthcare access and service delivery. 17 Finally, as a single-centre study, based in South East London, the findings may not be fully generalisable to other settings or regions. Nevertheless, the patterns observed provide important insights into the structural determinants of oral health. Future Directions A prevention-focused model of care is urgently needed. Improving oral health literacy and supporting behaviour change through education and outreach may also reduce the incidence of advanced-stage infections. Addressing CIOOs and dental care on a broader scale requires a coordinated approach that combines equitable service provision with upstream investment in the social and behavioural determinants of oral health. This study's findings support a shift toward proactive, population-based dental care models that prioritise prevention, integration, and community engagement. While this study focuses on CIOO requiring hospital admission, inclusion of patients who present to emergency departments with similar infections but are managed and discharged following incision and drainage under local anaesthetic may provide a more comprehensive picture of the burden of odontogenic infections, particularly in socioeconomically deprived populations. Future research should also explore how individual-level risk factors, such as smoking and diabetes, may influence the development and progression of CIOOs. Many of these factors are more prevalent in socioeconomically deprived populations and likely interact with structural barriers to care, significantly increasing the risk of CIOOs. 15 It is essential to work towards integrating NHS and private sector dental data to provide a more accurate and comprehensive understanding of the relationship between dental access and odontogenic infections requiring hospital admission. Conclusion This study demonstrates a strong association between increasing socioeconomic deprivation and cervicofacial infections of odontogenic origin in South East London requiring hospital admission. While improving service provision remains crucial, our findings highlight the urgent need for preventative strategies that address the broader social determinants of oral health. Tackling deprivation-related barriers upstream may be key to reducing hospital admissions and alleviating the burden of severe cervicofacial infections in our most vulnerable communities. Declarations Competing Interests The authors declare that they have no conflict of interest. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data Availability The data supporting this study's findings are available from the corresponding author upon reasonable request. Contributions Conception of the work: OJ, AR, LS, KF. Data collection: OJ, AR, LS. Statistical analysis and interpretation: OJ, AR, LS. Drafting the article: OJ, AR, LS. Critical revision of the article: KF. Final approval of the version to be published: OJ, AR, LS, KF. References Velhonoja J, Lääveri M, Soukka T, Haatainen S, Al-Neshawy N, Kinnunen I, et al. Severe orofacial and neck infections: risk factors and preventative measures. A three-year observational study. BMC Oral Health. 2025;25(136). Henry A, Dawoud B, Kent S, McDonald C, Logan G, Hennedige A, et al. Clinical features and presentation of cervicofacial infection: a Maxillofacial Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg. 2021;59(4):433–8. Steele J, Shen J, Tsakos G, Fuller E, Morris S, Watt R, et al. The interplay between socioeconomic inequalities and clinical oral health. J Dent Res. 2015;94(1):19-26. Thomson WM, Poulton R, Kruger E, Boyd D. Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort. Community Dent Oral Epidemiol. 2004;32(5):345-53. Public Health England. Inequalities in oral health in England. London: Public Health England; 2020. Available from: https://assets.publishing.service.gov.uk/media/6051f994d3bf7f0453f7b9a9/Inequalities_in_oral_health_in_England.pdf. Whyman RA, Mahoney EK, Morrison D, Stanley J. Potentially preventable admissions to New Zealand public hospitals for dental care: a 20-year review. Community Dent Oral Epidemiol. 2014;42(3):234-44. Office for National Statistics. 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Available from: https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-023-03030-x Hansen C, Curl C, Geddis-Regan A. Barriers to the provision of oral health care for people with disabilities. BDJ In Pract. 