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The impact of demographic, health-related and social factors on dental services utilization: Systematic review and meta-analysis
Abstract
Objectives Regular and/or preventive dental services utilization is an indicator of healthcare access and associated with improved health outcomes. We assessed the proportion of individuals regularly/preventively utilizing dental services, and how this was affected by demographic, health-related and social factors.Sources Three electronic databases (Medline, Embase, Central) were searched (2005-2017).Study selection We included observational studies investigating the association between preventive/regular dental service utilization and age, oral and general health, edentulism, family structure and health literacy.Data The proportion of individuals with regular/preventive utilization overall and in different sub-groups were extracted. Random-effects meta-analyses, with subgroup analyses by region, were performed. Meta-regression was used to assess whether and how associations changed with time and countries' human developmental status (HDI). 103 studies on 7,395,697 participants from 28 countries were included. The global mean (95% CI) proportion of individuals regularly/preventively utilizing dental services was 54% (50-59%). In countries with higher HDI, more individuals regularly/preventively utilized services (p < 0.001). Age did not have a significant impact on utilization in adults (OR = 1.00; 0.89-1.12). Utilization was significantly lower in younger than older children (OR = 0.52; 0.46-0.59), individuals with poorer general health (OR = 0.73; 0.65-0.80) and poorer oral health (OR = 0.64; 0.52-0.75), edentulous individuals (OR = 0.32; 0.23-0.41), and individuals with less supportive family structures (OR = 0.81; 0.73-0.89) or poor health literacy (OR = 0.41; 0.01-0.81). The observed differences within populations did not significantly change with time and were universally present.Conclusions Regular/preventive utilization varied widely between and within countries. Understanding and tackling the reasons underlying this may help to consistently improve utilization.Clinical significance Higher developmental status of countries is reflected in greater regular/preventive utilization of dental services. However, large demographic, health-related and social differences in utilization remain. These may contribute to dental health inequalities.
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“Previous studies have shown evidence that similar variables are predictors for NCD incidence [20,21,22] and for health workforce [23].”
From Oral health workforce in Africa: a scarce resource (2023) · cites this paper as [21]
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Regular childhood dental visits, health-related factors and quality of life in later life
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“A previous systematic review reported differences in dental visits among countries (43,44); hence, affordable access to dental care should be offered.”
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“It is also noticed that the use of regular and preventive dental services is unequally distributed around the world and among different groups within countries (Reda et al., 2018).”
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“Higher education, ever screened for cholesterol, being divorced, separated, or widowed, poor SROH, and experienced difficulty in chewing foods in the past 12 months were associated with >12 months or past 12 months DSU.”
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“These estimates could be lowered as medical costs for people who die at a certain age could be more significant than that for those who normally survive [21,22].”
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“However, just under half of adults world-wide do not attend a dentist regularly (9) and as such, do not receive this important messaging.”
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Kaur, G., King, T. L., Karahalios, A., & Singh, A. (2025) · Journal of Dental Research · doi:10.1177/00220345251315155 · Cited by 3
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Applications of spatial autocorrelation in global dentistry: a scoping review
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"Can I please postpone my dentist appointment?" - Exploring a new area of procrastination
Rapoport, O., Möcklinghoff, S., Merz, S., & Neidhardt, E. (2023) · Current Psychology · doi:10.1007/s12144-023-04598-x · Cited by 5
“Globally, the number of unattended dental check-ups is estimated at 54% (Reda et al., 2018).”
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Tooth loss, prosthetic status, and prosthodontic treatment needs of an Indian fishing community
Rajesh, G., Bhatt, S., Rao, A., Shenoy, R., Pai, M. B., & Nayak, V. S. (2020) · SRM Journal of Research in Dental Sciences · doi:10.4103/srmjrds.srmjrds_78_19 · Cited by 3
“This points to a low utilization of oral health services which is consistent with the utilization patterns in developing countries with low Human Development Index.[22] Majority of the visitors (63.”
Resultde Andrade, F. B., & Andrade, F. C. D. (2021) · Cadernos Saúde Coletiva · doi:10.1590/1414-462x202129030186 · Cited by 4
Is Dichotomization into Regular versus Irregular Dental Attenders Valid? A Qualitative Analysis
van der Zande, M. M., Exley, C., Freeman, R., Thetford, C., & Harris, R. V. (2022) · JDR Clinical & Translational Research · doi:10.1177/23800844221118515 · Cited by 3
“2017), and globally, an average 54% of children and adults visit a dentist regularly or preventatively (Reda et al. 2018).”
