Re-evaluating Dental General Anaesthesia Service within Ayrshire and Arran

Objectives: To explore the differences in referrals received into the Public Dental Service Department and level of risk of dental general anaesthesia (DGA) between urban and rural areas within Ayrshire and Arran in Scotland. Methods: We used secondary data analysis of DGA data collected at Ayr dental hub over a 5-year period (2010-2015). Cross tabulations were computed to describe the study population and to explore any potential relationships within the data set. Poisson regression analysis was used to determine the incident rate ratio (IRR) of DGA referrals received per urban and rural areas and also to determine the number at risk of DGA within the study after adjustment for age, sex, deprivation, severity, reason for DGA and regular attendance. For patient’s geographical classification, the Scottish Government’s 6-fold Urban/Rural classification was used. Generalised estimating equation (GEE) analysis was performed to ascertain the IRR of number of teeth extracted between each of the urban and rural areas. Results: The study comprised 2839 patients (range 1- 22 years; 1504 males and 1335 females). There were more extractions (61%) and repeat DGA (n= 216) conducted in Other Urban Areas compared to rural areas. After adjusting for age and sex, all areas showed a significantly higher incident for DGA with Remote Small Towns showing a higher rate (IRR=2.84, 95%CI 2.55-3.17, p<0.001) compared to Other Urban Areas (IRR=2.72, 95%CI 2.62-2.82, p<0.001). In GEE analysis, patients in Accessible Small Towns showed a 6% increase in IRR for number of teeth extracted (Adjusted IRR=1.06, 95% CI 0.98-1.15, p>0.05) and other areas showed reduced incident. Conclusions: Despite improvements in dental caries with the implementation of the Childsmile programme, significant inequalities still persist in terms of level of DGA referrals within rural areas and those most deprived within Ayrshire and Arran.