High-need dental deserts in England: a national spatial analysis of NHS access and deprivation

High-need dental deserts in England: a national spatial analysis of NHS access and deprivation | 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 High-need dental deserts in England: a national spatial analysis of NHS access and deprivation Hugh Devlin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9117997/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 Aim(s) The aim of this study was to identify high-need dental deserts in England and to quantify the population affected, describe the distribution of geographic access, and profile the demographic characteristics of this subgroup relative to other deserts. Methods A cross-sectional spatial analysis was undertaken using LSOA December 2021 boundaries (England) linked to IMD 2025 File 7 (deciles; mid-2022 population denominators). NHS dental practices were geocoded from postcodes using the ONS Postcode Directory and analysed in British National Grid. Euclidean distance from each LSOA centroid to the nearest NHS-listed practice was calculated, and LSOAs with no NHS provider within 5 km were classified as dental deserts. The high-need desert subgroup comprised deserts in IMD deciles 1–3. Demographic profiling used Census 2021 ethnicity (TS021) and age structure (TS007a), comparing high-need deserts with other deserts. Results Across England, 1,340 LSOAs (population 2,342,985) had no NHS-listed dental provider within 5 km. The high-need desert subgroup comprised 112 LSOAs of 189,542 residents who lived in the most deprived IMD 1–3 group with high need but no dental provider within 5 km. This compared with 2,153,443 people in the more affluent IMD 4–10 group with no dental provider. The high-need desert population was predominantly White (97.9%) and had an age profile similar to other deserts not in the IMD 1–3 group (0–15: 19.4% vs 19.5%; 65+: 27.4% vs 26.9%). Conclusion(s) Geographic exclusion from NHS-listed dental provision affects about 2.3 million residents in England, while the high-need dental desert subgroup included approximately 190,000 residents. High-need deserts are demographically distinct in ethnic composition yet similar in age structure to other deserts. Routine national spatial audits using LSOA-level deprivation and access metrics could support targeted service planning for communities facing combined socioeconomic disadvantage and geographic isolation. Health sciences/Health care/Dentistry/Dental public health Figures Figure 4 Key points 1. Around 2.34 million people in England live in areas with no NHS dental provider within 5 km. 2. The most deprived population (in IMD 1–3) affected by poor access is concentrated not in inner cities, but in rural areas. Introduction The term “dental desert” has been used to describe those areas of the country lacking in a sufficient provision of dental services. A recent (2025) report from the Local Government Association 1 showed considerable variation in the availability of services. Local authorities with higher levels of overall deprivation were more likely to have fewer active NHS dental practices per 100,000 people than more affluent areas of England and Wales. The LGA report of 2022 found that deprived and rural local authority areas have fewer NHS dentists than those in more affluent urban areas. 2 It is known that the South West of England, Yorkshire and the Humber and the North West, are most severely affected (98% of practices there do not accept new adult NHS patients). 3 A dental desert was defined in this study as an area with no NHS dental providers within 5 km of that area’s geometric centre. A deprived subgroup of this population (high-need dental desert) was also obtained. The number of people living in England’s dental deserts, their geographic distribution and ethnic profile are not known. This study was undertaken to help fill that gap, providing evidence that can inform policy and stimulate debate. Methods Study design and setting A cross-sectional spatial analysis was carried out of geographic access to dental providers across England, using Lower Layer Super Output Areas (LSOAs; December 2021 boundaries) as the unit of analysis. LSOAs are small areas designed by the Office of National Statistics (ONS) and contain about 1,000–3,000 individuals. The English LSOA boundaries were obtained from the ONS Open Geography Portal (LSOA December 2021, EW, BGC). The socioeconomic deprivation and population data from each LSOA were taken from the Index of Multiple Deprivation (IMD) 2025 File 7. The IMD divides all English neighbourhoods into 10 equal-sized groups based on their level of deprivation, with deciles 1–3 specified as “high-need”. The IMD File 7 mid-2022 population denominator was used to estimate the number of residents living in areas meeting dental desert criteria. Dental providers were derived from an NHS dental practice dataset (“NHS dental practices from NHS England”). Practices were restricted to those marked ACTIVE where status was available. Accordingly, the provider set represents NHS-listed provision, rather than a complete census of all practices. Provider postcodes were standardised to uppercase and stripped of whitespace and linked to geographic coordinates using the ONS Postcode Directory (ONSPD) hosted table. Coordinates were obtained as British National Grid (OSGB36; EPSG:27700) eastings and northings. Practices without valid coordinates after linkage were excluded from distance calculations. Geographic access was measured by calculating the planar Euclidean distances from each