Dental Practice Distribution: Challenging Assumptions about Deprivation and Access.

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Hugh Devlin, Raman Bedi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8348729/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Aim To examine the distribution of dental practices across deprivation deciles, using data from Bristol Local Health Authority. Materials and Methods Analysis of dental practice density (dentists per 10,000 residents) across the Index of Multiple Deprivation (IMD) deciles. Decile 1 represents the most deprived areas and decile 10 the least deprived. Results A non-linear relationship was observed between deprivation and dental practice density. Deprivation did not predict dental practice distribution, with upper-middle deciles showing the highest provision. The least deprived decile (10) had the lowest NHS dental practice density (0.36 per 10,000 residents). The most deprived areas (deciles 1–3) showed variable practice densities (0.52, 0.93, 0.53). Conclusion Multiple demographic factors and market forces influence practice density. Commissioning strategies must incorporate data on these factors, rather than relying on deprivation indices. Areas with large populations, but little NHS dental provision, may require distinct policy responses. Health sciences/Health care/Dentistry/Dental public health Figures Figure 1 Introduction When strong market forces are present, the provision of high-quality medical care in the community is inversely proportional to its availability (the inverse care law) 1 . In England, dental services operate within a mixed economy, with NHS contract holders providing publicly funded care alongside private practitioners. The geographic distribution of dental practices has significant implications for health equity, especially given the strong association between socio-economic status and health outcomes. The latest Adult Oral Health Survey (AOHS) 2 , commissioned by the Government’s Office for Health Improvements and Disparities (OHID) - Department of Health and Social Care, showed that adults in more deprived areas are suffering disproportionately higher levels of oral disease and are also finding it harder to get a dental appointment than those in more affluent areas. The Bristol Local Authority was selected as a case study because it combines substantial socioeconomic diversity. The city encompasses areas spanning the full range of national deprivation levels, enabling comparisons of dental practice distribution across these regions. Using high-quality, publicly available data for Bristol, we tested whether population and deprivation were related to the distribution of NHS dental practice establishments. We considered whether the observed patterns conform to expectations derived from the inverse care law and consider the policy implications. Methodology This study examined the distribution of NHS dental practices within the Bristol Local Authority area and assessed how access to dental services varied according to socioeconomic deprivation and population size. Using publicly available datasets and geographic information system (GIS) techniques, analysis was performed using the R statistical environment (version RStudio 2025.09.2+418 "Cucumberleaf Sunflower" Release). The basic unit of the geographic analysis used was the “Lower Layer Super Output Area (LSOA)”, which is a small geographical area of around 1,000-3,000 inhabitants in England and Wales, used by the Office for National Statistics (ONS) to analyse inequalities, health outcomes, and other demographic data . Four open source primary datasets were utilised: Index of Multiple Deprivation (IMD) 2019 File 1: Index of Multiple Deprivation (IMD) 2019 was downloaded from the Department for Levelling Up, Housing and Communities and provided LSOA-level deprivation scores, ranks, and deciles. IMD is based on 37 indicators, across 7 domains of deprivation. LSOA Boundary Geometries 2021 Lower Layer Super Output Area (LSOA) spatial boundaries for England were obtained from the Office for National Statistics (ONS) Open Geography Portal. Only LSOAs within the Bristol Local Authority boundary were retained for analysis. NHS Dental Establishment Locations The dataset Health Establishments (containing geocoded NHS dental practices) was downloaded and filtered to include only providers with a recorded HEALTH_TYP of “Dentist”. LSOA Population Estimates 2021 LSOA_population_Bristol_2021.csv was obtained from ONS small-area population estimates and included total resident population counts for each Bristol LSOA. All datasets were imported into R using the sf, readr, and dplyr packages. LSOA-level IMD data were merged with LSOA boundary polygons based on the shared LSOA code. NHS dental practices were spatially joined to LSOA polygons using coordinate matching to calculate the number of dental establishments within each LSOA. The resulting dataset contained, for each LSOA: IMD decile, total number of dental practices ( ) and geographic boundary information. Only dental practices were included in this analysis, and not dentists per practice. Population data were pre-processed to retain only the variables representing the LSOA code and total resident population (“Total”). These were linked to the dental–IMD dataset, enabling