Key Points
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This is the first comparative study of pain relief and oral health gain experienced by dental patients attending different out-of-hours dental services.
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Despite the low response rates, the chances of receiving effective care for those who saw a dentist appears similar across services — whatever the treatment setting, contact arrangements or the type of dentist seen.
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An hour after seeing the emergency dentist, and even the day after, a considerable proportion of patients in all four services reported little or no relief from symptoms.
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Further research should focus on explaining who experiences these poor health outcomes, the possible effect of different service designs on access to care, and on other outcomes such as good advice and effective reassurance.
Abstract
Objective To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services.
Basic design Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status.
Setting Two health authorities in South Wales, UK.
Subjects A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires.
Results For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30–40% and 23–38% respectively). Although the 'rotas for all' — a telephone-access GDP-provided service for both registered and unregistered patients — achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care.
Conclusions Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.
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Acknowledgements
The authors gratefully acknowledge the generosity and understanding of the patients who completed and returned questionnaires, the cooperation of dentists and other staff at the services evaluated, and the assistance of the two Health Authorities and Local Dental Committees. RA was jointly funded to conduct this research by the Medical Research Council and the Wales Office for Research and Development in Health and Social Care.
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Anderson, R., Thomas, D. & Phillips, C. The effectiveness of out-of-hours dental services: I. pain relief and oral health outcome. Br Dent J 198, 91–97 (2005). https://doi.org/10.1038/sj.bdj.4811979
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DOI: https://doi.org/10.1038/sj.bdj.4811979
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