LSOA centroid to provider locations in the British National Grid (BNG) coordinate system (EPSG:27700). The Euclidean distance from each LSOA centroid to the nearest dental provider was computed, and the number of providers that were within a 5-km radius of each centroid was determined. This enabled identification of dental deserts, defined as LSOAs with zero dental providers within 5 km of the LSOA centroid. A “high-need dental desert” subgroup was defined as LSOAs in IMD deciles 1–3 with no providers within 5 km. The population residing in dental deserts and in the high-need subgroup was estimated. To assess deprivation patterning, we compared outcomes for IMD 1–3 with IMD 4–10, reporting the proportion of each group’s population living in LSOAs with no provider within 5 km. LSOA-level population characteristics were used to profile areas meeting the high-need dental desert definition (IMD 2025 deciles 1–3 and no NHS-listed dental provider within 5 km of the LSOA centroid) and to compare them with other desert and non-desert areas. Ethnicity was obtained from Census 2021 table TS021 and joined to the analytic dataset using LSOA 2021 codes; ethnic group was collapsed into five broad categories (White; Asian; Black; Mixed; Other). Age structure was obtained from Census 2021 table TS007a and aggregated into three bands (0–15, 16–64 and 65+). For age, proportions were calculated using Census 2021 usual resident denominators. Mean age was approximated from Census age-band counts by assigning each age band its midpoint (e.g., 20–24 → 22.5) and calculating a weighted average using the number of people in each band. For the open-ended top band (e.g., 90+), an upper cap of 95 years was assumed so a midpoint could be defined (treating 90 + as 90–95). Comparisons were made between: (I) high-need dental deserts (IMD 1–3 and no provider within 5 km), (ii) other dental deserts (IMD 4–10 and no provider within 5 km), and (iii) other deprived areas (IMD 1–3 with at least one provider within 5 km). Percentages were calculated within each comparison group. Figure 1 was constructed by linking LSOA December 2021 boundaries for England to IMD 2025 deciles and an NHS dental practice dataset. Active practices were geocoded from postcodes to British National Grid coordinates using the ONS Postcode Directory. For each LSOA, the centroid was calculated and Euclidean distance to the nearest NHS-listed practice was derived. High-need dental deserts were defined as LSOAs in IMD deciles 1–3 with no NHS-listed practice within 5 km (operationalised as nearest-provider distance > 5 km). The centroids of these LSOAs were plotted as blue points over an outline of England. Study geography and linkage completeness A total of 33,755 English LSOAs were included. IMD 2025 deciles and the mid-2022 population denominator were complete for all included LSOAs. The provider file contained 9,799 active practices after cleaning; 9,791 (99.9%) were successfully geocoded to valid British National Grid coordinates via ONSPD and included in distance calculations. Results Using the criterion of no provider within 5 km, 1,340 LSOAs (4.0% of English LSOAs) were classified as dental deserts, affecting 2,342,985 residents. High-need dental deserts (defined as IMD 1–3 and no provider within 5 km) comprised 112 LSOAs and affected 189,542 residents (Table 1 ). Table 1 Population living in LSOAs with no dental provider within 5 km, by deprivation group (England) IMD group Total LSOAs Total population LSOAs with no provider within 5 km Population with no provider within 5 km % of England population IMD 1–3 10,126 17,339,310 112 189,542 0.33% IMD 4–10 23,629 39,772,819 1,228 2,153,443 3.77% All IMD deciles (1–10) 33,755 57,112,129 1,340 2,342,985 4.1% High need dental deserts (IMD deciles 1–3) were less common among the most deprived LSOAs than among the more affluent IMD deciles 4–10. In IMD deciles 1–3, 189,542 inhabitants had no provider within 5 km, representing 1.09% of the IMD 1–3 population. In IMD deciles 4–10, there were 2,153,443 people with no provider within 5 km representing 5.41% of the IMD 4–10 population. Overall, 4.10% of the English population lived in LSOAs with no provider within 5 km. The high need dental desert group comprised 189,542 residents which were predominantly White (97.9%), with small proportions identifying as Asian, Black, Mixed, or Other ethnic groups. This contrasts with other deprived areas (IMD 1–3 LSOAs not in the desert group), which were substantially more ethnically diverse (70.1% White). In IMD deciles 4–10, 85.7% of residents were White. This indicates that the deprived communities experiencing the most geographic isolation from NHS-listed dental provision are demographically distinct from deprived areas overall. The age structure of the population living in LSOAs with no NHS provider within 5 km (Table 2 ) was similar in high-need severe deserts (IMD 1–3) and in other severe deserts (IMD 4–10). Table 2 Age structure of high need desert population (IMD 1–3) compared with the more affluent desert population (IMD 4–10) desert stratum LSOAs (n) Census 2021 usual residents (n) 0–15 years n (%) 16–64 years n (%) 65 + years n (%) High-need desert (IMD 1–3) 112 188,631 36,668 (19.4) 100,329 (53.2) 51,634 (27.4) Other desert (IMD 4–10) 1,228 2,129,536 415,383 (19.5) 1,141,829 (53.6) 572,324 (26.9) Summary counts (e.g., number of LSOAs and population affected) do not show whether high-need deserts are clustered or scattered, or where they occur in the country. Figure 1 shows that high-need dental deserts appear geographically clustered in