Arabulan Sevgi, Önçağ Rüştü Özant, Öcek Zeliha Aslı
Private Practice, Izmir, Türkiye.
Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany.
BMC Oral Health. 2025 May 2;25(1):680. doi: 10.1186/s12903-025-06053-8.
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 access to oral healthcare for children aged 0-13 during COVID-19 restrictions.
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.
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.
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.
新冠疫情严重扰乱了医疗系统，尤其影响了儿童和有特殊需求的人群等弱势群体，导致常规牙科服务出现延误和减少。本研究的目的是评估在新冠疫情限制措施期间，0至13岁儿童获得口腔医疗服务的水平，并确定其影响因素。
采用混合方法研究设计。这项横断面研究纳入了2021年8月至2022年2月期间前往伊兹密尔埃杰大学儿童牙科诊所就诊的270名0至13岁儿童。通过访谈员实施的问卷调查收集了社会人口统计学和经济特征信息，以及疫情期间牙科服务的使用情况。针对每次向该机构提出的申请，分别定义了获得口腔医疗服务以解决现有牙科问题的“可及性”。使用IBM SPSS Statistics 23进行统计分析，应用Pearson卡方检验、Fisher精确检验和二元逻辑回归检验来检验变量关系。采用95%置信区间和p < 0.05的显著性水平，使用Hosmer-Lemeshow检验和Nagelkerke R²评估模型拟合度。对16次深入访谈的定性数据进行主题分析，以探讨新冠疫情期间获得口腔医疗服务的障碍。
在疫情期间，62.3%的牙科机构申请获得的医疗服务可及性有限。父母的教育程度、就业状况和家庭收入对可及性有显著影响（p < 0.005）。多元逻辑回归显示，与公立牙科中心相比，向大学诊所（比值比[OR] = 4.78；95%置信区间2.24 - 10.21）和私立机构申请（OR = 4.33；95%置信区间2.30 - 8.17）可获得更高的可及率。父亲有固定工作（OR = 3.39；95%置信区间1.37 - 8.34）以及孩子之前有过牙科就诊经历（OR = 2.37；95%置信区间1.21 - 4.62）会增加获得口腔医疗服务的可能性。感染风险和收入损失是与疫情相关的障碍。最常见的障碍是公立牙科诊所服务的可获得性问题。残疾儿童由于感染风险、前往机构困难以及全身麻醉下未满足的牙科治疗需求而面临更多障碍。
较高的社会经济地位和过去与牙医的接触对获得口腔医疗服务有积极影响。公立机构提供的牙科服务可及性较低。新冠疫情凸显了口腔医疗服务的不平等，尤其是在土耳其，对于那些残疾儿童而言。政策制定者应加强公共卫生危机计划，以改善儿童获得口腔医疗服务的情况。