2021;34(3):30–34. Beaven A, Marshman Z. Barriers and facilitators to accessing oral healthcare for older people in the UK: a scoping review. Br Dent J. 2024 Aug 16; Available from: https://www.nature.com/articles/s41415-024-7740-x Bidmead E, Hayes L, Mazzoli-Smith L, Wildman J, Rankin J, Leggott E, et al. Poverty proofing healthcare: A qualitative study of barriers to accessing healthcare for low-income families with children in northern England. PLoS One. 2024 Apr 26;19(4):e0292983. Available from: https://doi.org/10.1371/journal.pone.0292983 Cope AL, Chestnutt IG. The implications of a cost-of-living crisis for oral health and dental care. Br Dent J. 2023;234(7):501-504. Available from: https://www.nature.com/articles/s41415-023-5685-0 National Institute for Health and Care Research. Multiple long-term conditions (multimorbidity) and inequality: addressing the challenge: insights from research. NIHR Evidence. 2023 Sep 20. doi: 10.3310/nihrevidence_59977. Available from: https://evidence.nihr.ac.uk/collection/multiple-long-term-conditions-multimorbidity-and-inequality-addressing-the-challenge-insights-from-research/ Simpson RM, Knowles E, O'Cathain A. Health literacy levels of British adults: a cross-sectional survey using two domains of the Health Literacy Questionnaire (HLQ). BMC Public Health. 2020;20(1):1819. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09727-w Stennett M, Tsakos G. The impact of the COVID-19 pandemic on oral health inequalities and access to oral healthcare in England. Br Dent J. 2022;232(3):109–114. Available from: https://www.nature.com/articles/s41415-021-3718-0 Additional Declarations There is no duality of interest Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: revise 24 Sep, 2025 Review # 2 received at journal 07 Sep, 2025 Review # 1 received at journal 14 Aug, 2025 Reviewer # 2 agreed at journal 12 Aug, 2025 Reviewer # 1 agreed at journal 08 Aug, 2025 Reviewers invited by journal 01 Aug, 2025 Editor assigned by journal 28 Jul, 2025 Submission checks completed at journal 28 Jul, 2025 First submitted to journal 21 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7179514","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":494325379,"identity":"621b3756-ace8-4f7b-9639-a6cebbac90c5","order_by":0,"name":"Oliver Jacob","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYDACduaGAwwFbEAWD+MDEMlHUAszI1CLAVgLswGIZCNGCwMDSC1QsQSIIqiFn5mx8cAHAz55/vbeY5Vfc+xk2BiYHz66gUeLZDNjw8EZBmyGM86cS7stuy0Z6DA2Y+McPFoMDjM2HOYxYGPcIJFjdltyGzNQCw+bNEEtfwzY7EFaiiW31ROpBRhiiSAtjB+3HSasBeyXHgO2ZKBfkqUZtx3nYWMm4Bd+9ubDH35UHLPtb+89+PHntmp7oMjDx/i0QMExMMnMAyYJKweBGjDJ+IM41aNgFIyCUTDCAAAWBEQCjByXLAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-0734-1583","institution":"King's College Hospital","correspondingAuthor":true,"prefix":"","firstName":"Oliver","middleName":"","lastName":"Jacob","suffix":""},{"id":494325380,"identity":"96d508d0-cef0-4f5f-9205-9f77af77bd8f","order_by":1,"name":"Alexander Rae","email":"","orcid":"","institution":"King's College 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2","display":"","copyAsset":false,"role":"figure","size":123612,"visible":true,"origin":"","legend":"\u003cp\u003eCervicofacial infections of odontogenic origin in the six London Boroughs comprising the Southeast London ICB requiring admission 2020-2024.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7179514/v1/44e58ecc955b89134fd7c508.png"},{"id":88894003,"identity":"c9cfe094-ba7a-4dcb-917d-597a142fba11","added_by":"auto","created_at":"2025-08-12 13:01:15","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":120443,"visible":true,"origin":"","legend":"\u003cp\u003eDental Access in the six London Boroughs comprising the Southeast London ICB 2015-2024.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7179514/v1/1c445295d8062cb0e00ca42a.png"},{"id":88896808,"identity":"dd0018e9-0894-4e3e-960f-569a89d23a53","added_by":"auto","created_at":"2025-08-12 13:09:15","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":92563,"visible":true,"origin":"","legend":"\u003cp\u003eInfection rate per IMD decile.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7179514/v1/635a7dda5a70fe2e1f1868ad.png"},{"id":88894007,"identity":"3bfc1a21-2a21-4e7d-93cf-8f3fea13b734","added_by":"auto","created_at":"2025-08-12 13:01:15","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":38471,"visible":true,"origin":"","legend":"\u003cp\u003eAverage IMD decile per borough in the six London Boroughs comprising the Southeast London ICB.