non-metropolitan parts of England and are not concentrated in major inner-city conurbations. Using the Rural–Urban Classification 2021, high-need dental deserts were overwhelmingly rural: 97.0% (183,848/189,542, with only 3.0% (5,694/189,542) in urban LSOAs. This indicates that dental deserts are not an inner-city phenomenon in this dataset. Cornwall, East Lindsey, King's Lynn and West Norfolk are the 3 local authorities with the greatest number of people in the high need desert group (Table 3 ). Table 3 The 10 local authorities with the greatest number of people living in high-need dental deserts Rank Local authority (LA) High-need desert LSOAs (n) Population in high-need deserts (n) % of high-need desert population 1 Cornwall 19 33,926 17.9% 2 East Lindsey 15 25,519 13.5% 3 King's Lynn and West Norfolk 9 15,264 8.1% 4 Fenland 5 8,805 4.6% 5 East Riding of Yorkshire 6 8,575 4.5% 6 North Kesteven 3 5,878 3.1% 7 West Lindsey 4 5,549 2.9% 8 County Durham 4 5,439 2.9% 9 North Norfolk 3 4,547 2.4% 10 North Lincolnshire 3 4,533 2.4% In Table 3 , high-need dental deserts were defined as LSOAs in IMD 1–3 with no NHS-listed provider within 5 km. Counts and populations refer to LSOAs meeting the high-need dental desert definition within each local authority. Percentages use the high-need desert population total of 189,542 as the denominator (see Table 1 ). Populations are from the IMD 2025 mid-2022 LSOA population denominator. Discussion Most of the English population lived within short distances of a provider, while the 5 km threshold captured a smaller group experiencing more severe geographic isolation. Deserts were defined using straight-line distances from LSOA centroids to NHS-listed practices; this provides a consistent national screening metric but does not capture travel-time or variability in the quality of transport links between regions. This analysis included only NHS dental provision, allowing recommendations on NHS commissioning, so private dental practices were not therefore included. The analysis only estimated the NHS access deserts. As a result, the findings estimate NHS-access deserts rather than total dental availability, and may overstate geographic scarcity in areas where private provision fills gaps. A useful next step would be to repeat the analysis using all CQC-registered dental locations and compare NHS-only versus all-provider deserts. Dental deserts (those without access to NHS dentists within 5 km) affects about 2.34 million people. In general, the deserts are more prevalent outside the most deprived IMD 1–3 communities because although deprivation can be concentrated in urban areas, NHS provision is generally higher there. It is the 189,542 people (0.33% of the English population) that lack NHS provision within 5KM, and are in the most deprived communities (IMD 1-3), that are the group best suited for targeted commissioning, outreach, or incentives. Although this represents a small proportion of England’s population, it identifies communities facing combined social and geographic barriers, where targeted interventions are most likely to improve equity. It is a group that is overwhelmingly rural and predominantly White (97.9%). Rahman et al.⁴ conducted a national spatial accessibility analysis of US dental clinics and found that rurality and socioeconomic deprivation were significant predictors of poor access to dental services. These underserved rural areas were predominantly inhabited by white populations. Similar challenges are evident in the UK, where recruiting and retaining dental professionals has become increasingly difficult. Evidence indicates that the situation is deteriorating, with several regions struggling to maintain a stable dental workforce.⁵ In Cornwall and Devon, for example, a survey of dental practices identified limited transport links, traffic congestion, high accommodation costs, and a lack of local training facilities as major disincentives to working in the area.⁵ The UK Government’s 2025 consultation outcome proposes moderate reforms to the NHS dental contract intended to better align incentives with need. 6 Measures include higher fees for unscheduled and urgent care, additional payments for patients with more complex treatment needs, and enhanced prevention payments for fissure sealants. While such changes may improve responsiveness and preventive delivery where services are already geographically accessible, this analysis indicates that severe access deficits are concentrated in non-metropolitan settings. Urban areas are generally well served by provider proximity, whereas deprived communities in geographically isolated rural LSOAs face a compounded access barrier that payment uplifts alone are unlikely to resolve, pointing to the need for more structural solutions in commissioning and service delivery. Structural measures such as targeted procurement of outreach and domiciliary services, support for satellite clinics and workforce retention incentives are more likely to succeed. Declarations Ethics Declaration The author declares that he has no conflict of interest. All data involved in the study was anonymous and publicly available. There was no primary data collection . Data availability: Researchers wishing to have access to the data and R code should apply to the corresponding author (HD). This will be considered on a case-by-case basis, subject to institutional approval and data-sharing agreements. Funding acknowledgement: For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any author accepted manuscript version arising from this manuscript. References Dental deserts. An analysis of active dental practices offering NHS services across local authorities in England and Wales (2025). https://www.local.gov.uk/publications/dental-deserts-analysis-active-dental-practices-offering-nhs-services-across-local. NHS “dental deserts” persist in rural and deprived communities – LGA analysis (2022). https://www.local.gov.uk/about/news/nhs-dental-deserts-persist-rural-and-deprived-communities-lga-analysis Westgarth, D. Dental deserts: The exception or the rule? BDJ In Practice 37: 126-127. https://doi.org/10.1038/s41404-024-2684-z Rahman MS, Blossom JC, Kawachi I, Tipirneni R, Elani HW. Dental Clinic Deserts in the US: Spatial Accessibility Analysis. JAMA Netw Open. 2024;7(12):e2451625. doi:10.1001/jamanetworkopen. 