population-standardised analysis. LSOAs without matching population values were excluded. Outcome Measures Two indicators of dental service provision were derived: Raw service density: number of NHS dental practices per LSOA. Population-adjusted access: number of NHS dental practices per 10,000 residents, calculated as: This adjustment accounted for substantial variation in population size across LSOAs and enabled meaningful comparison between areas. Statistical and Spatial Analyses The final analytical dataset was grouped by IMD decile. For each decile, summary statistics were generated, including: Total population, Total NHS dental practices, Mean and median dentists per 10,000 residents, Overall, dentists per 10,000 residents for the decile. Spatial outputs, including updated shapefiles, were exported for potential mapping in GIS software. All outputs were saved using st_write() and write_csv(). This reproducible workflow ensured transparent analytic stages and avoided manual data manipulation. To investigate whether deprivation or neighbourhood size influences where NHS dental practices are located in Bristol, each dental practice was assigned to the LSOA in which it falls based on its geographical coordinates. We then counted the number of practices in each LSOA and linked these counts to two characteristics of the same LSOA: their IMD decile (a measure of deprivation) and their physical area in square metres. We analysed these data using a linear regression model of the form: This model tests whether deprivation level or neighbourhood size helps predict the number of practices in an area. Results A total of 38 NHS dental practices were identified within the Bristol Local Authority boundary. These practices were spatially assigned to LSOAs and subsequently aggregated by the 2019 Index of Multiple Deprivation (IMD) deciles to examine patterns in service provision relative to area-level socioeconomic status. Substantial variation was observed in both the absolute distribution of dental services and their population-standardised availability. Distribution of NHS Dental Practices by Deprivation Raw counts indicated that dental practices were not evenly distributed across deprivation levels. The most deprived decile (IMD Decile 1) had 4 practices, whereas the second decile had the highest number (7). In contrast, the least deprived decile (Decile 10) contained only 1 practice. Intermediate deciles showed fluctuating values, with Decile 7 and Decile 9 each containing 5 practices. These patterns suggest that more deprived and more affluent areas do not necessarily have greater absolute provision, and raw counts alone may misrepresent true service accessibility. Population Characteristics Population size varied markedly between IMD deciles, ranging from 25,174 residents (Decile 6) to 76,390 residents (Decile 1). The most deprived areas contained the largest resident populations, while several less deprived deciles housed far fewer residents. This imbalance highlights the need to interpret raw practice counts cautiously, as identical practice counts may serve very different population sizes. Table 1 Population and Dental Practice Distribution by IMD Decile IMD Decile Total Population Total dental practices 1 76,390 4 2 75,573 7 3 56,955 3 4 56,498 6 5 46,813 3 6 25,174 1 7 51,488 5 8 33,057 3 9 27,093 5 10 27,732 1 Population-Adjusted Access to Dental Services To account for population differences, access was standardised as the number of NHS dental practices per 10,000 residents. Once adjusted, deprivation gradients became more apparent. The most deprived decile (Decile 1) had 0.52 dentists per 10,000 residents, despite having the highest population. By comparison, Decile 9 had 1.85 dental practices per 10,000 residents, representing the highest ratio in Bristol and more than three times that of the most deprived areas. Deciles 2, 4, 7, and 8 also exceeded the 0.9 threshold, with Decile 4 (1.06) being the only low-to-middle deprivation group to surpass 1 dentist per 10,000 residents. The least deprived decile (Decile 10) demonstrated 0.36 NHS dental practices per 10,000 residents, indicating low per-capita access and low deprivation scores. This analysis did not take into account private practice dental provision. A disproportionately large dentist-to-population ratio is observed in IMD Decile 9, but this may be due to the relatively small population in this cohort (27,093 residents). These affluent areas may offer opportunities for mixed NHS/private dental practices, which are less available in more deprived areas. Table 2 NHS Dental practices per 10,000 Residents by IMD Decile IMD Decile Dental practices / 10,000 residents 1 0.524 2 0.926 3 0.527 4 1.060 5 0.641 6 0.397 7 0.971 8 0.908 9 1.850 (highest) 10 0.361 (lowest) Only 7% of the variation in NHS dental practice availability per 10,000 residents is explained by deprivation (IMD decile), multiple R² = 0.070 and when adjusted for sample size, that relationship becomes negative (Adjusted R² < 0). The linear regression model is not statistically significant (p = 0.46), indicating that IMD decile does not meaningfully predict dental practice density once population size is considered. A non-parametric Kruskal–Wallis test identified a statistically significant difference in LSOA area across IMD