The impact of restricted access on the need and demand for specialist dental services – A consideration for future needs assessments

Introduction: The COVID-19 pandemic forced NHS Dental Services to adapt quickly and implement measures which would safeguard essential care provision, whilst mitigating COVID-19 transmission risks. However, these changes impacted on both dental access, and onward referrals for specialist care. Basic Research Design: A longitudinal study design is used to offer descriptive analysis of referrals sent across three referral groups (orthodontics, paediatric dentistry, suspected cancers) across three time-matched periods (1st July to 31st December in 2019, 2020 and 2021). Anonymised data, extracted from an electronic referral management system (eRMS), are considered. Number of referrals, reasons for referral, Indices of Multiple Deprivation for each referral are discussed. Results: Referrals reduced from 2019 to 2020. Proportionally, the greatest reduction in onward referral was observed amongst individuals from the lowest socioeconomic positions, across all groups. Although mandated to conduct only 62.5% of the 2019 activity, the 2021 referrals exceeded 2019 figures. Proportions referred from the lowest socioeconomic position were still slightly lower across all three groups. Conclusions: Referrals from the lowest socioeconomic groups decreased in 2020, followed by a rebound in 2021, despite a reduction in mandated clinical activity. There are potential implications for future oral health needs assessments that should be considered when developing interventions to enhance access for vulnerable populations as we emerge from the COVID-19 pandemic.