2024.51625. Lall M. Dental practice workforce challenges in rural England: survey into recruitment and retention in Devon and Cornwall. Br Dent J 2023; https://doi.org/10.1038/s41415-023-6276-9. Government response to consultation on NHS dentistry contract: quality and payment reforms. Department of Health & Social Care (2025). https://www.gov.uk/government/consultations/nhs-dentistry-contract-quality-and-payment-reforms/outcome/government-response-to-consultation-on-nhs-dentistry-contract-quality-and-payment-reforms#government-response-and-next-steps. Additional Declarations There is no duality of interest Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: revise 28 Apr, 2026 Review # 2 received at journal 27 Apr, 2026 Review # 1 received at journal 05 Apr, 2026 Reviewer # 2 agreed at journal 29 Mar, 2026 Reviewer # 1 agreed at journal 19 Mar, 2026 Reviewers invited by journal 19 Mar, 2026 Editor assigned by journal 17 Mar, 2026 Submission checks completed at journal 17 Mar, 2026 First submitted to journal 13 Mar, 2026 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. We do this by developing innovative software and high quality services for the global research community. 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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-9117997","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":608688859,"identity":"4efd73d5-e70c-48af-af25-821cd0ae4086","order_by":0,"name":"Hugh Devlin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYBACAwYGNjDiY2ZgfMzAIAEUY24AS0kQ0sLGzMBsDFLHw8BIrBYgkgaJENRiLpF+7QFDmU1iGzvvserCPRb29uyNDQw/ahgSZzZg12I5I6fcgOFcWmIbM1/a7RnPJBJ7eA42MPYcY0icjcthN3LSJBjbDhuzMfOY3eY5IJHAI5HYwMDbwJA4D7+W/2AtxUAt9iAtjH/xakk/BtRyQA6khRmohbEHqIUZZAtOh515wyaRcC4ZpMVYesYBoF/OHGw4LHNMwhiX9w2Opz+T+FBmx8PPf8bwc8GBOnv29uaDD9/U2MjOOIDDGgYeA4YEdLEDuGMFBNgf4JEcBaNgFIyCUQAEAIiaT+/q5ykDAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-5120-747X","institution":"University of Bristol","correspondingAuthor":true,"prefix":"","firstName":"Hugh","middleName":"","lastName":"Devlin","suffix":""}],"badges":[],"createdAt":"2026-03-13 20:45:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9117997/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9117997/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105221383,"identity":"910922c7-b968-40c2-add2-bb8b9b1f4977","added_by":"auto","created_at":"2026-03-23 15:41:59","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":290695,"visible":true,"origin":"","legend":"\u003cp\u003eHigh Need Dental Deserts. \u0026nbsp;These include LSOAs with high need (IMD decile 1-3) and no NHS provider within 5 km represented by blue dots.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9117997/v1/98eae90894f42cb4532cff32.png"},{"id":105221436,"identity":"548396d8-d781-4936-a6fb-84b737a5d1ff","added_by":"auto","created_at":"2026-03-23 15:42:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":691124,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9117997/v1/00e65503-9b07-4525-95b6-4d4cc8f89e2b.pdf"}],"financialInterests":"There is no duality of interest","formattedTitle":"High-need dental deserts in England: a national spatial analysis of NHS access and deprivation","fulltext":[{"header":"Key points","content":"\u003cp\u003e1. Around 2.34\u0026nbsp;million people in England live in areas with no NHS dental provider within 5 km.\u003c/p\u003e\u003cp\u003e2. The most deprived population (in IMD 1\u0026ndash;3) affected by poor access is concentrated not in inner cities, but in rural areas.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eThe term \u0026ldquo;dental desert\u0026rdquo; has been used to describe those areas of the country lacking in a sufficient provision of dental services. A recent (2025) report from the Local Government Association\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e showed considerable variation in the availability of services. Local authorities with higher levels of overall deprivation were more likely to have fewer active NHS dental practices per 100,000 people than more affluent areas of England and Wales. The LGA report of 2022 found that deprived and rural local authority areas have fewer NHS dentists than those in more affluent urban areas.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e It is known that the South West of England, Yorkshire and the Humber and the North West, are most severely affected (98% of practices there do not accept new adult NHS patients).\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA dental desert was defined in this study as an area with no NHS dental providers within 5 km of that area\u0026rsquo;s geometric centre. A deprived subgroup of this population (high-need dental desert) was also obtained. The number of people living in England\u0026rsquo;s dental deserts, their geographic distribution and ethnic profile are not known. This study was undertaken to help fill that gap, providing evidence that can inform policy and stimulate debate.