deciles (χ²(9) = 25.98, p = 0.002). LSOA area differs according to deprivation level, although no linear relationship was identified between deprivation and area. A parametric ANOVA did not detect a difference in mean LSOA area across IMD deciles, (F(1,261) = 1.39, p = 0.24), suggesting that the variation is non-linear and distributional rather than reflected in the mean values. As a result, comparisons of service provision by deprivation level may also reflect differences in the size of the areas being compared, rather than deprivation alone. There was no evidence of a simple increasing or decreasing trend between deprivation and area. A linear regression model was therefore used to test whether deprivation level or neighbourhood size was predictive of the number of dental practices in an area. The results showed that neither IMD decile nor LSOA area had a statistically significant association with the number of NHS dental practices, and the model explained almost none of the variation in their distribution (adjusted R² ≈ 0). Deprived and less deprived areas were therefore equally likely to contain a practice, and larger LSOAs did not have more or fewer practices than smaller ones. Discussion These findings demonstrate that the absolute number of NHS dental practices within an area was independent of deprivation index or LSOA size. Typically, deprived neighbourhoods experience the highest burden of oral disease, but they do not contain significantly more NHS dental practices after accounting for area size. There was no consistent pattern of dental practice numbers across the spectrum of IMD deciles. This analysis did not account for private dental practice, and unmet NHS demand may be mitigated through private dental services, although this requires further investigation. It has been traditionally assumed that inequality in dental access is directly related to socioeconomic deprivation. Still, the present analysis found no linear or nonlinear association between IMD decile and NHS dental practice density. Instead, dental practices appear to cluster in commercially viable locations characterised by good transport links, accessible premises, and opportunities for mixed NHS–private provision. These spatial-economic factors may better explain the low density of practices observed in deprived areas, rather than deprivation itself. The concentration of NHS dental practices in IMD decile 9, rather than decile 10, suggests an optimal business model that balances potential patient income, population density and operating costs (see Fig. 1 ). Our analysis did not account for the historical pattern of dental practice locations. Localised concentrations of practices can persist despite changing socioeconomic conditions. For example, some areas may have inherited dental infrastructures from a previous period when they were more or less prosperous. Furthermore, our data analysis may represent an over-simplification and require a deeper investigation of appointment availability, dentist numbers, and patient flows. Social and environmental factors are important in influencing health 3 and health provision. The 2009 independent review of NHS dental services 4 emphasised the need for a service focused on oral health outcomes and prevention, delivered equitably across the population. The complex patterns identified in this analysis emphasise the continued relevance of these recommendations and suggest that equitable access remains an ongoing challenge requiring sustained policy attention. References Hart JT. The inverse care law. Lancet 1971; 297(7696): 405–412. Adult Oral Health Survey (AOHS), commissioned by the Government’s Office for Health Improvements and Disparities (OHID) - Department of Health and Social Care. https://www.gov.uk/government/statistics/adult-oral-health-survey-2023 . Watt RG, Sheiham A. Integrating the common risk factor approach into a social determinants framework. Community Dent Oral Epidemiol. 2012;40(4):289–96. Department of Health. NHS dental services in England: an independent review led by Professor Jimmy Steele. London: Department of Health; 2009. Additional Declarations There is no duality of interest Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: revise 10 Feb, 2026 Review # 4 received at journal 08 Feb, 2026 Reviewer # 4 agreed at journal 30 Jan, 2026 Review # 3 received at journal 07 Jan, 2026 Reviewer # 3 agreed at journal 05 Jan, 2026 Reviewer # 2 agreed at journal 31 Dec, 2025 Reviewer # 1 agreed at journal 17 Dec, 2025 Reviewers invited by journal 17 Dec, 2025 Editor assigned by journal 16 Dec, 2025 Submission checks completed at journal 16 Dec, 2025 First submitted to journal 16 Dec, 2025 Unknown event 14 Dec, 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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1","display":"","copyAsset":false,"role":"figure","size":100723,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8348729/v1/7675ac21682547b2fa3ba58f.png"},{"id":98782575,"identity":"34506be2-05a3-4ee5-89cf-e7d1eff0aec4","added_by":"auto","created_at":"2025-12-22 12:40:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":504214,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8348729/v1/b3c745df-820f-4242-8feb-e34d6eb6bf96.pdf"}],"financialInterests":"There is no duality of interest","formattedTitle":"Dental Practice Distribution: Challenging Assumptions about Deprivation and Access.