INCOME, EDUCATION, AND BARRIERS TO DENTAL CARE ACCESS IN RURAL COMMUNITIES. A CROSS-SECTIONAL STUDY
DOI:
https://doi.org/10.22551/Abstract
Access to dental services in rural areas is often limited by socio-economic and structural barriers, contributing to a high prevalence of dental caries and persistent oral health inequalities. Aim: This study aimed to assess access to dental services in a rural population and to analyze the associations between socio-economic factors, perceived barriers to care, and oral health status, measured using the DMFT index. Materials and methods: A cross-sectional observational study was conducted in 2025 among 72 adults living in rural areas of Bacău County, Romania. Participants underwent a standardized dental examination based on ICDAS criteria, and caries experience was assessed using the DMFT index. A structured questionnaire collected socio-demographic data and evaluated perceived financial, educational, and geographic barriers to dental care using a five-point Likert scale. Results: A very high prevalence of dental caries was identified, with DMFT values ranging from 0 to 25. Only 1.39% of participants were caries-free, while 22.22% presented DMFT ≥ 13. Higher DMFT scores were significantly associated with lower educational level (r = −0.342, p = 0.003), perceived financial constraints, and the perception that household income influences dental attendance (r = 0.260, p = 0.027). Geographic barriers also contributed, as perceived distance to the dental office was positively correlated with DMFT (r = 0.340, p = 0.003). Financial barriers were strongly interrelated and linked to delayed care and emergency-only visits (p < 0.001). Lower educational attainment was further associated with reduced understanding of medical advice and limited access to preventive information. Conclusions: Oral health disparities in rural populations are driven by interconnected socio-economic, educational, and geographic factors, underscoring the need for targeted preventive strategies, improved rural dental infrastructure, and enhanced public support.
References
1. CareQuest Institute for Oral Health. Rural oral health disparities: Barriers to care and potential solutions, 2023. Retrieved from https: //www.carequest.org.
2. Chelaru R, Petcu R, Vasilescu C. Socioeconomic inequalities and dental service utilization in Romania: A regional perspective. International Journal of Health Economics 2024; 11(2): 98-105.
3. Sfeatcu R, Dumitrascu L, Ionescu E. Oral health behavior among Romanian rural children: A national survey. Oral Health & Preventive Dentistry 2023; 21(2): 135-142.
4. Obeidat SR, Naalweh KS, Taani DQ. Socioeconomic status and use of dental services: An international comparative analysis. International Dental Journal 2024; 74(1): 45-52.
5. Rural Health Information Hub. Oral health in rural communities. 2022. Retrieved from https: //www.ruralhealthinfo.org/topics/oral-health.
6. Bellu L, Drăgan I, Șerban A. Disparități în accesul la servicii stomatologice în România: analiză asupra mediului rural. Revista Română de Sănătate Publică 2021; 69(3): 210-217.
7. Ismail AI, Sohn W, Tellez M, et al. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dentistry and Oral Epi-demiology 2007; 35(3): 170-178.
8. World Health Organization (WHO). Oral Health. Geneva: WHO, 2022.
9. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bulletin of the World Health Organization, 2005.
10. Peres MA, Macpherson LMD, Weyant RJ, et al. Oral diseases: a global public health challenge. The Lancet 2019; 394(10194): 249-260.
11. Obeidat R, et al. The Role of Housing Instability in Oral Health Disparities. Journal of Public Health Dentistry 2024; 24(1): 1518.
12. Listl S, Galloway J, Mossey PA. Marcenes W. Global economic impact of dental diseases. Journal of Dental Research 2015; 94(10): 1355-1361.
13. Watt RG, Daly B, Allison P, et al. Strengthening the prevention of oral diseases: The WHO approach. Community Dental Health 2019; 36(3):179-185.
14. Rahman MS, Blossom JC, Kawachi I, et al. Dental clinic deserts in the US: Spatial accessibility analysis. JAMA Network Open 2024; 7(12): e2451625.
15. Nakao K, Kotani K. Utilization of teledentistry in rural areas: A scoping review. mHealth 2026; 12: 11.
16. Petersen PE. World Health Organization global policy for improvement of oral health--World Health Assembly 2007. Int Dent J 2008; 58(3): 115-121.
17. World Health Organization. Global oral health status report: Towards universal health coverage for oral health by 2030. World Health Organization 2022 / https://www.who.int/publications/i/item/9789 240061484.
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