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design and setting\u003c/p\u003e \u003cp\u003eA cross-sectional spatial analysis was carried out of geographic access to dental providers across England, using Lower Layer Super Output Areas (LSOAs; December 2021 boundaries) as the unit of analysis. LSOAs are small areas designed by the Office of National Statistics (ONS) and contain about 1,000\u0026ndash;3,000 individuals. The English LSOA boundaries were obtained from the ONS Open Geography Portal (LSOA December 2021, EW, BGC). The socioeconomic deprivation and population data from each LSOA were taken from the Index of Multiple Deprivation (IMD) 2025 File 7. The IMD divides all English neighbourhoods into 10 equal-sized groups based on their level of deprivation, with deciles 1\u0026ndash;3 specified as \u0026ldquo;high-need\u0026rdquo;. The IMD File 7 mid-2022 population denominator was used to estimate the number of residents living in areas meeting dental desert criteria.\u003c/p\u003e \u003cp\u003eDental providers were derived from an NHS dental practice dataset (\u0026ldquo;NHS dental practices from NHS England\u0026rdquo;). Practices were restricted to those marked ACTIVE where status was available. Accordingly, the provider set represents NHS-listed provision, rather than a complete census of all practices. Provider postcodes were standardised to uppercase and stripped of whitespace and linked to geographic coordinates using the ONS Postcode Directory (ONSPD) hosted table. Coordinates were obtained as British National Grid (OSGB36; EPSG:27700) eastings and northings. Practices without valid coordinates after linkage were excluded from distance calculations.\u003c/p\u003e \u003cp\u003eGeographic access was measured by calculating the planar Euclidean distances from each LSOA centroid to provider locations in the British National Grid (BNG) coordinate system (EPSG:27700). The Euclidean distance from each LSOA centroid to the nearest dental provider was computed, and the number of providers that were within a 5-km radius of each centroid was determined. This enabled identification of dental deserts, defined as LSOAs with zero dental providers within 5 km of the LSOA centroid. A \u0026ldquo;high-need dental desert\u0026rdquo; subgroup was defined as LSOAs in IMD deciles 1\u0026ndash;3 with no providers within 5 km. The population residing in dental deserts and in the high-need subgroup was estimated. To assess deprivation patterning, we compared outcomes for IMD 1\u0026ndash;3 with IMD 4\u0026ndash;10, reporting the proportion of each group\u0026rsquo;s population living in LSOAs with no provider within 5 km.\u003c/p\u003e \u003cp\u003eLSOA-level population characteristics were used to profile areas meeting the high-need dental desert definition (IMD 2025 deciles 1\u0026ndash;3 and no NHS-listed dental provider within 5 km of the LSOA centroid) and to compare them with other desert and non-desert areas. Ethnicity was obtained from Census 2021 table TS021 and joined to the analytic dataset using LSOA 2021 codes; ethnic group was collapsed into five broad categories (White; Asian; Black; Mixed; Other). Age structure was obtained from Census 2021 table TS007a and aggregated into three bands (0\u0026ndash;15, 16\u0026ndash;64 and 65+). For age, proportions were calculated using Census 2021 usual resident denominators. Mean age was approximated from Census age-band counts by assigning each age band its midpoint (e.g., 20\u0026ndash;24 \u0026rarr; 22.5) and calculating a weighted average using the number of people in each band. For the open-ended top band (e.g., 90+), an upper cap of 95 years was assumed so a midpoint could be defined (treating 90\u0026thinsp;+\u0026thinsp;as 90\u0026ndash;95). Comparisons were made between: (I) high-need dental deserts (IMD 1\u0026ndash;3 and no provider within 5 km), (ii) other dental deserts (IMD 4\u0026ndash;10 and no provider within 5 km), and (iii) other deprived areas (IMD 1\u0026ndash;3 with at least one provider within 5 km). Percentages were calculated within each comparison group.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e was constructed by linking LSOA December 2021 boundaries for England to IMD 2025 deciles and an NHS dental practice dataset. Active practices were geocoded from postcodes to British National Grid coordinates using the ONS Postcode Directory. For each LSOA, the centroid was calculated and Euclidean distance to the nearest NHS-listed practice was derived. High-need dental deserts were defined as LSOAs in IMD deciles 1\u0026ndash;3 with no NHS-listed practice within 5 km (operationalised as nearest-provider distance\u0026thinsp;\u0026gt;\u0026thinsp;5 km). The centroids of these LSOAs were plotted as blue points over an outline of England.