Non-traumatic dental presentations at accident and emergency departments in the UK: a systematic review.

Objective Attendance at accident and emergency departments (A&E) for non-traumatic dental conditions (NTDC) is increasing in high-income countries. Not all NTDC visits to A&E are inappropriate; however, those that are take up capacity with conditions which are adding to the pressure regarding cost and healthcare utilisation for A&E departments. The scale of this problem is yet to be understood in the United Kingdom (UK). The aim of this study was to systematically review the literature to identify peer-reviewed research publications reporting non-traumatic dental presentations at A&E departments in the UK. Data sources A structured search of Cochrane Library, EMBASE, MEDLINE, CINAHL, PsycINFO, Scopus and Web of Science databases from their earliest date to May 2018. Hand-searching of identified articles that met the inclusion criteria was also reviewed. Data selection Publications were included if they were primary research on A&E users in the UK with NTDC as the primary reason for the A&E visit. Data extraction Data were extracted on the study, patient and visit characteristics. Data synthesis Studies were assessed for methodological quality and the analysis took the form of a narrative review. Conclusion There is limited evidence, of variable quality, to inform on the extent of inappropriate presentations of patients with non-urgent NTDC to A&E departments in the UK. The evidence supports the hypothesis that dental patients are inappropriately seeking care for NTDC at A&E departments and this may be a driver of unnecessary antibiotic prescriptions. Further research should focus on the reasons for this occurrence.