Access and Utilization of Oral Healthcare Services and their Associated Factors Among Students with Disability in Al-Ahsa of Saudi Arabia

Abstract

Background: Oral health disparities are a significant issue for persons with disabilities (PWDs), who face various barriers to accessing dental care. Understanding these disparities and identifying associated factors is crucial for developing targeted interventions. Aim: We aim to provide an overview of the oral health outcomes of PWDs through systematic reviews. Additionally, we seek to assess the access to and utilisation of oral health care services and their associated factors among students with disabilities (SWDs) in Al-Ahsa, Saudi Arabia, while also exploring the preparedness of dental students and the role of special education teachers in promoting oral health, through cross-sectional studies. Methods: This thesis comprised two stages. The first stage involved conducting four systematic reviews on oral health disparities among PWDs in Saudi Arabia and one global overview of systematic reviews to identify common barriers faced by PWDs in accessing dental healthcare, as well as exploring potential solutions. The second stage included three cross-sectional studies conducted in Al-Ahsa. Surveys were administered to parents, special education teachers, and dental students, focusing on perceived oral healthcare behaviors and barriers to care for SWDs, special education teachers' involvement in oral health education and promotion for SWDs, and dental students' preparedness in managing PWDs. Results: The systematic reviews highlighted significant oral health disparities among PWDs in Saudi Arabia, including high rates of dental caries, periodontal disease, and orthodontic issues. Additionally, PWDs and their families experienced low oral health-related quality of life. Global barriers to accessing dental care for PWDs included financial constraints, provider-related issues, access-related challenges, systemic barriers, and patient-related factors. In the cross-sectional studies conducted in Al-Ahsa, findings from parents revealed concerns regarding the oral health behaviours of SWDs, including irregular tooth brushing (45.7% brushing irregularly), lack of flossing (only 4.3% flossing regularly), and frequent sugar intake (48.1% consuming sweets daily). Infrequent dental visits (51.9% sought only on an emergency basis) indicated limited utilisation of oral healthcare services. The most reported barriers were fear of treatment (47.1%), long waiting times (44.7%), and difficulty finding willing dentists (45.5%). Special education teachers played a critical role, yet their involvement in oral health education was constrained by inadequate resources (56.1%), limited knowledge (29.2%), misconceptions about primary teeth removal (47.4%), and challenges in recommending dentists for SWDs (62.5%). Only 20.8% of teachers had received oral health education, and collaboration with dental professionals was minimal. The project also assessed the attitudes, training, and exposure of dental students to PWDs, identifying gaps in their education. Notably, 42.5% of students felt unprepared to manage PWDs. Addressing these gaps through structured exposure to PWDs during training is essential to equip future healthcare providers to deliver comprehensive and compassionate care. Conclusion: Our studies underline the need for targeted interventions to ease access to healthcare services, including improved dental education to prepare professionals to effectively manage PWDs, increased resources and training for special education teachers, and policy reforms to address systemic and financial barriers impacting dental care for PWDs. Schools would serve as effective and efficient collaborative platforms for delivering oral health education and implementing effective, cost-efficient preventive strategies for SWDs, aligning with Saudi Vision 2030’s goals of promoting accessible healthcare, enhancing the value of healthcare services, and strengthening prevention against health threats for the Saudi population.