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

<title>Abstract</title> 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.