“Access” is a term used for a broad set of concerns that center on the degree to which individuals and groups are able to obtain needed services from the health care system.
Reason for not obtaining dental needs (hpi@ada.org)
Addressing the following key barriers will allow the public to properly gain and utilize available oral health care:
1. General factors
I. Oral health literacy
II. Perceptions of need
III. Dental anxiety states
2. Psychological factors
I. Turning literacy into healthy behaviors (Patient activation)
II. Treatment mentality vs. prevention mentality
III. Social and cultural misperceptions
Oral Health Literacy
Increased oral health literacy provides a first step toward enabling patients to see value and ask for services;
§ Developing a comprehensive oral health education component for schools’ health curriculums.
§ Equipping teachers at various levels with creative educational tools, including educational videos, puzzles, word searches, and experiments that show children the value of their teeth and how to care for them.
§ Training daycare providers and school nurses on the importance of oral health, including nutrition’s role in maintaining healthy teeth.
§ Providing dental information on the use of bottled water, fluoride, fluoride varnishes, which are helpful in prevention of tooth decay.
§ Offering multi-factorial interventions and educational programs to parents of young children, including through public media and information provided at hospitals and other health care points of care
Perceptions Of Need
Peoples' perceptions of treatment need range from those who attend on a regular basis with no visible sign of normative need to those who attend only when in pain.
For instance when asked about dental attendance an 80 year old edentulous woman commented; 'I ain't got any teeth so I’m lucky no need to go... haven't been to the dentist since these teeth were fitted...that must be ... oh ... at least 20 years ago'.
Whereas a 70 year old woman with her own teeth perceived dental care as an important part of her overall health care regime; 'I'd be worried about what would happen to my teeth if I didn't go... I don't want too much treatment just enough to make sure my teeth last me out'.
Dental Anxiety States
Dental anxiety has been highlighted as being one of the most important barriers with regard to dental attendance. There is the view that anyone who presents with fear of dental treatment experiences an equivalent intensity of emotion which results in the avoidance of dental care. However, despite their considerable dental fears some patients accept regular dental treatment. It would seem that the relationship between dental anxiety and avoidance is not a simple one. Depending on the intensity of anxiety experienced, the fearful patient may find dental treatment troublesome or look upon it as an intolerable encounter.
As a barrier to accessing dental care, dental anxiety in children may be a consequence of the child's stage of personality development, parental dental anxieties or the parent's fears and wishes to deny her child any distress or anxiety. This wish may be a culmination of mother's own anxieties together with her disquiet at the sight of her child's distress and unhappiness. Such difficulties on the parent's behalf may result in the parent delaying care. Only when an emergency situation arises can the parent bear to subject the child to treatment.
Patient Activation, Turning Literacy Into Healthy Behaviors
Unfortunately, evidences have shown that educating patients about the importance of proper oral health care isn’t enough to lead to patient activation and positive patient outcomes. Education must be coupled with health promotion to ultimately result in patients’ realizing and acting upon their need for preventive care, both through self-care at home and through regular visits to their dentist
Treatment mentality vs. Prevention mentality
The success of our efforts for oral health improvement should be measured by the outcome goal of no disease. However, in contrast, some countries like Denmark—a nation whose dental health outcomes are much more positive than those of like New Zealand and even the United States—succeed due to their focus on prevention at a very early age, rather than the notion that fillings, extractions, and root canals are the answer. By focusing on the preventable nature of dental disease, Denmark has greatly reduced the need for treatment interventions, whereas in New Zealand and elsewhere, the use of increased treatment mainly by therapists has not caused a decrease in dental caries.
The issue of emergency room visits is a symptom of our treatment mentality when it comes to health care, and prevention is the solution. We must stop resorting to emergency rooms as a place for oral health care, and promote preventive oral health care at home and in the dental home.
Social And Cultural Misperceptions
“Oral health knowledge and practices differ by ethnicity and culture. Groups vary in beliefs about the usefulness of treating the primary teeth, caries etiologies/cause, the meaning of oral pain, dental discolorations, or loss, home remedies, dental hygiene and preventive efficacy, and trusted dental information sources.”
However, these social and cultural misperceptions may be overcome by:
Working with community leaders to break down cultural barriers; providing oral health information in multiple languages through multiple community channels.
Financial Costs
Financial costs of dental treatment remain a significant barrier to accessing dental care.
The difficulties and problems encountered by people on low income is said to be related to the degree of competition for the families' disposable income. Where competition is the greatest, dental treatment may be felt as an unaffordable luxury and, while being valued, may be low on a list of priorities when compared with other essential commodities. Ideas such as these suggest that an inverse care law is operative with those in greatest need receiving the least in the way of dental health care.
