Potentially preventable paediatric dental emergency department presentations: a metropolitan Australian retrospective observational study

Abstract Background To analyse the epidemiological characteristics and systemic drivers of potentially preventable dental-related emergency department (ED) presentations among children and adolescents (0–17 years) within a major Australian metropolitan health service. Methods A retrospective observational study of 1,108 dental-related ED visits from May 2018 to June 2024 was conducted. Presentations were identified using administrative coding for non-traumatic dental conditions and classified as potentially preventable based on established national criteria. Data were analysed using Stata 19.5 to evaluate demographic characteristics, hospital utilisation, socioeconomic status (using SEIFA indices), triage urgency, and clinical outcomes. Multivariable logistic regression identified predictors for potentially preventable versus non-preventable presentations. Results The mean age at presentation was 6.8 years, with the highest utilisation in the 4–9-year age group (37.76%). Males accounted for 51.8% of visits. Most presentations were self-referred (90.9%) and occurred outside standard public dental clinic hours (73.1%). While 80.5% of patients were discharged from ED, a marked socioeconomic gradient was observed consistently throughout the study period. Children from the most disadvantaged areas experienced higher utilisation, with inequality ratios reaching 16.6:1 for the Index of Education and Occupation. Half of all visits (49.5%) involved late-stage pulp/periapical disease or supporting structure disorders rather than early-stage caries. Younger age (0–3 years), female sex, and greater socioeconomic disadvantage were independently associated with higher odds of potentially preventable ED presentations. Conclusion Paediatric dental ED utilisation is primarily driven by advanced, preventable conditions in children from disadvantaged backgrounds, often occurring when primary care is unavailable. The significant inequality ratios suggest that current service models fail to reach the most vulnerable populations. These findings highlight an urgent need for targeted preventive programmes and integrated after-hours dental pathways to reduce the sustained burden on emergency services.