Deprivation linked to severe dental infections in South East London
Study shows deprivation, not dental access alone, drives severe infections: implications for NHS planning and prevention strategy.
Strong link between poverty and hospital admissions for dental infections
A four-year study of 378 patients admitted to King's College Hospital with cervicofacial infections of odontogenic origin (CIOO) found infection rates nearly double in the most deprived areas compared to the least deprived. Using data from October 2020 to October 2024, researchers analysed admissions across six South East London boroughs: Bexley, Bromley, Greenwich, Lambeth, Lewisham, and Southwark. Infection rates showed a strong negative correlation with the Index of Multiple Deprivation (Spearman's ρ = -0.94, p <0.001), meaning as deprivation increased, infection rates rose consistently.
NHS dental access alone does not explain infection rates
Surprisingly, the availability of NHS primary care dentistry showed no association with infection rates (incidence rate ratio 1.0, p = 0.915). This finding challenges the assumption that expanding dental services alone will reduce severe infections. Researchers suggest unmeasured barriers such as health literacy, cost concerns, mistrust of healthcare providers, and health-seeking behaviours play a larger role. Many patients in deprived areas delay seeking care until infections become severe enough to require hospital admission. The study notes that the COVID-19 pandemic disrupted dental access across all six boroughs from 2020 to 2022, with recovery remaining incomplete by 2024.
Implications for public health strategy
The findings indicate that tackling severe odontogenic infections requires interventions beyond service provision. Boroughs with mean deprivation decile scores below five—Southwark, Lambeth, Greenwich, and Lewisham—should be prioritised for targeted public health strategies. Researchers recommend a prevention-focused model combining oral health literacy campaigns with upstream investment in social determinants of health. The study emphasises that CIOO admissions can serve as sentinel events indicating failure at multiple points in the care pathway, including early detection, prevention, and timely access to treatment.
Frequently asked questions
How much more common are severe dental infections in deprived areas?
Infection rates were nearly twice as high in the most deprived areas compared to the least deprived (incidence rate ratio 1.95, p <0.001). The study analysed 378 hospital admissions over four years across South East London.
Does having more NHS dentists in an area reduce severe dental infections?
No. The study found no correlation between NHS primary care dental access and hospital admission rates for severe infections (p = 0.915). This suggests barriers beyond service availability, such as health literacy and cost, play a larger role.
Which London boroughs have the highest risk of severe dental infections?
Southwark, Lambeth, Greenwich, and Lewisham all have mean deprivation deciles of four, placing them in the more deprived half nationally. These areas showed higher infection rates and should be prioritised for targeted intervention.
What barriers to care beyond dental access contribute to severe infections?
The study identifies health literacy challenges, financial concerns, mistrust of healthcare providers, prioritisation of other immediate needs, and lack of awareness of early warning signs. Patients may also delay seeking care until infections become life-threatening.
How did COVID-19 affect dental access in South East London?
All six boroughs showed a notable decrease in NHS dental access from 2020 to 2022 during lockdowns and service disruptions. Although there has been some improvement since 2022, access has not recovered to pre-2020 levels.