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7179514/v1/e07aa0256bccbb10b0ae4fa6.png"},{"id":88897891,"identity":"ac15c28e-da4e-4570-9a05-ec1dea865b48","added_by":"auto","created_at":"2025-08-12 13:17:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3095184,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7179514/v1/2ea4b73f-d377-4af1-85c8-0104fab81c30.pdf"}],"financialInterests":"There is no duality of interest","formattedTitle":"The Association Between Social Deprivation Dental Access and Cervicofacial Infections of Odontogenic Origin in Southeast London","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBetween October 2020 and October 2024, a retrospective review was conducted at King\u0026rsquo;s College Hospital, London, to examine patterns in cervicofacial infections of odontogenic origin (CIOOs). During just one year of this period (October 2023 to October 2024), approximately 750 patients presented to the emergency department with dental pain and facial swelling and were referred to the Oral and Maxillofacial Surgery team, illustrating the high volume of acute dental presentations.\u003c/p\u003e\n\u003cp\u003eCervicofacial infections of odontogenic origin (CIOO) significantly burden healthcare systems, often resulting in hospital admissions, intensive care unit (ICU) management, and life-threatening complications such as airway compromise and sepsis.\u003csup\u003e1,2\u0026nbsp;\u003c/sup\u003eA well-established connection exists between oral health disparities and socioeconomic status, yet the exact role of access to dental care in mediating these disparities remains unclear.\u003csup\u003e3,4,5\u003c/sup\u003e A national audit of cervicofacial infections indicated that many patients requiring maxillofacial surgical intervention did not initially seek treatment from primary care dental services, frequently arriving at the emergency department with systemic infections that required prompt medical and surgical intervention.\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResearch on geospatial inequalities in CIOO remains limited.\u003csup\u003e6\u003c/sup\u003e Understanding the relative impact of dental service accessibility compared to socioeconomic deprivation on infection rates is critical for designing targeted public health interventions, including commissioning National Health Service (NHS) dentistry.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAims and Objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study investigates the relationship between socioeconomic deprivation, dental access, and the incidence of CIOO requiring admission to King\u0026rsquo;s College Hospital, a large teaching hospital in Southeast London, at both borough and Lower Layer Super Output Area (LSOA) levels.\u003c/p\u003e\n\u003cp\u003e1. To assess whether hospital admission rates for CIOOs are linked to socioeconomic deprivation.\u003c/p\u003e\n\u003cp\u003e2. To assess whether geographical areas with limited dental access are associated with higher hospital admission rates for CIOOs.\u003c/p\u003e\n\u003cp\u003e3. To identify geographic zones where deprivation and poor access overlap, highlighting areas for targeted intervention.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eElectronic records for all patients admitted under the Oral and Maxillofacial Surgery team at King\u0026rsquo;s College Hospital, London, for the management of cervicofacial infections of odontogenic origin (CIOO) were retrospectively studied over four years, from October 2020 to October 2024.\u0026nbsp;The patients\u0026rsquo; residential postcodes were used to map geographical distribution, while their date of admission was used to evaluate the admission trend over time. Patients were excluded from the analysis if their registered address fell outside the boundary of the South East London Integrated Care Board (ICB).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe NHS Business Services Authority provided information on the number of unique adult patients in each borough and LSOA within the South East London ICB \u0026mdash; which includes the London Boroughs of Bexley, Bromley, Greenwich, Lambeth, Lewisham, and Southwark \u0026mdash; who had visited an NHS primary care dentist in the previous 24 months. Dental access data was combined with population estimates published by the Office for National Statistics (ONS) to determine the percentage of the population in each borough and LSOA that had accessed NHS primary care dental services during the study period.\u003csup\u003e7\u003c/sup\u003e The proportion of the local population attending an NHS dentist served as an indicator of dental access. The mean percentage of dental access was calculated for each LSOA within the South East London ICB, with each LSOA assigned an NHS dental access decile, where 1 indicates the lowest access and 10 represents the highest access at the South East London ICB level.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDeprivation was measured using the 2019 Index of Multiple Deprivation (IMD), which serves as the official measure of relative area-level deprivation in England and takes into account factors beyond poverty.