BackgroundDental service utilization in the general adult population in Bangladesh
Pengpid, S., & Peltzer, K. (2024) · Journal of Public Health Dentistry · doi:10.1111/jphd.12616 · Cited by 3
Oral health of Dutch primary school children in relation to social and health aspects
Grift, B. G., Duijster, D., van der Heijden, G. J. M. G., Bruers, J. J. M., & Jerković‐Ćosić, K. (2024) · Acta Odontologica Scandinavica · doi:10.2340/aos.v83.42053 · Cited by 2
“Previous research also shows that large inequalities have been identified in oral healthcare service utilization in children [28] especially socioeconomic differences, whereas children from a low SEP visit the dentist less regularly for check-ups [35].”
BackgroundMethodGomes, A. C., Vettore, M. V., Quadros, L. N., Rebelo, M. A. B., & Vieira, J. M. R. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09596-0 · Cited by 2
“Use of dental services can be influenced by demographic and socioeconomic factors related to general and oral health [21, 22].”
BackgroundDental and Medical Service Utilisation in a German Population - Findings of the LIFE-Adult-Study.
Schmidt, J., Ziebolz, D., Zeynalova, S., Löffler, M., Stengler, K., Wirkner, K., & Haak, R. (2020) · PubMed Central · doi:10.3290/j.ohpd.a45412 · Cited by 2
The Pattern of Dental Care Utilization Among Saudi School Children
Aboubakr, R. M., & Elkwatehy, W. (2021) · Al-Azhar Dental Journal for Girls · doi:10.21608/adjg.2021.60122.1337 · Cited by 2
“This under use of dental services may be due to oral health illiteracy dentist-related factors, financial and transportation barriers (44,45).”
BackgroundMelgar, X. C., Azañedo, D., & Hugo, F. N. (2024) · Community Dentistry And Oral Epidemiology · doi:10.1111/cdoe.12945 · Cited by 2
Winkelmann, J., Rossi, J. G., Schwendicke, F., Dimova, A., Атанасова, Е., Habicht, T., Kasekamp, K., Gandré, C., Or, Z., McAuliffe, Ú., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-964070/v1 · Cited by 2
Garcés‐Elías, M. C., Castillo-López, C. E. D., Beltrán-Silva, J. A., & León-Manco, R. A. (2023) · BMC Oral Health · doi:10.1186/s12903-023-03083-y · Cited by 1
Sava-Roşianu, R., Campus, G., Alexa, V. T., Bălean, O., Sfeatcu, R. I., Murariu, A. M., Muntean, A., Esian, D. E., Dăguci, C., Olaru-Poşiar, S., et al. (2025) · Methods and Protocols · doi:10.3390/mps8030049 · Cited by 1
Madhavan, K., & Sajan, S. A. (2026) · Community Dentistry And Oral Epidemiology · doi:10.1111/cdoe.70104 · Cited by 1
Public preferences for preventative dental care: a discrete choice experiment in China
Yang, D., Li, X., Chen, B., Liu, B., Huang, Z., Qin, M., Chen, W., Tang, Y., Wu, X., & Chen, J. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1886047 · Cited by 1
“Previous studies have indicated that the uptake of PDC is influenced not only by service availability and quality but also by individual-level factors, including oral health literacy, socioeconomic status, and cultural context (17–20).”
Permatasari, P., Arbitera, C., & Wenny, D. M. (2022) · International Conference on Medical and Health Informatics (ICMHI) · doi:10.1145/3545729.3545787 · Cited by 1
Regular dental check-up status and related factors among Thai residents in Japan
Fukuda, H., Kobori, E., Miura, H., Mizumoto, K., Nozue, M., Hazano, S., Kamata, K., & Maeda, Y. (2024) · Odontology · doi:10.1007/s10266-024-00954-w · Cited by 1
“Systematic reviews have reported that the rate of regular dental check-ups is not associated with age [13, 14].”
Anterior Hyperfunction Syndrome: Literature Review and Conceptual Model
Aranda‐Herrera, B., la Cruz, T. R. A.-D., Jurado, C. A., & García‐Contreras, R. (2024) · Clinics and Practice · doi:10.3390/clinpract14040128 · Cited by 3
“Timely patient attention is crucial, considering issues such as limited access to quality dental services, resulting in a lack of preventive care [50,51].”
BackgroundTu, J., Zhou, J., Li, X., Zhang, Q., Luo, M., & Zhou, J. (2024) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2509347 · Cited by 1
“The Medical Research Institute emphasizes the need to evaluate the quality of transitional care from the patient’s perspective [28].”