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWhen strong market forces are present, the provision of high-quality medical care in the community is inversely proportional to its availability (the inverse care law)\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In England, dental services operate within a mixed economy, with NHS contract holders providing publicly funded care alongside private practitioners. The geographic distribution of dental practices has significant implications for health equity, especially given the strong association between socio-economic status and health outcomes. The latest Adult Oral Health Survey (AOHS)\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, commissioned by the Government\u0026rsquo;s Office for Health Improvements and Disparities (OHID) - Department of Health and Social Care, showed that adults in more deprived areas are suffering disproportionately higher levels of oral disease and are also finding it harder to get a dental appointment than those in more affluent areas.\u003c/p\u003e \u003cp\u003eThe Bristol Local Authority was selected as a case study because it combines substantial socioeconomic diversity. The city encompasses areas spanning the full range of national deprivation levels, enabling comparisons of dental practice distribution across these regions. Using high-quality, publicly available data for Bristol, we tested whether population and deprivation were related to the distribution of NHS dental practice establishments. We considered whether the observed patterns conform to expectations derived from the inverse care law and consider the policy implications.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis study examined the distribution of NHS dental practices within the Bristol Local Authority area and assessed how access to dental services varied according to socioeconomic deprivation and population size. Using publicly available datasets and geographic information system (GIS) techniques, analysis was performed using the R statistical environment (version RStudio 2025.09.2+418 \u0026quot;Cucumberleaf Sunflower\u0026quot; Release). \u0026nbsp;The basic unit of the geographic analysis used was the \u0026ldquo;Lower Layer Super Output Area (LSOA)\u0026rdquo;, which is a small geographical area of around 1,000-3,000 inhabitants in England and Wales, used by the Office for National Statistics (ONS) to analyse inequalities, health outcomes, and other demographic data .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFour open source primary datasets were utilised:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cem\u003eIndex of Multiple Deprivation (IMD) 2019\u003cbr\u003e\u0026nbsp;\u003c/em\u003eFile 1: \u003cem\u003eIndex of Multiple Deprivation (IMD) 2019\u003c/em\u003e was downloaded from the Department for Levelling Up, Housing and Communities and provided LSOA-level deprivation scores, ranks, and deciles. \u0026nbsp; IMD is based on 37 indicators, across 7 domains of deprivation.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eLSOA Boundary Geometries\u003c/em\u003e\u003cbr\u003e\u0026nbsp;2021 Lower Layer Super Output Area (LSOA) spatial boundaries for England were obtained from the Office for National Statistics (ONS) Open Geography Portal. Only LSOAs within the Bristol Local Authority boundary were retained for analysis.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eNHS Dental Establishment Locations\u003c/em\u003e\u003cbr\u003e The dataset \u003cem\u003eHealth Establishments\u003c/em\u003e (containing geocoded NHS dental practices) was downloaded and filtered to include only providers with a recorded HEALTH_TYP of \u0026ldquo;Dentist\u0026rdquo;.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eLSOA Population Estimates 2021\u003c/em\u003e\u003cbr\u003e \u003cem\u003eLSOA_population_Bristol_2021.csv\u003c/em\u003e was obtained from ONS small-area population estimates and included total resident population counts for each Bristol LSOA.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAll datasets were imported into R using the sf, readr, and dplyr packages. LSOA-level IMD data were merged with LSOA boundary polygons based on the shared LSOA code. NHS dental practices were spatially joined to LSOA polygons using coordinate matching to calculate the number of dental establishments within each LSOA. The resulting dataset contained, for each LSOA: IMD decile, total number of dental practices (\u003cimg width=\"55\" height=\"22\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e) and geographic boundary information. \u0026nbsp;Only dental practices were included in this analysis, and not dentists per practice. \u003c/p\u003e\n\u003cp\u003ePopulation data were pre-processed to retain only the variables representing the LSOA code and total resident population (\u0026ldquo;Total\u0026rdquo;). These were linked to the dental\u0026ndash;IMD dataset, enabling population-standardised analysis. LSOAs without matching population values were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOutcome Measures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTwo indicators of dental service provision were derived:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eRaw service density: number of NHS dental practices per LSOA.