\u003csup\u003e8\u003c/sup\u003e The IMD incorporates seven domains: barriers to housing and services, crime, education, employment, health, income, and living environment. There are 32,844 Lower Layer Super Output Areas (LSOAs) in England, each assigned a ranked IMD score, where 1 indicates the most deprived area and 32,844 denotes the least deprived.\u003csup\u003e7\u003c/sup\u003e This study analysed the IMD deciles: Decile 1 represent the most deprived, while decile 10 signify the least deprived.\u003csup\u003e9\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe South East London ICB was organised into boroughs and LSOAs based on the boundaries established in 2021. LSOAs are stable geographical areas created to enhance the reporting of small-area statistics in England. Each LSOA and borough was assigned an IMD decile based on national level data.\u003c/p\u003e\n\u003cp\u003ePopulation estimates at the borough and LSOA levels were used to standardise the prevalence of admission rates for odontogenic infections, ensuring that variations in population size within the studied areas were considered. Each admission record was assigned to a borough and LSOA.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eStatistical Analyses\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData was analysed using descriptive and inferential statistical methods to examine temporal trends, intergroup differences, and associations between severe odontogenic infection rates, dental access, and socioeconomic deprivation across six London boroughs. One-way ANOVA was used to compare infection rates and dental access across boroughs, with post hoc Tukey\u0026rsquo;s HSD tests applied as necessary. Differences in average IMD decile across boroughs were assessed using the Kruskal-Wallis rank sum test, followed by Dunn\u0026rsquo;s post hoc tests with Bonferroni correction. Associations between infection rates, socioeconomic deprivation, and dental access were evaluated using Spearman\u0026rsquo;s rank correlation and Poisson regression models, incorporating a log-offset for population size. To facilitate interpretation of regression coefficients, IMD deciles were reverse coded in the model such that higher values represented greater deprivation; however, all results are reported using the standard IMD scale (1 = most deprived, 10 = least deprived). A significance threshold of p \u0026lt; 0.05 was adopted for all analyses. All statistical analyses were conducted using R Version 2024.04.2+764.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe review board of King\u0026rsquo;s College Hospital, London, exempted the study from requiring ethical approval. \u0026nbsp;The stud\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eDescriptive statistics\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBetween 2020 and 2024, a total of 378 patients living within the South East London ICB area who were admitted to King\u0026rsquo;s College Hospital for cervicofacial infections of odontogenic origin (CIOO) were recorded (Figure 1). Of these patients, 64% were female, with a mean age of 36 years (range18-92). The incidence of CIOO has steadily increased since 2020, reaching a peak in 2023 before declining in 2024. Rates of infection varied significantly by borough; for instance, Southwark showed sharp fluctuations, while Bexley and Lewisham demonstrated a more gradual upward trend in infection rates over time (Figure 2). A one-way ANOVA test found no statistically significant difference in infection rates across the boroughs (F(5, 24) = 1.11, p=0.383). Access to dental care, measured as the percentage of adults in each borough who visited a primary care NHS dentist annually, remained stable from 2015 to 2019 before a notable decrease occurred across all six boroughs from 2020 to 2022. Although there has been some improvement starting in 2022, NHS dental access has yet to recover to pre-2020 levels, indicating a general decline in access throughout all six boroughs since 2015. A one-way ANOVA revealed a statistically significant difference in dental access among the boroughs (F(5, 54) = 17.41, p\u0026lt;0.001), with post-hoc Tukey\u0026rsquo;s HSD analysis showing that Bexley and Bromley had significantly lower dental access compared to other boroughs (p\u0026lt;0.01) (Figure 3).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eRelationship between socioeconomic deprivation and cervicofacial infections requiring hospital admission\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the relationship between socioeconomic deprivation and infection rates, Spearman\u0026rsquo;s rank correlation was used to evaluate the monotonic association between the IMD decile and infection rate. A strong, statistically significant negative correlation was observed (Spearman\u0026rsquo;s \u0026rho; = \u0026ndash;0.94, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), indicating that infection rates consistently increased with higher levels of deprivation (Figure 3).