Where NHS dental access in England is least resilient.

Aims Demographic change may affect access to National Health Service (NHS) dentistry unevenly. This study assessed how fixed provider geography performs under population growth, ageing, and deprivation-focused growth.Methods A scenario-based spatial analysis was conducted using lower layer super output area-level population, age, and index of multiple deprivation (IMD) data. Dental deserts were defined as areas located >5 km from the nearest NHS provider; high-need deserts were those in IMD deciles 1-3. Three scenarios were modelled: 5% general population growth, ageing, and 10% growth concentrated in IMD deciles 1-3.Results At baseline, 2.34 million residents lived in dental deserts, including 189,542 in high-need deserts. General growth increased desert population by 117,135 and high-need desert population by 9,477. Ageing had minimal impact. Concentrated deprived-area growth increased high-need desert population by 18,960, approximately double that seen under general growth. The largest increases occurred in rural and semi-rural authorities.Conclusions Population growth expands exposure to dental deserts, while growth in deprived areas disproportionately increases high-need burden. NHS dental access appears unevenly resilient to demographic change.