Dental Status of the Bulgarian Population: The Influence of Barriers to Accessing Dental Care.

Introduction Dental caries is the most common disease worldwide and affects more than 90% of Europeans. The dental status of a population is an important indicator of quality of life. Different factors act as barriers and can obstruct access to dental services. Patients experiencing such barriers have worse dental status than their counterparts. Methods We conducted a cross-sectional study utilizing an anonymous, self-administered questionnaire and dental checkups among 416 Bulgarians. The study design and instruments were approved by the Ethics Committee of the Medical University, Sofia, and the research was conducted in accordance with the World Medical Association Declaration of Helsinki as revised in 2013. Results Prevalence of dental caries by persons (E) was 98.56%, and intensity (decayed, missing, and filled teeth (DMFT)) was 16.25. Prevalence per tooth (E) was 52.7% for the sample, and average values of decayed (D), missing (M), and filled (F) teeth were D=3.41, M=2.89, and F=9.95, respectively. A plurality of participants (n=192, 46.15%) experienced complex influence of barriers to accessing dental services. The leading factors reported by respondents were psychosocial. Among patients with fear of dental procedures were registered the highest values of prevalence of dental caries by teeth (E=55.86%), intensity (DMFT=17.21), and number of missing teeth (M=3.06). Patients with negative experiences of dental treatment had the most decayed teeth (D=4.33) within the sample. Individuals who experienced a lack of access to dental services had the most filled teeth (F=10.86). Values of E, DMFT, D, M, and F were higher among patients for whom fear of dental procedures and cost of treatment were barriers than for their counterparts. Prevalence (E=53.53%) and intensity (DMFT=16.5) were higher among individuals who perceived lack of pain and complaints as a barrier to accessing services. Conclusion Dental caries affected almost the entire Bulgarian population, which corresponded to the trend toward widespread dental diseases in Europe. Barriers to accessing dental services showed complex interactions. Psychosocial factors such as dental fear, lack of pain, and lack of time were the leading ones according to participants. Negative experience of dental treatment had the greatest impact on dental health compared to the other barriers. Patients with negative experiences had a significantly higher number of decayed teeth than their counterparts. More decayed teeth were also registered among patients for whom cost of treatment, dental fear, and lack of time were barriers. Patients with dental fear and financial obstacles had more extracted teeth than the others. Prevalence and intensity of dental caries, as well as the number of filled teeth, were relatively higher among patients who indicated dental fear, cost of treatment, lack of time, and lack of access as barriers.