\u003c/p\u003e\n\u003cp\u003eThe link between socioeconomic deprivation and increasing CIOOs was supported by regression analysis, which included a log offset for population size to account for differences in population among deciles. The results indicated that each one-point decrease in the IMD decile (i.e., increasing deprivation) was associated with a 13% increase in infection rates (IRR = 1.13, 95% CI [1.08, 1.18], \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) (Figure 4). The model fit was deemed acceptable (residual deviance = 11.37 on 8 degrees of freedom).\u003c/p\u003e\n\u003cp\u003eA similar model was used to further examine this pattern by employing a binary grouping of deprivation: the most deprived half (IMD deciles 1\u0026ndash;5) compared to the least deprived half (deciles 6\u0026ndash;10). Infection rates were significantly higher in the more deprived group, with an incidence rate nearly double that of the less deprived group (IRR = 1.95, 95% CI [1.53, 2.51], \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAverage IMD decile per borough\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAverage IMD decile scores were initially examined to investigate differences in socioeconomic deprivation across the boroughs. Greenwich, Lambeth, Lewisham, and Southwark all had a mean IMD decile of four, placing them in the more deprived half of the national distribution. Conversely, Bromley and Bexley had mean IMD deciles of 7, indicating they fall within the less deprived half (Figure 4). These patterns were statistically confirmed by a Kruskal-Wallis rank sum test, which identified significant differences in deprivation levels among the six boroughs (\u003cem\u003e\u0026chi;\u0026sup2;\u003c/em\u003e(5) = 106.97, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). Post hoc pairwise comparisons using Dunn\u0026rsquo;s test with Bonferroni correction verified that Bexley and Bromley were significantly less deprived than Greenwich, Lambeth, Lewisham, and Southwark (\u003cem\u003eadjusted p\u003c/em\u003e \u0026lt; 0.001 for most comparisons) (Figure 5).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eRelationship between dental access and infections \u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA Spearman\u0026rsquo;s rank correlation was performed to evaluate the relationship between dental access decile and infection rate. The results indicated no significant association between the two variables (\u0026rho;=0.006, \u003cem\u003ep\u003c/em\u003e=1). This implies that infection rates do not demonstrate a monotonic relationship with levels of dental access. Additionally, regression analysis showed no significant association between dental access level and infection rates (IRR 1.0, 95% CI [0.97, 1.04], \u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.915).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eKey Considerations and Implications\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe most significant finding of this study is the strong association between socioeconomic deprivation and the incidence of cervicofacial infections of odontogenic origin requiring hospital admission. This consistent and statistically significant relationship highlights the disproportionate burden of advanced dental disease in more deprived communities, reinforcing the role of socioeconomic factors as key determinants of oral health outcomes.\u003csup\u003e5\u003c/sup\u003e Notably, boroughs such as \u003cstrong\u003eSouthwark, Lambeth, Greenwich, and Lewisham\u003c/strong\u003e have an average IMD decile \u003cstrong\u003ebelow 5\u003c/strong\u003e, indicating higher levels of deprivation. These areas should be prioritised in targeted public health strategies to address deprivation-related barriers to early dental intervention and prevention. This finding adds weight to the well-established link between deprivation and adverse health outcomes, including reduced life expectancy and fewer years of good health.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eInterestingly, no association was found between NHS primary care dental access rates and incidence of CIOOs requiring hospital admission, suggesting that the availability of services alone may be insufficient to mitigate severe disease in high-risk populations.\u0026nbsp;A\u0026nbsp;range of non-structural barriers to care, including health-seeking behaviours, financial concerns, perceptions of dental care, and broader health literacy challenges, may explain this.