Access to oral healthcare for children during the COVID-19 pandemic: A mixed-methods study in the Aegean Region of Türkiye

Abstract

Background 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 the accessibility of dental services and identify determinants of access to oral health care for children aged 0–13 years during the COVID-19 pandemic restriction period. Methods We used a mixed-method research design. 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. 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. Results During the pandemic, 62.3% of dental institutions' applications failed to access 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. Conclusion 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.