Territorial disparities and organisational responses in emergency dental care: A national cross-sectional survey in France

In France, the absence of weekday on-call dental services leaves general dental practitioners (GDPs) as primary providers of urgent dental care. This study examined territorial inequalities in unscheduled and urgent dental care demand and provision and how GDPs adapt their organisation amid unequal workforce distribution. A national cross-sectional online survey was conducted among 945 licensed general dental practitioners. The main outcome measures were the weekly number of emergency consultations and calls per GDP and the answer-to-demand rate. Territorial workforce distribution was assessed using the Localized Potential Accessibility (LPA) index. Multivariable negative binomial regression examined associations with weekly emergency consultations. GDPs reported a median of 7 emergency consultations per week. Emergency demand and organisational patterns varied across workforce density gradients. The lowest and intermediate LPA terciles showed similar emergency pressure, while highly supplied areas showed lower demand and fewer consultations. In under-served areas, practices reported higher daily patient flows and more restrictive acceptance of unknown patients. Distance to the nearest hospital dental service was independently associated with emergency activity. The answer-to-demand rate varied across territorial gradients: over-served areas converted 80% of calls into consultations compared with 60% in under-served and 63% in adequately served areas, suggesting demand rationing in high-pressure territories. Overall, unscheduled and urgent dental care activity appears structured along a territorial continuum shaped by workforce distribution, secondary care accessibility, and practice-level organisational adaptation. Improving access to urgent dental care requires systemic approaches considering territorial configuration of services, referral pathways, and continuity of care rather than workforce numbers alone.