\u003csup\u003e10,11,12\u003c/sup\u003e Individuals in deprived areas may delay seeking care until infection becomes severe, due to factors such as mistrust of healthcare providers, prioritisation of other immediate needs, or lack of awareness of early warning signs of oral disease.\u003csup\u003e13,14,10\u003c/sup\u003e In this context, CIOOs can be seen as sentinel events indicating failure across multiple points in the care pathway. However, the study\u0026rsquo;s sole reliance on NHS dental access data means we may not have fully captured dental access, especially in areas with higher uptake of private dental care. This potential underestimation introduces a source of misclassification that may obscure a real but unmeasured relationship. Additionally, we could not assess the relationship between dental access and patients who attended hospital for management of a CIOO but did not require admission. As such, the true association between dental access and CIOOs remains unclear.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion of a large dataset spanning four years and comprising 378 admissions allows for meaningful analysis of trends in cervicofacial infections. The use of LSOA data provides high-resolution geospatial insights, enabling precise mapping of infection rates in relation to both deprivation and dental access. Additionally, the study employs validated national metrics, such as the Index of Multiple Deprivation (IMD) and NHS dental access data, and adjusts for population size, enhancing the reliability and comparability of findings across boroughs and deprivation deciles. Importantly, the analysis is grounded in real-world clinical data from a major NHS teaching hospital, improving its relevance to public health policy and service planning.\u003c/p\u003e\n\u003cp\u003eNonetheless, there are limitations to consider. The retrospective observational design precludes causal inference and is subject to potential selection bias and limits control over confounding factors. The reliance on NHS dental access data excludes patients using private dental services, potentially underestimating true access in more affluent areas. Other unmeasured influences, such as oral hygiene practices, comorbidities, and health literacy, may also affect infection risk.\u003csup\u003e5,15,16\u003c/sup\u003e The overlap with the COVID-19 pandemic introduces temporal confounding due to disruptions in healthcare access and service delivery.\u003csup\u003e17\u003c/sup\u003e Finally, as a single-centre study, based in South East London, the findings may not be fully generalisable to other settings or regions. Nevertheless, the patterns observed provide important insights into the structural determinants of oral health.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFuture Directions\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA prevention-focused model of care is urgently needed. Improving oral health literacy and supporting behaviour change through education and outreach may also reduce the incidence of advanced-stage infections. Addressing CIOOs and dental care on a broader scale requires a coordinated approach that combines equitable service provision with upstream investment in the social and behavioural determinants of oral health. This study\u0026apos;s findings support a shift toward proactive, population-based dental care models that prioritise prevention, integration, and community engagement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile this study focuses on CIOO requiring hospital admission, inclusion of patients who present to emergency departments with similar infections but are managed and discharged following incision and drainage under local anaesthetic may provide a more comprehensive picture of the burden of odontogenic infections, particularly in socioeconomically deprived populations. Future research should also explore how individual-level risk factors, such as smoking and diabetes, may influence the development and progression of CIOOs. Many of these factors are more prevalent in socioeconomically deprived populations and likely interact with structural barriers to care, significantly increasing the risk of CIOOs.\u003csup\u003e15\u003c/sup\u003e It is essential to work towards integrating NHS and private sector dental data to provide a more accurate and comprehensive understanding of the relationship between dental access and odontogenic infections requiring hospital admission.