Barriers To Dental Care Research Articles

Racial/ethnic disparities in cost-related barriers to care among near-poor beneficiaries in Medicare Advantage vs traditional Medicare.

To compare racial and ethnic disparities in cost-related medical care and dental care barriers and use of vision care among near-poor Medicare beneficiaries in Medicare Advantage (MA) vs traditional Medicare (TM) overall and stratified by supplemental insurance enrollment. Cross-sectional analysis of 2015-2019 data from the nationally representative Medicare Current Beneficiary Survey. Propensity score-weighted difference-in-disparities analyses comparing Black-White and Hispanic-White disparities in MA vs TM among near-poor Medicare beneficiaries with incomes between 101% and 250% of the federal poverty level. We assessed differences in cost-related medical care barriers and cost-related dental care barriers as well as receipt of annual eye exams in MA vs TM. For cost-related barriers to medical care, Hispanic-White disparities were narrower by 8.8 (95% CI, -14.0 to -3.6) percentage points in MA relative to TM but differences in Black-White disparities were not statistically significant. MA was not associated with narrower differences in Hispanic-White or Black-White disparities in dental care access. Higher proportions of Black and Hispanic beneficiaries in MA received an annual eye exam vs White beneficiaries in both MA and TM. MA was associated with narrower racial disparities primarily compared with TM without supplemental insurance. Among near-poor Black and Hispanic Medicare beneficiaries, MA was associated with greater use of vision care and narrowing of some disparities in cost-related access barriers vs TM. However, MA did not uniformly narrow racial/ethnic disparities in access and use. These findings highlight the importance of maintaining and enhancing features of Medicare coverage that may promote equitable access to care, including additional benefits and lower cost sharing.

Risk Factors Associated with Children Receiving Treatment at Emergency Dental Clinics: A Case-Control Study.

(1) Background: The process of managing children at the emergency dental clinic (ER-C) is a difficult challenge. This matched case-control study assessed risk factors associated with children visiting the ER-C compared to visits at the regular dental clinic (RD-C). (2) Methods: The participants included 421 children aged three to 12 years who were recruited at the ER-C (cases) and RD-C (controls) at King Abdulaziz University Dental Hospital, with each group matched for gender and age. A data-collection form was developed and validated in both Arabic and English, containing the following four sections: DMFT/dmft index, Frankl’s behaviour rating scale, Dental Neglect Scale, and Dental Care Barriers questionnaire. (3) Results: The ER-C (vs RD-C) group showed significantly more uncooperative behaviour (p = 0.002), a higher total mean dental neglect score (p = 0.003), and a higher dental barrier score (p < 0.001). Binary regression analysis showed that those making their first visit (AOR: 2.65, p < 0.001) and with higher dental barriers (AOR: 1.121, p < 0.001) were statistically significantly more associated with ER-C visitation. (4) Conclusion: These findings suggest that children who visit the ER-C are more prone to dental care barriers, uncooperative behaviour, and dental neglect, thus highlighting the importance of encouraging and planning their attendance to ensure optimal dental care.

Access to dental care barriers and poor clinical oral health in Australian regional populations.

This paper investigated the associations between oral health with behavioural, demographic, periodontitis risk, financial and access to dental care barriers and compared the results in three Australian regional areas. Data were obtained from the Australian National Study of Adult Oral Health (2017-18). Oral health status was measured using DMFT-score, and mean numbers of decayed, missing or filled teeth and periodontitis prevalence using the Center for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) Periodontal Classification. The analysis included these dependent variables by three regional areas, seven socio-demographic variables, two periodontal disease risk factors, two preventive dental behaviours, two barriers to dental care and three access to dental care variables. Of the 15,731 people interviewed, 5,022 were examined. There was no significant difference in periodontitis prevalence between the regions. All the socio-demographic characteristics, periodontal disease risk factors and preventive dental behaviours were significantly associated with at least one of the dental caries indicators. In multivariable analysis, there was no significant association between regional location with any of the four clinical dental caries variables. Poorer oral health outside major cities was associated with household income, education level, higher smoking, usual reason for and frequency of dental visiting.

