Summary This qualitative study aimed to explore psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity (PwCSO). Eight focus groups were conducted by one researcher with 40 adult participants at the Adult Healthy Weight Clinic within a hospital‐based obesity service. Thematic analysis of focus group transcripts was performed to reveal insights relating to how PwCSO experience dental care and view oral health. A total of 11 participants were male, 29 female, all between the ages of 23 to 74 (mean age of 50). The body mass index of participants ranged from 31.6 to 84.6 kg/m2. The results highlighted four key themes, including “disempowerment to act to improve oral health”, “weight‐related stigma and discrimination”, “unpredictability of the dental environment” and a “lack of tailored services for PwCSO”. A number of subthemes were identified, which reflect the six categories of barriers to access from the disability literature: availability, affordability, acceptability, accommodation, accessibility and appropriateness. These were explored to further appreciate the unique psychosocial considerations for this group. This study concluded that PwCSO face significant barriers to accessing dental services across all six categories highlighted in the disability literature. The study findings provide valuable patient‐based information regarding the psychosocial barriers to accessing dental services, which are relevant for all healthcare professionals. The study reflected an increased need for promotion of the dentist's role in obesity management and obesity‐related dental training, including familiarization with the biopsychosocial domains of obesity to reduce weight related stigma and discrimination, as an area for further study. The findings also guide the design of Specialized Bariatric Dental Services in the future, with a focus on enablers to access.

In the absence of dental related guidelines available in Australia specific to obesity and minimal awareness of the clinical implications on local dental practice, bariatric dental care can be perceived as a 'silent disability crisis'. This opinion piece and brief clinical note aims to question and raise awareness amongst dental professionals surrounding the current limited availability of bariatric dental chairs, difficulties in access, the safety of dental care delivery and ethical considerations for the dental management of people with obesity.

Obesity, classified as a chronic disease by the World Health Organisation (WHO), is a worldwide public health problem. Obesity has links with numerous systemic diseases which may complicate dental management and as such, patients with obesity and concomitant medical comorbidities are commonly managed by Special Needs Dentistry specialist departments in Australia. The sparsity of available evidence on the dental status in this group is likely due to significant access issues experienced by the class 3 obese, who often weigh >140 kg and therefore are unable to be examined or treated in conventional dental chairs. “Bariatric” is a term used to refer to a specific branch of medicine dealing with causes, prevention, and treatment of obesity. It is used widely in the literature to refer to obese patients; however, dentistry for this cohort (“bariatric dentistry”) is less well defined and represents less frequently used terminology. This case report is of a 58-year-old female, with class 3 obesity, who presented in May 2018 for outpatient consult to the Special Needs Unit/Medically Complex Dental Clinic at Westmead Centre for Oral Health, Sydney, Australia, with a compromised and neglected dentition and requiring full dental clearance. The case highlights many of the significant access issues and considerations for safe and effective delivery of dental management. As we move into the future, dental professionals need to become more aware of the growing challenge obesity presents and understand how medical complexities influence dental management. Facilities need to be able to meet this growing need and the specific requirements for a functional and safe bariatric dental service; dependent on both appropriate infrastructure and training.

SummaryData linking body mass index (BMI) and dental service utilization with oral and general health, quality of life, wellbeing, and mental health are lacking. Adult patients with clinically severe obesity attending a hospital‐based obesity service in Greater Western Sydney were invited to participate in a cross‐sectional survey that collected data on dental utilization and visiting patterns, dental anxiety, and oral health‐related quality of life (OHRQoL). General health data were obtained from participants' medical records. Of the 82 individuals who consented to participate, 81 (98.8%) completed the study questionnaire, and 74 (91.3%) answered additional screening questions related to their general wellbeing and mental health. Of the participants, 50 (61.7%) reported that their last dental visit was more than 1 year ago, 43 (53.1%) visited only as needed and 22 (27.2%) participants reported favourable dental visiting patterns. Twenty‐four (29.6%) participants reported high levels of dental anxiety, and low levels of OHRQoL compared with national data. Screening questions suggested low general wellbeing and poor mental health in this patient cohort. Within this group, BMI was not significantly correlated with any of the variables of dental service utilization, dental anxiety, OHRQoL, wellbeing, or mental health (p > .05). There was a negative correlation between dental anxiety and dental utilization (p < .05). Patients with clinically severe obesity reported poor dental utilization, low OHRQoL, and high levels of dental anxiety. This study highlighted the frequency of medical complications, lack of wellbeing, and poor mental health, which were evident in this cohort and may complicate dental management.