\u003c/li\u003e\n \u003cli\u003ePopulation-adjusted access: number of NHS dental practices per 10,000 residents, calculated as:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cimg width=\"441\" height=\"38\" 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\" alt=\"image\"\u003e\u003c/p\u003e\n\u003cp\u003eThis adjustment accounted for substantial variation in population size across LSOAs and enabled meaningful comparison between areas.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical and Spatial Analyses\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe final analytical dataset was grouped by IMD decile. For each decile, summary statistics were generated, including:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTotal population,\u003c/li\u003e\n \u003cli\u003eTotal NHS dental practices,\u003c/li\u003e\n \u003cli\u003eMean and median dentists per 10,000 residents,\u003c/li\u003e\n \u003cli\u003eOverall, dentists per 10,000 residents for the decile.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eSpatial outputs, including updated shapefiles, were exported for potential mapping in GIS software. All outputs were saved using st_write() and write_csv(). This reproducible workflow ensured transparent analytic stages and avoided manual data manipulation.\u003c/p\u003e\n\u003cp\u003eTo investigate whether deprivation or neighbourhood size influences where NHS dental practices are located in Bristol, each dental practice was assigned to the LSOA in which it falls based on its geographical coordinates. We then counted the number of practices in each LSOA and linked these counts to two characteristics of the same LSOA: their IMD decile (a measure of deprivation) and their physical area in square metres.\u003c/p\u003e\n\u003cp\u003eWe analysed these data using a linear regression model of the form:\u003c/p\u003e\n\u003cp\u003e\u003cimg width=\"547\" height=\"20\" 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\" alt=\"image\"\u003e\u003c/p\u003e\n\u003cp\u003eThis model tests whether deprivation level or neighbourhood size helps predict the number of practices in an area.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 38 NHS dental practices were identified within the Bristol Local Authority boundary. These practices were spatially assigned to LSOAs and subsequently aggregated by the 2019 Index of Multiple Deprivation (IMD) deciles to examine patterns in service provision relative to area-level socioeconomic status. Substantial variation was observed in both the absolute distribution of dental services and their population-standardised availability.\u003c/p\u003e\n\u003ch3\u003eDistribution of NHS Dental Practices by Deprivation\u003c/h3\u003e\n\u003cp\u003eRaw counts indicated that dental practices were not evenly distributed across deprivation levels. The most deprived decile (IMD Decile 1) had 4 practices, whereas the second decile had the highest number (7). In contrast, the least deprived decile (Decile 10) contained only 1 practice. Intermediate deciles showed fluctuating values, with Decile 7 and Decile 9 each containing 5 practices. These patterns suggest that more deprived and more affluent areas do not necessarily have greater absolute provision, and raw counts alone may misrepresent true service accessibility.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePopulation Characteristics\u003c/h2\u003e \u003cp\u003ePopulation size varied markedly between IMD deciles, ranging from 25,174 residents (Decile 6) to 76,390 residents (Decile 1). The most deprived areas contained the largest resident populations, while several less deprived deciles housed far fewer residents. This imbalance highlights the need to interpret raw practice counts cautiously, as identical practice counts may serve very different population sizes.\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 and Dental Practice Distribution by IMD Decile\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMD Decile\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal dental practices\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76,390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75,573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56,955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56,498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46,813\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25,174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51,488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33,057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27,093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27,732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePopulation-Adjusted Access to Dental Services\u003c/h2\u003e \u003cp\u003eTo account for population differences, access was standardised as the number of NHS dental practices per 10,000 residents. Once adjusted, deprivation gradients became more apparent.