This article explores psychosocial barriers to dental care and implications for caries management. At-risk populations experience an increased potential for stressors and obstacles that interrupt oral health care and lessen the potential for these groups to pursue dental treatment. These impediments may include financial restrictions, lack of reliable transportation, or inappropriate informed consent. Involving a social worker in dental caries management can help patients to overcome the barriers that hinder oral health care. An increased awareness of these barriers, along with the resources that are available, may help dental providers to better reach their patients and manage dental caries.
Key points
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Many people face barriers when pursuing dental care. Social workers are instrumental in connecting patients and families to resources that help to overcome these obstacles.
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Transportation is a common barrier in dental caries management. There are a variety of resources to assist with issues associated with transportation, including rides and gas reimbursement.
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Limited finances limit the dental care people can afford. Exploring local, state, and federal financial resources can help people to afford necessary dental care.
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Informed consent is essential in all dental treatment. Ensuring the legally appropriate person is consenting to treatment is particular important for minors and dependent adults.
Social workers are valuable members of any health care team, including oral health care. Social workers overcome challenges by connecting people to resources and assisting in the navigation of health care systems. Using the biopsychosocial perspective, social workers assist patients and families in overcoming barriers to care. This article outlines the most common obstacles for patients, including transportation, finances, and informed consent, as well as the enablers that help increase access to dental care. Special attention is paid to vulnerable populations and other types of social worker involvement.
Biopsychosocial perspective
Social workers bring an important perspective to help engage patients in their oral health care. The biopsychosocial perspective explores the biological, psychological, and social aspects that affect patients and families every day, which allows social workers and others to identify and target the important factors that connect patients to oral health care. Biological factors may include physical health, genetic makeup, and oral anatomy. Psychological factors may include self-esteem and perceptions of dentists. Social factors may include family influence, school or work environment, and peer interactions. These factors all constantly interact for each individual, influencing people’s relationships and personalities as well as their oral health care.
Considering the biological, psychological, and social facets of a person sheds light on the complexity of each individual as well as grants access to people’s values and attitudes, which are important components of oral health. Along with incorporating each person’s values and attitudes, the biopsychosocial perspective blends well with the model of social determinants of health. Factors commonly addressed in social work, including social support, culture, and socioeconomic status, affect outcomes in oral health for people across a variety of circumstances. Bearing in mind these concepts in oral health care is likely to increase access to oral health care needs and understanding of the patients being served. Examples of biopsychosocial factors are illustrated in Fig. 1 .
Barriers
Exploring the complexity of each patient through the biopsychosocial model provides valuable insight into options to increase attendance at recall visits. The biopsychosocial model offers information on what else could be going on in a patient’s life that may be hindering him or her from attending a recall appointment. For example, priorities such as medical conditions, work schedule, or child rearing may be interfering with appointment attendance. Considering these factors and exploring solutions for the impeding barriers help providers better serve their patients and collaborate to develop an effective plan for recall appointments. Some of the most common barriers include transportation, finances, and informed consent.
Transportation
If patients cannot physically get to the dental office, it is particularly challenging for them to receive dental care. Transportation is a common barrier for patients, often due to cost or inability to drive. Many patients cannot drive themselves and must rely on someone else with a working vehicle and active driver’s license to transport them to all appointments. These circumstances can be challenging for patients with limited social support and resources and is a time and financial commitment for the drivers. Other patients are able to drive, but do not have a reliable vehicle to get them to appointments, which may be a significant distance from their homes.
Many people cannot afford gas to travel to their dental appointments, especially when multiple visits are needed to complete treatment. In other circumstances, patients are required to pay for parking when visiting a dental office. These fees may cost more than the patient with limited finances is able to spare and thus deters people from seeking routine dental care.
Finances
Cost of treatment is a common consideration for many people seeking dental care. Paying for treatment out of pocket can be challenging and even impossible for many. Finances are especially relevant for those people with significant dental needs. Although dental insurance is a helpful option, it is not always a viable option. Some may not be able to afford the cost of dental insurance, and some plans do not cover the services that patients may be seeking. If patients cannot pay for dental treatment and do not have insurance, they may not pursue dental care until it reaches an emergency state. This delay provides time for more issues to manifest, particularly more severe consequences of dental caries.
Informed Consent
Providers have a legal and ethical responsibility to get informed consent for all procedures. If a patient cannot legally consent to his or her own treatment and does not bring the legal guardian to sign the treatment plan, he or she may not be able to pursue dental treatment. Minors and dependent adults cannot legally consent to their own dental treatment and must have a legal guardian or Power of Attorney (POA) present to consent to all treatment. A legal guardian is a person designated by a judge in a court of law who has the full decision-making rights of the ward. A POA may be established using a notary or lawyer and outlines which aspects of a person’s life the POA is able to make decisions regarding, such as health care or finances. Informed consent is an essential component of any treatment completed, and ensuring the legally appropriate person is willing and able to consent can be a major obstacle for treatment.
Vulnerable Populations
Any pool of patients may experience barriers to dental care. However, there are certain groups that are more strongly impacted by these social obstacles, which negatively affect their oral health care. The most vulnerable populations include, but are not limited to, children, geriatric populations, those with low socioeconomic status, inmates, immigrants, refugees, and individuals with special needs. Transportation to appointments, paying for oral hygiene supplies, scheduling appointments, and meeting important dental needs are often especially challenging with these groups of patients, which could make the social worker’s role even more valuable.
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