62.3% of dental institutions had limited access to care during the pandemic.
Parental education, employment status, and household income significantly influenced .
Children applying to university clinics or private institutions had higher access rates compared to those using public dental centres.
Children with prior dental visits were more likely to access oral healthcare.
Barriers to accessing care included concerns about infection and service availability at public clinics.
Children with disabilities faced additional challenges, including difficulty reaching facilities and unmet treatment needs.
Simplified
BACKGROUND: The COVID-19 pandemic significantly disrupted healthcare systems, particularly affecting vulnerable populations such as children and individuals with special needs, causing delays and reductions in routine dental services. The aim of this study was to evaluate level of access and identify determinants of for children aged 0-13 during COVID-19 restrictions.
METHODS: Mixed-methods research design was adopted. This cross-sectional study included 270 children aged 0 to 13 years who visited Ege University Pediatric Dental Clinics between August 2021 and February 2022. Interviewer-administered questionnaires collected information about sociodemographic and economic characteristics, as well as dental service utilization during the pandemic. "Access" to receive oral health care to address existing dental problems is defined separately for each application to the institution. Statistical analyses were conducted using IBM SPSS Statistics 23, with Pearson's Chi-Square, Fisher's Exact, and Binary Logistic Regression tests applied to examine variable relationships. A 95% confidence interval and a significance level of p < 0.05 were adopted, with model fit assessed using the Hosmer-Lemeshow test and Nagelkerke R². Qualitative data from 16 in-depth interviews were analysed using thematic analysis to explore the barriers to accessing oral healthcare during the COVID-19 pandemic.
RESULTS: During the pandemic, 62.3% of dental institutions' applications had limited access to care. Parental education, employment status, and household income significantly affected access (p < 0.005). Multiple logistic regression revealed that applying to university clinics (OR = 4.78; 95% CI 2.24-10.21) and private institutions (OR = 4.33; 95% CI 2.30-8.17) led to higher access rates when compared to public dental centres. The father's regular employment (OR = 3.39; 95% CI 1.37-8.34) and the child's previous dental contacts (OR = 2.37; 95% CI 1.21-4.62) increased the likelihood of accessing oral healthcare. The risk of contracting infections and income loss were pandemic related barriers. The most common barriers were those concerning the availability of services at public dental clinics. Children with disabilities faced further barriers due to the risk of infection, difficulty reaching institutions, and unmet dental needs for treatment under general anaesthesia.
CONCLUSION: Higher socioeconomic status and past contact with dentists had a positive effect on oral healthcare access. Dental services provided by public institutions had a lower level of access. The COVID-19 pandemic highlighted oral healthcare inequalities, particularly for those children with disabilities in Türkiye. Policymakers should strengthen public health crisis plans in order to improve children's oral healthcare access.
Key numbers
62.3%
Limited Access Rate
Percentage of applications with limited access to dental services.
3.39×
Higher Access Odds
Odds ratio for access based on father's employment status.
2.37×
Increased Access Likelihood
Odds ratio for access based on previous dental visits.
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Declarations. Ethics approval and consent to participate: Ethical approval to conduct this study has been approved by the Ege University Faculty of Medicine Ethics Committee in 04.02.2021, Ref. No. 21-2T/11. This study was conducted in accordance with the Declaration of Helsinki. Written informed consent to participate in study activities was gathered from the parents/legal guardians of all study participants. Clinical trial registration is not applicable, as the study does not involve any interventions. Consent for publication: Written and verbal consent for publication was obtained from all participants in the in-depth interviews and from those who completed the questionnaire. They were informed about the study’s objectives and the use of their data in the research. Competing interests: The authors declare no competing interests.