Dental experiences of a group of autistic adults based in the United Kingdom

Previous international research has shown that autistic people have difficulty accessing dental care due to sensory processing, anxiety and communication issues. However, it is not known whether autistic adults in the United Kingdom are experiencing similar dental care barriers. The current study investigated autistic adults' dental experiences in the United Kingdom. A mixed methods survey was given to self-selecting autistic (n=37) and non-autistic adults (n=43) to compare whether autistic individuals had more negative experiences than non-autistic individuals. Closed questions asked about anxiety, patient-practitioner communication, satisfaction and the dental environment. Open questions asked about autism-specific dental challenges, what works well at the dentist, and improving autistic individuals' experiences. Responses were analyzed using thematic analysis. Overall, results demonstrated that autistic adults in the United Kingdom have more negative dental experiences than non-autistic adults. These predominantly related to interactions with dental practitioners, a challenging sensory environment, anxiety, pain, and disclosure. Participants recommended sensory environment adaptations, ways to increase preparedness, longer appointments, and individual accommodations. This study offers best-practice strategies for working with autistic patients and highlights the importance of dentists working with autistic individuals to maximize the quality of care and outcomes for this underserved population.

Dental visit experience and dental care barriers among Hong Kong preschool children with special education needs.

Children with special education needs (SEN) require additional supports in education settings, as well as extra supports in healthcare services. To investigate dental visit experience and dental care barriers among Hong Kong preschoolers with SEN. This was designed as a cross-sectional study. A structured questionnaire was employed to investigate dental attendance and dental care barriers among Hong Kong preschoolers with SEN. Binary logistic regression and multi-factor ANOVA were performed to identify factors associated with children's dental visit experience. A total of 383 children were included in the final analysis. The average age of the recruited children was 3.87±0.95 years. 72.5% parents reported that dental visits were a challenging task for their children. Among children with caries, 70.7% had never visited a dentist. Regression models indicated that (a) children over 3years or children whose parents received tertiary education were more likely to visit a dentist; (b) the existence of dental care barriers was associated with children's primary diagnosis, practical skills, conceptual skills, and parents' education attainment; and (c) children with low conceptual skills (95%CI:0.71 to 2.40, P<.001), or children from low-income families (95%CI:1.21 to -0.06, P=.031) had more dental care barriers than their counterparts. Unmet dental treatment needs and dental care barriers existed among pre-schoolers with SEN. Dental care barriers were associated with children's developmental profile, parents' education attainment, and household income.

Transgender HIV status, self-perceived dental care barriers, and residents' stigma, willingness to treat them in a community dental outreach program: Cross-sectional study.

Assess the association between high risk transgender (TG) HIV status, self-perceived barriers toward oral care, and the residents' stigma and willingness to treat during community dental outreach. Demographics, tobacco habits, HIV status, willingness for rapid HIV testing, and self- perceived oral health, barriers toward oral care were assessed in a cross-sectional study among 212 transgender in South India. Further, the residents' stigma across three subscales and residents' willingness to treat the transgender was evaluated. Overall, 88% had begging as the sole income, and 93% lived in slums and used some form of tobacco. Oral health was perceived to be poor by more than half, and the mean probing pocket depth (PPD) and decayed, missing, or filled teeth (DMFT) was 4.2mm and 3.67, respectively. The residents reported significantly low regard and willingness to treat TG irrespective of high/low stigma and when the transgender HIV status was positive/do not know. Residents with greater fear of exposure expressed least regard and willingness to treat TG (P<0.05). The self-perceived oral health of transgender' was poor corresponding to the clinical examination findings. Moreover, the stigmatizing attitude and low regard to provide oral care is rampant among the dental residents, which further frustrates dental care.

Reasons for use and nonuse of dental services among people visiting a dental hospital in urban India: A descriptive study.

AIMS AND OBJECTIVES:The aim and objective of this study was to sort out the reasons for use and nonuse of dental services among people visiting a private dental hospital in urban India.MATERIALS AND METHODS:A descriptive cross-sectional study was carried out on 1800 people, aged 18–65 years, visiting a multispecialty dental hospital in urban India. A self-administered questionnaire was used to collect data about the history of dental visits and reasons for use and nonuse of dental services.RESULTS:For a majority of the people (45%), time since the last dental visit was more than 2 years, and the main reason for visiting a dentist was dental pain (38%). Majority of the people had received restoration of teeth in their previous dental visit (46%). The major reason cited for not visiting a dentist was lack of knowledge toward dental problems and their consequences (30%). Only few people visited dentists for preventive reasons. More patients with better educational levels visited dentists than patients with poor educational status.CONCLUSION:Majority of the people visited dentists when their problem was severe enough to have a dental appointment. Dental practitioners across locations should also educate the patients regarding the importance of regular dental care, discuss barriers for dental care, and promote attitudinal changes toward a positive health-seeking behavior.