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy geography and linkage completeness\u003c/h2\u003e \u003cp\u003eA total of 33,755 English LSOAs were included. IMD 2025 deciles and the mid-2022 population denominator were complete for all included LSOAs. The provider file contained 9,799 active practices after cleaning; 9,791 (99.9%) were successfully geocoded to valid British National Grid coordinates via ONSPD and included in distance calculations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eUsing the criterion of no provider within 5 km, 1,340 LSOAs (4.0% of English LSOAs) were classified as dental deserts, affecting 2,342,985 residents. High-need dental deserts (defined as IMD 1\u0026ndash;3 and no provider within 5 km) comprised 112 LSOAs and affected 189,542 residents (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePopulation living in LSOAs with no dental provider within 5 km, by deprivation group (England)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMD group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal LSOAs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLSOAs with no provider within 5 km\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePopulation with no provider within 5 km\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e% of England population\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMD 1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10,126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17,339,310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e189,542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMD 4\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23,629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39,772,819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2,153,443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.77%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll IMD deciles (1\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33,755\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57,112,129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2,342,985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHigh need dental deserts (IMD deciles 1\u0026ndash;3) were less common among the most deprived LSOAs than among the more affluent IMD deciles 4\u0026ndash;10. In IMD deciles 1\u0026ndash;3, 189,542 inhabitants had no provider within 5 km, representing 1.09% of the IMD 1\u0026ndash;3 population. In IMD deciles 4\u0026ndash;10, there were 2,153,443 people with no provider within 5 km representing 5.41% of the IMD 4\u0026ndash;10 population. Overall, 4.10% of the English population lived in LSOAs with no provider within 5 km.\u003c/p\u003e \u003cp\u003eThe high need dental desert group comprised 189,542 residents which were predominantly White (97.9%), with small proportions identifying as Asian, Black, Mixed, or Other ethnic groups. This contrasts with other deprived areas (IMD 1\u0026ndash;3 LSOAs not in the desert group), which were substantially more ethnically diverse (70.1% White). In IMD deciles 4\u0026ndash;10, 85.7% of residents were White. This indicates that the deprived communities experiencing the most geographic isolation from NHS-listed dental provision are demographically distinct from deprived areas overall.\u003c/p\u003e \u003cp\u003eThe age structure of the population living in LSOAs with no NHS provider within 5 km (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) was similar in high-need severe deserts (IMD 1\u0026ndash;3) and in other severe deserts (IMD 4\u0026ndash;10).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge structure of high need desert population (IMD 1\u0026ndash;3) compared with the more affluent desert population (IMD 4\u0026ndash;10)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003edesert stratum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLSOAs (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCensus 2021 usual residents (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u0026ndash;15 years n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u0026ndash;64 years n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65\u0026thinsp;+\u0026thinsp;years n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh-need desert (IMD 1\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e188,631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36,668 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100,329 (53.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51,634 (27.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther desert (IMD 4\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,129,536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e415,383 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,141,829 (53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e572,324 (26.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSummary counts (e.g., number of LSOAs and population affected) do not show whether high-need deserts are clustered or scattered, or where they occur in the country. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that high-need dental deserts appear geographically clustered in non-metropolitan parts of England and are not concentrated in major inner-city conurbations. Using the Rural\u0026ndash;Urban Classification 2021, high-need dental deserts were overwhelmingly rural: 97.0% (183,848/189,542, with only 3.0% (5,694/189,542) in urban LSOAs. This indicates that dental deserts are not an inner-city phenomenon in this dataset. Cornwall, East Lindsey, King's Lynn and West Norfolk are the 3 local authorities with the greatest number of people in the high need desert group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe 10 local authorities with the greatest number of people living in high-need dental deserts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocal authority (LA)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh-need desert LSOAs (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePopulation in high-need deserts (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e% of high-need desert population\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCornwall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33,926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEast