Dental Attendances to General Medical Practitioners in Wales: a 44 Year Analysis

One-third of the UK population are problem-orientated dental attenders, seeking dental care only when they have acute dental pain or problems. Patients seek urgent dental care from a range of health care professionals, including general medical practitioners. The study aimed to identify trends in dental attendance at Welsh medical practices over a 44-year period, specifically in relation to dental policy change, and factors associated with repeat attendance. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practice in Wales (UK). Read codes associated with dental diagnoses were extracted for patients attending their general medical practitioner between 1974 and 2017. Data were analysed using descriptive statistics, univariate and multivariable logistic regression. Over the 44-year period, there were 439,361 dental Read codes, accounting for 288,147 patient attendances. The overall attendance rate was 2.60 attendances per 1000 patient-years (95% CI 2.59-2.61). The attendance rate was negligible through 1987 but increased sharply to 5.0 per 1,000 patient-years in 2006 (95% CI 4.94-5.09) before almost halving to 2.6 per 1,000 patient years in 2017 (95% 2.53-2.63) – a pattern that coincided with changes to dental National Health Service policies. 26,312 patients were repeat attenders, and repeat attenders were associated with living in an area classified as “urban and deprived” (OR 1.22, 95% CI 1.19-1.25, p<0.0001), or “rural” (OR 0.84, 95% CI 0.83-0.85, p<0.0001). Repeat attendance was associated with greater odds having received an antibiotic prescription (OR 2.53, 95% CI 2.50-2.56, p<0.0001), but lower odds of having been referred to another service (OR 0.75, 95% CI 0.70-0.81, p<0.0001). Welsh patients’ reliance on medical care for dental problems was influenced by social deprivation and health policy. This indicates that future interventions to discourage dental attendance at medical practitioners should be targeted at those in the most deprived urban areas, or rural areas. In addition, health policy may influence attendance rates both positively and negatively and should be considered in the future when decisions related to policy change are made.