\u003c/p\u003e\n\u003cdiv id=\"_com_2\" language=\"JavaScript\"\u003e\u003cbr\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates a strong association between increasing socioeconomic deprivation and cervicofacial infections of odontogenic origin in South East London requiring hospital admission. While improving service provision remains crucial, our findings highlight the urgent need for preventative strategies that address the broader social determinants of oral health. Tackling deprivation-related barriers upstream may be key to reducing hospital admissions and alleviating the burden of severe cervicofacial infections in our most vulnerable communities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting this study\u0026apos;s findings are available from the corresponding author upon reasonable request.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConception of the work: OJ, AR, LS, KF. Data collection: OJ, AR, LS. Statistical analysis and interpretation: OJ, AR, LS. Drafting the article: OJ, AR, LS. Critical revision of the article: KF. Final approval of the version to be published: OJ, AR, LS, KF.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVelhonoja J, L\u0026auml;\u0026auml;veri M, Soukka T, Haatainen S, Al-Neshawy N, Kinnunen I, et al. Severe orofacial and neck infections: risk factors and preventative measures. A three-year observational study. BMC Oral Health. 2025;25(136).\u003c/li\u003e\n\u003cli\u003eHenry A, Dawoud B, Kent S, McDonald C, Logan G, Hennedige A, et al. Clinical features and presentation of cervicofacial infection: a Maxillofacial Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg. 2021;59(4):433\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eSteele J, Shen J, Tsakos G, Fuller E, Morris S, Watt R, et al. The interplay between socioeconomic inequalities and clinical oral health. J Dent Res. 2015;94(1):19-26.\u003c/li\u003e\n\u003cli\u003eThomson WM, Poulton R, Kruger E, Boyd D. Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort. Community Dent Oral Epidemiol. 2004;32(5):345-53.\u003c/li\u003e\n\u003cli\u003ePublic Health England. Inequalities in oral health in England. London: Public Health England; 2020. Available from: https://assets.publishing.service.gov.uk/media/6051f994d3bf7f0453f7b9a9/Inequalities_in_oral_health_in_England.pdf.\u003c/li\u003e\n\u003cli\u003eWhyman RA, Mahoney EK, Morrison D, Stanley J. Potentially preventable admissions to New Zealand public hospitals for dental care: a 20-year review. Community Dent Oral Epidemiol. 2014;42(3):234-44.\u003c/li\u003e\n\u003cli\u003eOffice for National Statistics. Lower layer Super Output Area population estimates (supporting information). 2021. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/lowersuperoutputareamidyearpopulationestimates\u003c/li\u003e\n\u003cli\u003eMinistry of Housing, Communities \u0026amp; Local Government. The English Indices of Deprivation 2019. Gov.UK. Available from: https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019.\u003c/li\u003e\n\u003cli\u003eOffice for National Statistics. Health state life expectancies by national deprivation deciles, England: 2018 to 2020. 2022 Apr 25 [cited 2025 Mar 30]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstatelifeexpectanciesbyindexofmultipledeprivationimd/2018to2020\u003c/li\u003e\n\u003cli\u003eLeggett H, Vinall-Collier K, Csikar J, Douglas GVA. Barriers to prevention in oral health care for English NHS dental patients: a qualitative study of views from key stakeholders. BMC Oral Health. 2023;23(1):332. Available from: https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-023-03030-x\u003c/li\u003e\n\u003cli\u003eHansen C, Curl C, Geddis-Regan A. Barriers to the provision of oral health care for people with disabilities. BDJ In Pract. 2021;34(3):30\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eBeaven A, Marshman Z. Barriers and facilitators to accessing oral healthcare for older people in the UK: a scoping review. Br Dent J. 2024 Aug 16; Available from: https://www.nature.com/articles/s41415-024-7740-x\u003c/li\u003e\n\u003cli\u003eBidmead E, Hayes L, Mazzoli-Smith L, Wildman J, Rankin J, Leggott E, et al. Poverty proofing healthcare: A qualitative study of barriers to accessing healthcare for low-income families with children in northern England. PLoS One. 2024 Apr 26;19(4):e0292983. Available from: https://doi.org/10.1371/journal.pone.0292983\u003c/li\u003e\n\u003cli\u003eCope AL, Chestnutt IG. The implications of a cost-of-living crisis for oral health and dental care. Br Dent J. 2023;234(7):501-504. Available from: https://www.nature.com/articles/s41415-023-5685-0\u003c/li\u003e\n\u003cli\u003eNational Institute for Health and Care Research. Multiple long-term conditions (multimorbidity) and inequality: addressing the challenge: insights from research. NIHR Evidence. 