BackgroundAssociação entre o alfabetismo funcional e o reconhecimento da palavra bruxismo em adolescentes
de Lima, L. C. M., Bernardino, V. M. M., Neves, É. T. B., Serra‐Negra, J. M., Ferreira, F. M., Paiva, S. M., & Granville‐Garcia, A. F. (2022) · Arquivos em Odontologia · doi:10.35699/2178-1990.2021.29679 · Cited by 1
“≤ 7 pontos 86 (40,4) 127 (59,6) < 0,001 2,66 (1,66-4,26) <0,001 > 7 pontos 33 (20,2) 130 (79,8) 1.”
Socioeconomic inequalities in dental visits among high school students in Chile, years 2013 and 2017
Urrutia, C. G., Tapia-Pinto, C., & Cornejo‐Ovalle, M. (2023) · Community Dental Health · doi:10.1922/cdh_00276garrido-urrutia05 · Cited by 1
“Living in rural communities decreases use of dental services (Reda et al ., 2018; 2018; Curi et al., 2018), often due to restricted geographical access (Guay, 2004).”
InfluentialPermatasari, P., Arbitera, C., & Wenny, D. M. (2021) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2021.7146
An Assessment of Impact of Higher Education on Oral Health Knowledge, Practices and Lifestyle habits
Bokhari, S. A. H., Nasir, E. F., Sanikommuo, S., Alnaim, A., Almulhim, A. A., Khames, G. B., Hababi, Z., Hashim, A., & Otaibi, A. R. A. (2021) · Pakistan Journal of Medical and Health Sciences · doi:10.53350/pjmhs2115123277
Jeffreys, M., Lopez, M. I., Russell, L., Smiler, K., Ellison‐Loschmann, L., Thomson, M., & Cumming, J. (2020) · doi:10.26686/wgtn.12940055.v1
Jeffreys, M., Lopez, M. I., Russell, L., Smiler, K., Ellison‐Loschmann, L., Thomson, M., & Cumming, J. (2020) · doi:10.26686/wgtn.12940055
Morais, I. D. O., D’Assunção, F. L. C., Caldas, J. M. P., Veloso, H. H. P., Costa, M. D. D. A. S., & Salazar-Silva, J. R. (2023) · Research Society and Development · doi:10.33448/rsd-v12i6.42025
Dental Therapy of Patients Prior to Endoprostheses: A Retrospective, Telephone-Based Cohort Study
Schmalz, G., Wirtz, J., Haak, R., Fenske, F., Roth, A. J., & Ziebolz, D. (2023) · Dentistry Journal · doi:10.3390/dj11080198
“Second, a recent meta-analysis reported on dental service utilization; it was reported that poorer overall dental health, as well as several sociodemographic factors, could negatively affect the utilization of dental services [19].”
BackgroundSchmitt, E. J., Rocha, J. S., Caldarelli, P. G., Ditterich, R. G., Ignácio, S. A., Moysés, S. J., & Gabardo, M. C. L. (2021) · Saúde e Desenvolvimento Humano · doi:10.18316/sdh.v9i3.7882
MEDICAL AND SOCIAL APPROACHES IN MANAGING THE QUALITY OF MEDICAL DENTAL CARE FOR THE POPULATION
GALIULLIN, A. N., Yakimova, J., Хадыева, М. Н., & Львовна, Б. С. (2024) · The actual problems in dentistry · doi:10.18481/2077-7566-2024-20-2-12-19
Metadata
- Authors
- Reda, S. M., Krois, J., Reda, S. F., Thomson, W. M., & Schwendicke, F.
- Affiliations
- Stiftung Charité (DE)
- University of Otago (NZ)
- Corresponding author
- Schwendicke, Falk
- Venue
- Journal of Dentistry
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 75
- Pages
- 1-6
- ISSN
- 0300-5712 (ISSN-L)
- OpenAlex
- W2799740911
- Cited by
- 125
- References
- 41
- Citations by year
- 2026: 14 · 2025: 10 · 2024: 18 · 2023: 14 · 2022: 14 · 2021: 23 · 2020: 25 · 2019: 5 · 2018: 2
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Dentistry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Dentistry › General Dentistry › Dental Health and Care Utilization
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Health Professions › General Health Professions › Dental Education, Practice, Research
- Keywords
- service utilization, preventive dentistry, health care access, oral health, health status, edentulism, family structure, health literacy, Human Development Index, socioeconomic disparities, children's dental care, determinants of health care use, cross-national comparison, dental caries prevention, oral cancer screening, periodontal disease
- MeSH terms
- Facilities and Services Utilization, Adult, Child, Demography, Dental Care, Humans, Oral Health, Socioeconomic Factors
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