Disparities in access to dental care : a cross-sectional study in Beirut secondary school children

Abstract

Disparities in the utilization of dental services among children have a particular epidemiological significance: dental decay is the most prevalent disease in childhood and dental care is the most prevalent unmet health need among children. The aim of this study is to assess the disparities in the utilization of dental services and it’s determinants among secondary school children attending private (PVS) and public schools (PBS) in Beirut-Lebanon.A comparative cross-sectional study of 948 secondary school adolescents aged 11-18 years attending public and private schools (514 PVS and 434 PBS) was conducted. Data were collected through self-administered structured questionnaires targeting parents and the adolescents, and through dental examination of the adolescents. Andersen healthcare utilization model was used to define the determinants of dental care utilization. The questionnaires included questions on child- and family predisposing characteristics (demographics and dental believes), enabling factors (economic indicators, dental insurance status, and awareness of affordable dental centers), perceived need (child perception of his-her oral health status) and utilization of dental services (12 months utilization of dental services, utilization of preventive services and utilization of curative services). The modified index for orthodontic treatment need (IOTN) and the score of Decayed, Missing and Filled teeth (DMFT) were measured through calibrated examiners. Bivariate and multivariable analyses were performed to explore the determinants of dental services utilization. Unadjusted and adjusted Odds Ratios and their 95 percent Confidence interval were reported Public school students were 3 times more likely to have never been examined by a dentist compared to private schools students. The dental service utilization during the previous year was estimated to be 65percent and it was significantly lower for PBS than PVS (52percent and 75percent respectively, p-value 0.0007). The majority of children in PBS visited the dentist for em