2023 Sep 20. doi: 10.3310/nihrevidence_59977. Available from: https://evidence.nihr.ac.uk/collection/multiple-long-term-conditions-multimorbidity-and-inequality-addressing-the-challenge-insights-from-research/\u003c/li\u003e\n\u003cli\u003eSimpson RM, Knowles E, O\u0026apos;Cathain A. Health literacy levels of British adults: a cross-sectional survey using two domains of the Health Literacy Questionnaire (HLQ). BMC Public Health. 2020;20(1):1819. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09727-w\u003c/li\u003e\n\u003cli\u003eStennett M, Tsakos G. The impact of the COVID-19 pandemic on oral health inequalities and access to oral healthcare in England. Br Dent J. 2022;232(3):109\u0026ndash;114. Available from: https://www.nature.com/articles/s41415-021-3718-0\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"british-dental-journal","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bdj","sideBox":"Learn more about [British Dental Journal](http://www.nature.com/bdj/)","snPcode":"41415","submissionUrl":"https://mts-bdj.nature.com/cgi-bin/main.plex","title":"British Dental Journal","twitterHandle":"@the_bdj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7179514/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7179514/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCervicofacial infections of odontogenic origin (CIOO) pose a significant public health issue, often requiring hospital admissions. However, the effects of socioeconomic deprivation and access to primary care dentistry are unclear.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study analysed all CIOO admissions at King\u0026rsquo;s College Hospital from October 2020 to 2024, focusing on patients within the South East London Integrated Care Board boundary. Infection rates were evaluated against the Index of Multiple Deprivation (IMD) and NHS dental access data at borough and LSOA levels. Statistical analyses included ANOVA, Kruskal-Wallis tests, Spearman\u0026rsquo;s correlation, and Poisson regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 378 CIOO patients met the inclusion criteria. Infection rates were strongly correlated with higher socioeconomic deprivation (ρ = \u0026minus;\u0026thinsp;0.94, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with the most deprived areas displaying nearly twice the incidence compared to the least deprived (IRR\u0026thinsp;=\u0026thinsp;1.95, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, dental access had no significant association with infection rates (IRR\u0026thinsp;=\u0026thinsp;1.0, p\u0026thinsp;=\u0026thinsp;0.915).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis study shows a consistent link between socioeconomic deprivation and CIOO incidence, emphasising the need for targeted interventions. The lack of correlation with dental access indicates that broader structural factors must improve alongside service provision to reduce the disease burden.\u003c/p\u003e","manuscriptTitle":"The Association Between Social Deprivation Dental Access and Cervicofacial Infections of Odontogenic Origin in Southeast London","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-12 13:01:10","doi":"10.21203/rs.3.rs-7179514/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2025-09-24T10:24:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-09-07T18:59:47+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-08-14T23:40:18+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-08-12T12:02:34+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-08-08T07:40:39+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-08-01T13:05:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-28T14:07:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-28T14:07:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"British Dental Journal","date":"2025-07-21T16:23:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"british-dental-journal","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bdj","sideBox":"Learn more about [British Dental Journal](http://www.nature.com/bdj/)","snPcode":"41415","submissionUrl":"https://mts-bdj.nature.com/cgi-bin/main.plex","title":"British Dental Journal","twitterHandle":"@the_bdj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"5980eadd-6d89-4ef9-9a0d-c0578c04da25","owner":[],"postedDate":"August 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":52502697,"name":"Health sciences/Health care/Dentistry/Dental public health/Dental epidemiology"}],"tags":[],"updatedAt":"2025-11-26T11:05:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-12 13:01:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7179514","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7179514","identity":"rs-7179514","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}