Lindsey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25,519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKing's Lynn and West Norfolk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15,264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFenland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEast Riding of Yorkshire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth Kesteven\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWest Lindsey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCounty Durham\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth Norfolk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth Lincolnshire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, high-need dental deserts were defined as LSOAs in IMD 1\u0026ndash;3 with no NHS-listed provider within 5 km. Counts and populations refer to LSOAs meeting the high-need dental desert definition within each local authority. Percentages use the high-need desert population total of 189,542 as the denominator (see Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Populations are from the IMD 2025 mid-2022 LSOA population denominator.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMost of the English population lived within short distances of a provider, while the 5 km threshold captured a smaller group experiencing more severe geographic isolation. \u0026nbsp;Deserts were defined using straight-line distances from LSOA centroids to NHS-listed practices; this provides a consistent national screening metric but does not capture travel-time or variability in the quality of transport links between regions. \u0026nbsp;This analysis included only NHS dental provision, allowing recommendations on NHS commissioning, so private dental practices were not therefore included. \u0026nbsp;The analysis only estimated the NHS access deserts. \u0026nbsp; As a result, the findings estimate NHS-access deserts rather than total dental availability, and may overstate geographic scarcity in areas where private provision fills gaps. A useful next step would be to repeat the analysis using all CQC-registered dental locations and compare NHS-only versus all-provider deserts.\u003c/p\u003e\n\u003cp\u003eDental deserts (those without access to NHS dentists within 5 km) affects about 2.34 million people. \u0026nbsp;In general, the deserts are more prevalent outside the most deprived IMD 1–3 communities because although deprivation can be concentrated in urban areas, NHS provision is generally higher there. \u0026nbsp;It is the 189,542 people (0.33% of the English population) that lack NHS provision within 5KM, and are in the most deprived communities (IMD 1-3), that are the group best suited for targeted commissioning, outreach, or incentives. \u0026nbsp;Although this represents a small proportion of England’s population, it identifies communities facing combined social and geographic barriers, where targeted interventions are most likely to improve equity. \u0026nbsp;It is a group that is overwhelmingly rural and \u0026nbsp;predominantly White (97.9%). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRahman et al.⁴ conducted a national spatial accessibility analysis of US dental clinics and found that rurality and socioeconomic deprivation were significant predictors of poor access to dental services. These underserved rural areas were predominantly inhabited by white populations. Similar challenges are evident in the UK, where recruiting and retaining dental professionals has become increasingly difficult. Evidence indicates that the situation is deteriorating, with several regions struggling to maintain a stable dental workforce.⁵ In Cornwall and Devon, for example, a survey of dental practices identified limited transport links, traffic congestion, high accommodation costs, and a lack of local training facilities as major disincentives to working in the area.⁵ \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe UK Government’s 2025 consultation outcome proposes moderate reforms to the NHS dental contract intended to better align incentives with need.\u003csup\u003e6\u003c/sup\u003e\u0026nbsp; Measures include higher fees for unscheduled and urgent care, additional payments for patients with more complex treatment needs, and enhanced prevention payments for fissure sealants. While such changes may improve responsiveness and preventive delivery where services are already geographically accessible, this analysis indicates that severe access deficits are concentrated in non-metropolitan settings. Urban areas are generally well served by provider proximity, whereas deprived communities in geographically isolated rural LSOAs face a compounded access barrier that payment uplifts alone are unlikely to resolve, pointing to the need for more structural solutions in commissioning and service delivery. \u0026nbsp;Structural measures such as targeted procurement of outreach and domiciliary services, support for satellite clinics and workforce retention incentives are more likely to succeed.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Declaration\u003c/p\u003e\n\u003cp\u003eThe author declares that he has no conflict of interest. All data involved in the study was anonymous and publicly available. There was no primary data collection\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData availability: Researchers wishing to have access to the data and R code should apply to the corresponding author (HD). This will be considered on a case-by-case basis, subject to institutional approval and data-sharing agreements.