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<p><b>Introduction</b> Inequitable distribution of the workforce is a major global challenge, regardless of country income status. England is facing a crisis in access to NHS dental care, with areas of the country being designated ‘dental deserts'. Solutions are actively being pursued.</p><p><b>Objective</b> To review global literature addressing geographic barriers to dental care and make recommendations for health policy and future research in relation to access.</p><p><b>Methods</b> A systematic review was conducted through OVID, searching Medline, Embase and Global Health. Titles and abstracts were screened and full texts reviewed against eligibility criteria with data extraction. Interventions were identified and thematically categorised, then aligned with <i>The</i> <i>Lancet'</i>s ‘High-quality health systems framework'.</p><p><b>Results</b> We included 37 papers from 26 countries, reporting on 14 types of interventions across four categories: workforce initiatives (dental team skill mix and non-dental personnel, recruitment and retention strategies); outreach (teledentistry, mobile, outreach and school-based services, new community clinics); in-reach (dental school clinics); and ‘auxiliary access initiatives' (local community engagement, affordability of care, cost-effectiveness and clinician remuneration). All interventions appeared to provide access to care. Every paper addressed between two and seven components of the high-quality health systems framework, with the ‘foundations' domain addressed across all 37 papers, ‘quality impacts' in 30 and ‘processes of care' in 15 papers.</p><p><b>Conclusion</b> All identified initiatives demonstrated positive impacts on access to care across the domains of the high-quality health systems framework, indicating the importance of a multi-dimensional health-systems approach to tackling dental deserts. Published evidence, mainly from high- and middle-income countries, supports the co-design and co-production of initiatives with local communities to facilitate sustainable improvements in access.</p>

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Tackling geographic barriers to primary dental care (dental deserts): a systematic review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月20日

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  • James W. Edwards,
  • Birke Bogale,
  • Jennifer E. Gallagher

摘要

Introduction Inequitable distribution of the workforce is a major global challenge, regardless of country income status. England is facing a crisis in access to NHS dental care, with areas of the country being designated ‘dental deserts'. Solutions are actively being pursued.

Objective To review global literature addressing geographic barriers to dental care and make recommendations for health policy and future research in relation to access.

Methods A systematic review was conducted through OVID, searching Medline, Embase and Global Health. Titles and abstracts were screened and full texts reviewed against eligibility criteria with data extraction. Interventions were identified and thematically categorised, then aligned with The Lancet's ‘High-quality health systems framework'.

Results We included 37 papers from 26 countries, reporting on 14 types of interventions across four categories: workforce initiatives (dental team skill mix and non-dental personnel, recruitment and retention strategies); outreach (teledentistry, mobile, outreach and school-based services, new community clinics); in-reach (dental school clinics); and ‘auxiliary access initiatives' (local community engagement, affordability of care, cost-effectiveness and clinician remuneration). All interventions appeared to provide access to care. Every paper addressed between two and seven components of the high-quality health systems framework, with the ‘foundations' domain addressed across all 37 papers, ‘quality impacts' in 30 and ‘processes of care' in 15 papers.

Conclusion All identified initiatives demonstrated positive impacts on access to care across the domains of the high-quality health systems framework, indicating the importance of a multi-dimensional health-systems approach to tackling dental deserts. Published evidence, mainly from high- and middle-income countries, supports the co-design and co-production of initiatives with local communities to facilitate sustainable improvements in access.