Perceived and normative needs, utilization of oral healthcare services, and barriers to utilization of dental care services at peripheral medical centre: Poonjeri, Mamallapuram, India

Introduction: Dental care utilization is limited, and teeth are often left untreated or extracted in India. Several barriers exist for the utilization of dental services. The present study was undertaken to assess the oral healthcare needs, utilization pattern of oral healthcare services, and barriers to utilization of oral healthcare services among the outpatients of Peripheral Medical Centre, Poonjeri, Mamallapuram, India. Materials and Methods: Simple random sampling was conducted among outpatients and their attenders reporting to the health centre; demographic profile of the patients were recorded followed by interviewer-administered questionnaire for recording the self-perceived dental needs and barriers in utilizing dental care services followed by Type II clinical examination to assess normative dental treatment needs. Results: N =282 study participants participated in the present study; majority of the study participants were from upper lower class and lower middle class. Among the study subjects n = 124 (44%) have not accessed any dentist, n = 112 (39.7%) had visited dentist for toothache. Common reason cited as Self – perceived barriers for dental care are n = 184 (65.2%) – 'Unaware of the dental problems' and n = 118 (41.8%) 'Fear of dental treatment'. Logistic regression showed that significant difference was seen in gender, socioeconomic status, and barriers to dental care (P < 0.05) in influencing the utilization pattern of dental care. Conclusion: Perceived and normative dental needs were high among the study population due to problem-oriented care, and it is influenced by various barriers such as unawareness of dental problems, fear, cost, accessibility, and time.

Dental Care for Survivors of Adolescent and Young Adult Cancer: Special Considerations.

Oral health is important for quality of life, but may be undermanaged for survivors of cancer. We examine dental care use and barriers among long-term survivors of adolescent and young adult (AYA) cancer in comparison to individuals without a history of cancer. The 2008-2012 Medical Expenditure Panel Survey (MEPS) identified 1216 individuals diagnosed with cancer at AYA ages (15-39 years), who were at least 5 years from diagnosis. A comparison group was matched using age, sex, and other factors. We evaluated self-reported dental visits in the previous 12 months, and inability and delay in receiving necessary dental care among survivors and the comparison group. Furthermore, individual factors associated with dental care use were identified using multivariable logistic regressions. Of survivors, 60.86% reported no dental visits in the previous year compared to 51.96% of the comparison individuals (p < 0.001). Survivors were more likely to report inability (10.71% vs. 6.29%, p = 0.001) and delay (8.12% vs. 4.45%, p = 0.001) in getting necessary dental care than the comparison group. Notably, survivors without dental insurance were more likely to report inability and delay. Female survivors were more likely to use dental care than males (odds ratio = 1.76, 95% confidence interval 1.15-2.71, p = 0.01). Hispanic survivors, those diagnosed at younger ages, and uninsured survivors were less likely to have at least one dental visit. Survivors of AYA cancer need timely surveillance to manage late effects, including dental complications. Yet, these survivors, particularly those who are uninsured, delay dental care more often than individuals from the general population. Survivor-specific interventions are needed to reduce dental care barriers.

Listening to older adults: community consultation on a new dental service.

Increased life expectancy, retention of a natural dentition often heavily restored, and increasing risks of oral disease mean that older people have particular dental needs and yet uptake of care is low. A new health and wellbeing centre in south London offering student-delivered care has been built to serve the local community. Community views could informed the planning of acceptable care for older people. To explore the views and expectations of older adults towards dental services and ascertain how a new dental centre may best provide dental care. This qualitative study used in-depth and triad interviews to explore the views of older people. Purposive sampling of local centres/groups for older adults was undertaken and all willing clients interviewed. Interviews were audio recorded, transcribed and analysed using Framework Methodology with emerging themes categorised according to Maxwell's six descriptors of quality. Nine sessions (five triad and four in-depth interviews) involving 17 older adults were conducted in local day centres. Barriers to dental care were largely related to fear, cost, transport, lack of perceived need and the attitude of clinicians. Outcomes related to acceptability featured highly in a dental service for older adults; the overarching principles of 'delivering mutual benefit' for students and older people, 'experiencing warm humanity' and 'restoring dignity and worth' were central to their views of quality care. The importance of clinicians, whether student or staff, delivering person centred care with warm humanity was dominant: comprising 'welcoming', 'valuing', 'listening' 'communicating' and 'caring' for older adults to enhance relationships and contributing to 'restoring dignity and worth'. Community engagement identified a willingness amongst older adults to utilise dental services where mutual benefit was perceived and, importantly, there were low barriers to care and a warm humanity was exhibited.