\u003c/p\u003e \u003cp\u003eThe most deprived decile (Decile 1) had 0.52 dentists per 10,000 residents, despite having the highest population. By comparison, Decile 9 had 1.85 dental practices per 10,000 residents, representing the highest ratio in Bristol and more than three times that of the most deprived areas. Deciles 2, 4, 7, and 8 also exceeded the 0.9 threshold, with Decile 4 (1.06) being the only low-to-middle deprivation group to surpass 1 dentist per 10,000 residents. The least deprived decile (Decile 10) demonstrated 0.36 NHS dental practices per 10,000 residents, indicating low per-capita access and low deprivation scores. This analysis did not take into account private practice dental provision.\u003c/p\u003e \u003cp\u003eA disproportionately large dentist-to-population ratio is observed in IMD Decile 9, but this may be due to the relatively small population in this cohort (27,093 residents). These affluent areas may offer opportunities for mixed NHS/private dental practices, which are less available in more deprived areas.\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\u003eNHS Dental practices per 10,000 Residents by IMD Decile\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMD Decile\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDental practices / 10,000 residents\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\u003e\u003cb\u003e0.524\u003c/b\u003e\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\u003e\u003cb\u003e0.926\u003c/b\u003e\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\u003e\u003cb\u003e0.527\u003c/b\u003e\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\u003e\u003cb\u003e1.060\u003c/b\u003e\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\u003e\u003cb\u003e0.641\u003c/b\u003e\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\u003e\u003cb\u003e0.397\u003c/b\u003e\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\u003e\u003cb\u003e0.971\u003c/b\u003e\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\u003e\u003cb\u003e0.908\u003c/b\u003e\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\u003e\u003cb\u003e1.850\u003c/b\u003e \u003cem\u003e(highest)\u003c/em\u003e\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\u003e\u003cb\u003e0.361\u003c/b\u003e \u003cem\u003e(lowest)\u003c/em\u003e\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\u003e \u003c/p\u003e \u003cp\u003eOnly 7% of the variation in NHS dental \u003cem\u003epractice availability per 10,000 residents\u003c/em\u003e is explained by deprivation (IMD decile), multiple R\u0026sup2; = 0.070 and when adjusted for sample size, that relationship becomes negative (Adjusted R\u0026sup2; \u0026lt; 0). The linear regression model is not statistically significant (p\u0026thinsp;=\u0026thinsp;0.46), indicating that IMD decile \u003cem\u003edoes not meaningfully predict\u003c/em\u003e dental practice density once population size is considered.\u003c/p\u003e \u003cp\u003eA non-parametric Kruskal\u0026ndash;Wallis test identified a statistically significant difference in LSOA area across IMD deciles (χ\u0026sup2;(9)\u0026thinsp;=\u0026thinsp;25.98, p\u0026thinsp;=\u0026thinsp;0.002). LSOA area differs according to deprivation level, although no linear relationship was identified between deprivation and area. A parametric ANOVA did not detect a difference in mean LSOA area across IMD deciles, (F(1,261)\u0026thinsp;=\u0026thinsp;1.39, p\u0026thinsp;=\u0026thinsp;0.24), suggesting that the variation is non-linear and distributional rather than reflected in the mean values. As a result, comparisons of service provision by deprivation level may also reflect differences in the size of the areas being compared, rather than deprivation alone. There was no evidence of a simple increasing or decreasing trend between deprivation and area.\u003c/p\u003e \u003cp\u003eA linear regression model was therefore used to test whether deprivation level or neighbourhood size was predictive of the number of dental practices in an area. The results showed that neither IMD decile nor LSOA area had a statistically significant association with the number of NHS dental practices, and the model explained almost none of the variation in their distribution (adjusted R\u0026sup2; \u0026asymp; 0). Deprived and less deprived areas were therefore equally likely to contain a practice, and larger LSOAs did not have more or fewer practices than smaller ones.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThese findings demonstrate that the absolute number of NHS dental practices within an area was independent of deprivation index or LSOA size. Typically, deprived neighbourhoods experience the highest burden of oral disease, but they do not contain significantly more NHS dental practices after accounting for area size. There was no consistent pattern of dental practice numbers across the spectrum of IMD deciles. This analysis did not account for private dental practice, and unmet NHS demand may be mitigated through private dental services, although this requires further investigation.