# The Impact of Demographic, Psychosocial, and Socioeconomic Factors on Barriers to Accessing Dental Services in Bulgaria

## TL;DR

This study explores how personal, social, and economic factors affect dental care access in Bulgaria, finding that patient-related issues are the biggest barriers.

## Contribution

The study identifies patient-related barriers as the primary obstacle to dental care access in Bulgaria, with insights into demographic and psychosocial influences.

## Key findings

- Patient-related barriers accounted for 67.03% of obstacles to dental care access in Bulgaria.
- Psychosocial factors like dental fear and anxiety were more significant than cost in delaying dental visits.
- Barriers by state and society were more commonly reported by men, low-income individuals, and less educated groups.

## Abstract

Introduction

Dental health is an important component of overall health. Many factors can obstruct access to dental care and limit the utilization of services. Barriers to accessing dental services are divided into three groups - by patients, by dental profession, and by state and society. Factors by patients are proven to be the leading ones.

Methods

We conducted an anonymous survey among 416 Bulgarians to study the barriers to accessing dental services and the demographic, psychosocial, and socioeconomic factors that influence those barriers. The research complies with ethical standards and is approved by the Ethics Committee of Medical University, Sofia.

Results

The main group of barriers to accessing dental care in the Republic of Bulgaria was patient-related (67.03%). They led all groups by gender, age, residence, education, income, overall health status, self-assessment of dental health, and frequency of visits. Barriers by state and society were second in importance (28.9%) and were mentioned mainly among men, low-income people (33.96%), the less educated (27.33%), age group 45-65 years (22.76%), and patients visiting a dental office only in case of emergency (32.97%). The leading reason for the postponement of visits was lack of pain (31.21%). Lack of pain was more often indicated among women (20.04%), age group 45-65 years (28.28%), and rural population (31.04%). The cost of dental treatment (15.54%) was not a significant factor and was outweighed by psychosocial factors such as lack of time (17.8%) and dental fear and anxiety (16.67%). Dental fear and anxiety were cited mainly among women (9.12%), younger patients (17.9%), the less educated (12.21%), those with low income (9.62%), and those without income (25%), as well as among people with low self-estimation of their oral health status (40%) and those visiting a dental office irregularly (25.53%).

Conclusion

The main group of barriers to accessing dental services in the Republic of Bulgaria was those created by patients and were indicated mainly among women, people with higher education and income, and those from rural populations, while barriers by state and society were indicated mainly by men, low income, less educated, and people over 45 years. Complex impact by more than one group of factors was reported mainly by middle-aged people, city populations, people visiting a dental office irregularly, and those with low self-assessment of their dental status. Patients postponed dental treatment mainly due to lack of pain, which was more significant among women, people over 45 years, and rural populations. The cost of dental treatment is no longer a significant factor and has been overtaken by psychosocial factors such as lack of time and dental fear and anxiety.