Treatment perception and utilization of dental services during pregnancy among sampled women in Riyadh, Saudi Arabia

To determine the access of dental care among a sample of pregnant women in Riyadh, Saudi Arabia and identify possible barriers for dental care during pregnancy. The target population in this cross-sectional study was female patients attending one private and two governmental hospitals in Riyadh, Saudi Arabia. The age range for these patients was limited to child bearing age (18–48 years old). The pregnant women were identified in obstetric and gynecology clinics. The control group of non-pregnant women was identified in dermatology clinics. A self-administered questionnaire was developed to assess the pattern of dental service utilization and attitude toward dental treatment during pregnancy. Personal information such as age, education, employment and number of live births were also collected. A total of 959 properly filled questionnaires out of 1176 (71% response rate) were used in the analysis. The mean age of the sampled subjects was 29.6 (±7.0) years. Only 22% of the sampled pregnant women indicated that they visited their dentists during their current pregnancy. Seventy-two percent of the sampled pregnant women indicated that they have experienced at least one dental problem that might need a dental intervention during their current pregnancy. The likelihood of visiting a dentist during pregnancy for pregnant women who visited the dentist before pregnancy was 20.4 times more compared to pregnant women who did not visit the dentist before pregnancy ( N = 510, OR = 20.4, 95% CI [11.9, 34.5]). A lack of knowledge of the importance and safety of dental treatment during pregnancy was reported by the majority of sampled women to be significant barriers for dental care during pregnancy. The majority of the sampled pregnant women did not visit the dentist during pregnancy and had major misconceptions about the need for and/or the safety of dental treatment during pregnancy.

Effects of the State Children's Health Insurance Program on Access to Dental Care and Use of Dental Services

To provide national estimates of implementation effects of the State Children's Health Insurance Program (SCHIP) on dental care access and use for low-income children. The 1997-2002 National Health Interview Survey. The study design is based on variation in the timing of SCHIP implementation across states and among children observed before and after implementation. Two analyses were conducted. The first estimated the total effect of SCHIP implementation on unmet need for dental care due to cost in the past year and dental services use for low-income children (family income below state SCHIP eligibility thresholds) using county and time fixed effects models. The second analysis estimated differences in dental care access and use among low-income children with SCHIP or Medicaid coverage and their uninsured counterparts, using instrumental variables methods to control for selection bias. Both analyses controlled for child and family characteristics. When SCHIP had been implemented for more than 1 year, the probability of unmet dental care needs for low-income children was lowered by 4 percentage points. Compared with their uninsured counterparts, those who had SCHIP or Medicaid coverage were less likely to report unmet dental need by 8 percentage points (standard error: 2.3), and more likely to have visited a dentist within 6 or 12 months by 17 (standard error: 3.7) and 23 (standard error: 3.6) percentage points, respectively. SCHIP program type had no differential effects. Consistent results from two analytical approaches provide evidence that SCHIP implementation significantly reduced financial barriers for dental care for low-income children in the U.S. Low-income children enrolled in SCHIP or Medicaid had substantially increased use of dental care than the uninsured.

Improving Patient Retention and Access to Oral Health Care: The CARES Program

Improving access to dental care for patients experiencing barriers such as financial, transportation, or mental health is a public health concern. Dental schools have an obligation to assist patients experiencing such barriers as well as to educate future dentists and allied professionals on how to assist these patients in overcoming barriers. Once admitted to the dental clinic, retention issues can further complicate the provision of dental care. This article will describe an innovative program designed to address biopsychosocial barriers to dental care. Needs assessments of patients sitting in the waiting room of the dental clinic were conducted by master's of social work (M.S.W.) students. Based on needs assessment results, common dental care barriers were identified and served as the foundation for the establishment of a social work program in the dental clinic. Dental students, faculty, and staff refer patients to the social work program when barriers to care are found. These biopsychosocial barriers are addressed by social workers, uniquely qualified professionals in providing case management, advocacy, referrals, education, and services (CARES). Over the course of three years, 80 percent of patients experiencing an identified barrier to the receipt of dental care were retained through social work intervention. These patients were able to receive dental care within the past year. Dental schools can collaborate with social work schools to establish a protocol and assistance program for dental patients experiencing difficulty accessing care, thereby improving oral health status, retention rates, and dental student education.

Dental welfare profiles in a group of disabled Norwegian adults

In a group of 496 non-institutionalized disabled Norwegian adults the possibility of identifying groups with particular dental welfare profiles which could be ascribed to a set of resource profiles was studied. Eight independent resource variables and seven dependent dental welfare variables were included in the model using canonical correlation analysis. Three main dental welfare profiles were identified: The most important profile was dominated by number of own teeth and differences were mainly ascribed to age, income, marital status and education. The second profile comprised a combination of absence of payment arrangement, chewing problems and barriers for dental care and differences were ascribed to sex, hospital experience, and organized assistance. The third profile discriminating between the disabled individuals was problems with performing dental hygiene associated with irregular use of dental services and barriers for dental care and differences were related to sex, marital status, degree of dependency, and organized assistance. For all profiles, individual characteristics were more important than contextual resources.