\u003c/p\u003e \u003cp\u003eIt has been traditionally assumed that inequality in dental access is directly related to socioeconomic deprivation. Still, the present analysis found no linear or nonlinear association between IMD decile and NHS dental practice density. Instead, dental practices appear to cluster in commercially viable locations characterised by good transport links, accessible premises, and opportunities for mixed NHS\u0026ndash;private provision. These spatial-economic factors may better explain the low density of practices observed in deprived areas, rather than deprivation itself. The concentration of NHS dental practices in IMD decile 9, rather than decile 10, suggests an optimal business model that balances potential patient income, population density and operating costs (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur analysis did not account for the historical pattern of dental practice locations. Localised concentrations of practices can persist despite changing socioeconomic conditions. For example, some areas may have inherited dental infrastructures from a previous period when they were more or less prosperous. Furthermore, our data analysis may represent an over-simplification and require a deeper investigation of appointment availability, dentist numbers, and patient flows.\u003c/p\u003e \u003cp\u003eSocial and environmental factors are important in influencing health\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e and health provision. The 2009 independent review of NHS dental services\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e emphasised the need for a service focused on oral health outcomes and prevention, delivered equitably across the population. The complex patterns identified in this analysis emphasise the continued relevance of these recommendations and suggest that equitable access remains an ongoing challenge requiring sustained policy attention.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHart JT. The inverse care law. Lancet 1971; 297(7696): 405\u0026ndash;412.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdult Oral Health Survey (AOHS), commissioned by the Government\u0026rsquo;s Office for Health Improvements and Disparities (OHID) - Department of Health and Social Care. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.uk/government/statistics/adult-oral-health-survey-2023\u003c/span\u003e\u003cspan address=\"https://www.gov.uk/government/statistics/adult-oral-health-survey-2023\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatt RG, Sheiham A. Integrating the common risk factor approach into a social determinants framework. Community Dent Oral Epidemiol. 2012;40(4):289\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Health. NHS dental services in England: an independent review led by Professor Jimmy Steele. London: Department of Health; 2009.\u003c/span\u003e\u003c/li\u003e\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-8348729/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8348729/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eTo examine the distribution of dental practices across deprivation deciles, using data from Bristol Local Health Authority.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eAnalysis of dental practice density (dentists per 10,000 residents) across the Index of Multiple Deprivation (IMD) deciles. Decile 1 represents the most deprived areas and decile 10 the least deprived.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA non-linear relationship was observed between deprivation and dental practice density. Deprivation did not predict dental practice distribution, with upper-middle deciles showing the highest provision. The least deprived decile (10) had the lowest NHS dental practice density (0.36 per 10,000 residents). The most deprived areas (deciles 1\u0026ndash;3) showed variable practice densities (0.52, 0.93, 0.53).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMultiple demographic factors and market forces influence practice density. Commissioning strategies must incorporate data on these factors, rather than relying on deprivation indices. Areas with large populations, but little NHS dental provision, may require distinct policy responses.\u003c/p\u003e","manuscriptTitle":"Dental Practice Distribution: Challenging Assumptions about Deprivation and Access.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-19 17:17:42","doi":"10.21203/rs.3.rs-8348729/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2026-02-10T16:13:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-02-08T16:53:11+00:00","index":4,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-01-30T09:21:56+00:00","index":4,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-01-07T14:17:23+00:00","index":3,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-01-05T10:30:38+00:00","index":3,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-12-31T17:19:13+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-12-17T12:05:23+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-12-17T08:12:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-16T11:20:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-16T11:20:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"British Dental Journal","date":"2025-12-16T09:49:25+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2025-12-14T21:45:24+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":"December 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":59798255,"name":"Health sciences/Health care/Dentistry/Dental public health"}],"tags":[],"updatedAt":"2026-03-11T13:31:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-19 17:17:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8348729","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8348729","identity":"rs-8348729","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}