(17) The Impact of Socioeconomic Deprivation and Dental Access on the Incidence of Severe Odontogenic Infections in Southeast London

Abstract: Severe cervicofacial infections originating from odontogenic sources represent a considerable clinical and economic burden, frequently necessitating hospital admission and posing life-threatening risks. While a well-documented correlation exists between oral health and socioeconomic status, the exact impact of restricted dental access on infection rates remains unclear. This study aims to investigate the influence of socioeconomic deprivation and the accessibility of publicly funded dental services on the incidence of severe odontogenic infections that require hospitalisation in Southeast London.

We conducted a retrospective epidemiological study of patients admitted to King’s College Hospital, London, between October 2020 and October 2024 for the management of severe cervicofacial infections of odontogenic origin. The study included all patients whose addresses fell within the South East London Integrated Care Board boundaries. National Health Service (NHS) dental access data and population estimates from the Office for National Statistics for the relevant London boroughs (Bromley, Bexley, Greenwich, Lambeth, Lewisham, Southwark) were utilized to calculate the proportion of residents accessing primary dental care by Lower Super Output Area (LSOA) and borough. Socioeconomic deprivation was assessed using the 2019 Index of Multiple Deprivation (IMD), which was grouped into deciles and quintiles. Admission rates were standardized by local population size.

Data analysis included descriptive statistics, chi-square tests for categorical comparisons, and one-way ANOVA to evaluate differences in dental access across boroughs. The associations between dental access, deprivation, and infection rates were examined using Spearman’s rank correlation, linear regression, and Poisson regression modelling to ascertain incidence rate ratios (IRRs) across IMD quintiles.

A total of 378 admissions were identified. Infection rates varied across boroughs but were not statistically significant (ANOVA P = .383). Dental access significantly declined across all boroughs during the COVID-19 pandemic and remained below pre-pandemic levels as of 2024 (ANOVA P < .001). Bexley and Bromley exhibited notably lower access rates than other boroughs. A Poisson regression model indicated a strong association between increasing deprivation and infection incidence. Compared to the least deprived quintile, patients in the most deprived quintile experienced significantly higher infection rates (IRR 5.79; 95% CI [3.83–9.15]; P < .0001). Overall, individuals residing in the bottom five IMD deciles were 3.3 times more likely to be admitted for severe odontogenic infections than those in the top five (IRR 3.3; 95% CI [2.59–4.26]; P < .001).

These findings demonstrate that socioeconomic deprivation and limited access to dental care are independently associated with higher rates of severe cervicofacial infections. The outcome data underscores the urgent need for targeted public health initiatives, particularly in areas facing deprivation and inadequate dental access. Policymakers and commissioners should prioritize these regions to improve dental service provision and reduce preventable hospital admissions and health inequalities.

References:
1. Velhonoja J, et al. Severe orofacial and neck infections: A three-year observational study. BMC Oral Health.2025;25(136).
2. Henry A, et al. Clinical features and presentation of cervicofacial infection: A Maxillofacial Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg. 2021;59(4):433–8.
Figure 1 - Severe cervicofacial infections of odontogenic origin requiring admission 2020-2024. Figure 2 - Incidence Rate Ratios across deprivation quintiles