Utilization of oral health care services and perceived barriers among adults residing in Jiri, Nepal: a cross-sectional study | BMC Public Health

Oral diseases continue to be neglected and receive little attention in many nations worldwide, despite being among the most prevalent diseases affecting large populations [19]. The factors influencing the use of oral health services by rural populations in developing nations are not well understood [12]. Therefore, this study was conducted to determine the status of dental care utilization and the barriers to utilization perceived by the heads of households residing in Jiri, which is situated in Dolakha district in Bagmati Province, Central Nepal.

Among the 725 adult residents who participated in this study, only 130 (17.9%) visited a dentist in the past year, and very few (87, 12%) had a dental visit in the past six months. Additionally, according to the annual report of Nepal, 2020, there is a low record of dental visits by only 3.89% of the Nepalese population [20]. The prevalence of dental health care utilization was found to be 15.4 ± 2.9% in Kerala [4] and 36% in Nellore, India, in the past year [21]. However, 60.3% and 9.9% reported visiting a dentist for dental treatment in the past year and for 6-monthly dental check-ups, respectively, in Kermanshah city, western Iran [3]. Past dental visits show that the person has given care to his/her oral health. It reflects the individual’s motivation and decision towards dental treatment. Utilization of dental services not even once a year indicates poor preventive oral health practices by people because they seek dental care only after they suffer from an acute dental problem [22]. In the current study, the utilization of dental services was low, and the major reason for the last dental visit was dental pain followed by tooth decay. Similarly, other studies reported that pain was the primary reason for visiting a dentist, followed by decayed teeth [22,23,24]. Pain and emergency care are the most common reasons for dental appointments [25].

In the present study, the associations of demographic factors with the utilization of dental services in the past year were determined. Age (P = 0.033) was significantly associated with the utilization of dental services. Among different age groups, utilization of dental services was observed more (51, 24.2%) among 35–49 years of age. In a study by Kakatkar et al., younger age group visited the dentist regularly in comparison to the older age group which may be because the younger age group had more knowledge and fewer barriers [26]. In the present study, many of those aged 65 years and above (109, 87.2%) had not visited a dentist in the past year. In accordance with the findings of this study, one study reported that the frequency of dental visits decreased with age [27]. The underutilization of dental services can be attributed to several factors, such as elderly people facing issues such as loss of income due to not being an active work force, increased risk of chronic diseases, loss of social support, and inadequate pensions, all of which have an impact on their general health and dental health [28]. In contrast, other studies have shown a significant association of dental service utilization with age, such that older age was observed to be an important factor for seeking and using dental health-care services [3, 25, 29,30,31]. The contrasting study findings for dental service utilization with respect to age suggest the need for both interindividual and intraindividual explanations [27].

In the present study, current occupational status (P = 0.001) was significantly associated with dental service utilization in the past year, such that the number of dental visits for seeking care was lower among most unemployed individuals (331, 86.9%) than among employed individuals (179, 75.5%) or self-employed individuals (85, 79.4%) in Jiri. Similarly, a study reported that people with unemployment status are more likely to experience unmet dental care needs due to their financial constraints [32]. Additionally, in other studies, most employed adults had a higher rate of regular dental attendance than the unemployed adults [4, 33, 34].

An analysis of the perceived barriers to dental service utilization by adult residents of Jiri revealed that the most common perceived barrier was the high cost of dental treatment, followed by a lack of awareness of seeking dental care and difficult access to oral health services due to scarce dental facilities. Similarly, the most frequent barriers reported by the elders in the study conducted by Saleh et al. were the high cost of dental services, lack of awareness of the importance of dental checkups, fear of dental procedures, difficult transportation and long distances, and poor experience [35]. Similarly, Al Johara reported that the high cost of dental care was the most discouraging factor for the utilization of dental services [2].

In the present study, most of the unemployed respondents (349, 91.6%) perceived at least one barrier in utilization to dental services than self-employed or employed groups (P = 0.015). This could be because career traits are consistently associated to subsequent self-perceived healthcare access barriers, with cost barriers being normally linked than service unavailability [36].

The present study provides useful information regarding the status of dental service utilization by people in the rural population of Nepal and its associations with demographic factors and perceived barriers. However, this study has several limitations that should be considered when interpreting its findings. Convenience sampling, a type of non-probability sampling method, was utilized for selecting the sample, which could have led to a high risk of causing selection as well as under coverage bias, owing to their unrepresentativeness towards the target population. Since dental visits in the past six months and one year were investigated, the probability of recall bias could not be avoided. Additionally, we could not assess whether the dental visit was limited to regular dental checkups or whether the participants sought any preventive or curative treatment measures. Furthermore, the cross-sectional nature of the study design could not reveal the temporal relationship between demographic factors and dental service utilization status.