\u003c/p\u003e\n\u003cp\u003eFunding acknowledgement: For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any author accepted manuscript version arising from this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDental deserts. An analysis of active dental practices offering NHS services across local authorities in England and Wales (2025). https://www.local.gov.uk/publications/dental-deserts-analysis-active-dental-practices-offering-nhs-services-across-local. \u003c/li\u003e\n\u003cli\u003eNHS \u0026ldquo;dental deserts\u0026rdquo; persist in rural and deprived communities \u0026ndash; LGA analysis (2022). https://www.local.gov.uk/about/news/nhs-dental-deserts-persist-rural-and-deprived-communities-lga-analysis\u003c/li\u003e\n\u003cli\u003eWestgarth, D. Dental deserts: The exception or the rule? BDJ In Practice 37: 126-127. https://doi.org/10.1038/s41404-024-2684-z\u003c/li\u003e\n\u003cli\u003eRahman MS, Blossom JC, Kawachi I, Tipirneni R, Elani HW. Dental Clinic Deserts in the US: Spatial Accessibility Analysis. JAMA Netw Open. 2024;7(12):e2451625. doi:10.1001/jamanetworkopen. 2024.51625.\u003c/li\u003e\n\u003cli\u003eLall M. Dental practice workforce challenges in rural England: survey into recruitment and retention in Devon and Cornwall. \u003cem\u003eBr Dent J \u003c/em\u003e2023; https://doi.org/10.1038/s41415-023-6276-9.\u003c/li\u003e\n\u003cli\u003eGovernment response to consultation on NHS dentistry contract: quality and payment reforms. Department of Health \u0026amp; Social Care (2025). https://www.gov.uk/government/consultations/nhs-dentistry-contract-quality-and-payment-reforms/outcome/government-response-to-consultation-on-nhs-dentistry-contract-quality-and-payment-reforms#government-response-and-next-steps.\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-9117997/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9117997/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim(s)\u003c/h2\u003e \u003cp\u003eThe aim of this study was to identify high-need dental deserts in England and to quantify the population affected, describe the distribution of geographic access, and profile the demographic characteristics of this subgroup relative to other deserts.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional spatial analysis was undertaken using LSOA December 2021 boundaries (England) linked to IMD 2025 File 7 (deciles; mid-2022 population denominators). NHS dental practices were geocoded from postcodes using the ONS Postcode Directory and analysed in British National Grid. Euclidean distance from each LSOA centroid to the nearest NHS-listed practice was calculated, and LSOAs with no NHS provider within 5 km were classified as dental deserts. The high-need desert subgroup comprised deserts in IMD deciles 1\u0026ndash;3. Demographic profiling used Census 2021 ethnicity (TS021) and age structure (TS007a), comparing high-need deserts with other deserts.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAcross England, 1,340 LSOAs (population 2,342,985) had no NHS-listed dental provider within 5 km. The high-need desert subgroup comprised 112 LSOAs of 189,542 residents who lived in the most deprived IMD 1\u0026ndash;3 group with high need but no dental provider within 5 km. This compared with 2,153,443 people in the more affluent IMD 4\u0026ndash;10 group with no dental provider. The high-need desert population was predominantly White (97.9%) and had an age profile similar to other deserts not in the IMD 1\u0026ndash;3 group (0\u0026ndash;15: 19.4% vs 19.5%; 65+: 27.4% vs 26.9%).\u003c/p\u003e\u003ch2\u003eConclusion(s)\u003c/h2\u003e \u003cp\u003eGeographic exclusion from NHS-listed dental provision affects about 2.3\u0026nbsp;million residents in England, while the high-need dental desert subgroup included approximately 190,000 residents. High-need deserts are demographically distinct in ethnic composition yet similar in age structure to other deserts. Routine national spatial audits using LSOA-level deprivation and access metrics could support targeted service planning for communities facing combined socioeconomic disadvantage and geographic isolation.\u003c/p\u003e","manuscriptTitle":"High-need dental deserts in England: a national spatial analysis of NHS access and deprivation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-23 15:40:30","doi":"10.21203/rs.3.rs-9117997/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2026-04-28T14:22:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-04-27T20:59:52+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-04-06T00:00:57+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-03-29T14:45:50+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-03-19T10:54:15+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2026-03-19T07:15:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-17T11:23:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-17T11:23:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"British Dental Journal","date":"2026-03-13T20:44:35+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":"9a6fa7f7-fb4d-4952-9840-c74fda129d5a","owner":[],"postedDate":"March 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":64771637,"name":"Health sciences/Health care/Dentistry/Dental public health"}],"tags":[],"updatedAt":"2026-05-05T20:06:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-23 15:40:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9117997","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9117997","identity":"rs-9117997","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}