Introduction
The issue of access to care is widely recognized as one of the most important problems related to public health (Perwira, 2014). Oral health is one of the fields where the challenges of poor access to care persist on the global scale. The problems linked to the insufficient access to dental and oral care can be observed in many developed and developing countries. In order to address this issue, healthcare systems worldwide focus on a broad range of factors and determiners associated with the problem (Maxey, 2014). The population groups affected by this issue are diverse and multiple, and so are their needs and the health concerns associated with it. Since the problem is rather complicated and multifaceted, there exists the need for further research in this area in order to ensure a deeper understanding of mechanisms, dynamics, causes, and effects of the limited access to dental care. The proposed research will target the inequalities in access to care among underserved and rural populations and seek to identify the most common causes and effects of the impaired access to oral care globally and in the territory of the United States in particular.
Problem Statement
The insufficiency or lack of full access to oral care is linked to a wide range of conditions such as heart disease and diabetes and problems such as the limited chances of finding employment or the overall diminished quality of life (Malecki et al., 2015). A problem of this size does not remain unnoticed by the healthcare leaders, and there have been developed several different solutions helping minimize its effects. For instance, one of the strategies addressing the inequalities in access to care faced by various population groups revolves around the opportunities of delivering mobile dental care to the communities affected by access limitations (Ganavadiya, Chandrashekar, Goel, Hongal, & Jain, 2014). This flexible model allows reaching remote and rural areas, people who require care in homebound settings, and displaced groups; also, it can be used for the delivery of health education and health promotion. Another model is based on the creation of specialized outreach programs curated by healthcare organizations and engaging the volunteering practitioners and students willing to deliver affordable dental care and educational programs to the populations in need (Razdan, Degenholtz, & Rubin, 2016).
However, the problem of poor access to dental and oral care continues to persist regardless of all the solutions and strategies in place. This tendency may result from the fact that the solutions described previously primarily target the effects of the limitations. There exists a theoretical framework according to which the access to care inequalities are viewed as resulting from the combinations of socioeconomic drivers and not from by the individual choices, behaviors, physiological and biological factors (Moysés, 2012). This approach allows creating a new set of strategies aimed at the improvement of the causes of access inequalities, thus fostering upstream solutions, preventative treatments, and long-term changes (Cheema & Sabbah, 2016). The obstacles complicating this approach are presented by the factors and determiners that could be involved in the formation of the access to care limitations. Differently put, the contributors are multiple, diverse, and tend to differ from one community or area to another. As a result, in order to create the effective strategies helping to solve the problems related to the poor access to dental care, it is critical to identify the exact factors taking part in the issue for every individual area.
Some of the most common contributors identified as powerful impacts in the formation of obstacles to access to dental care are the level of income, geographic location, and social status. In particular, the individuals with a low level of income, who are unable to afford dental care when needed or in the appropriate amount, tend to suffer from oral and dental conditions that are left untreated (Friedman & Mathu-Muju, 2014; Malecki et al., 2015). In addition, the communities residing in the remote and rural areas located far away from the dental offices and clinics are also likely to be underserved (Wendling, 2016; Fisher-Owens et al., 2016; Emami, Khiyani, Habra, Chassé, & Rompré, 2015). Moreover, social isolation serves as another powerful driver of poor access to oral care; it mainly affects the individuals and groups whose mobility is limited due to different reasons – jail inmates, older adults on institutional living, people with disabilities, and displaced or migrant communities (Perwira, 2014). The number of groups affected by the conditions and problems associated with the limited access to oral care is high; the additional populations suffering from this phenomenon are people placed in mental health institutions, homeless individuals, communities relocated due to natural disasters or armed conflicts. Each of these groups is underserved due to a set of specific causes and requires individual solutions.
Significance
A substantial body of research and a set of evaluation strategies exist as the basis for the identification of the primary care areas of medicine; they rely on the population characteristics and density (McKernan, 2012). In dentistry, there is the need for this type of research in terms of the causes of poor access to care as this issue is one of the major contributors to the prevalence dental conditions in the affected populations (Perwira, 2014; Razdan et al., 2016).
The significance of this problem is also represented by the connection of poor oral health to serious periodontal conditions that are, in turn, linked to a broader scope of health threats such as cerebrovascular disease, CVD, kidney disease, ventilator-associated pneumonia (VAP), and impaired cognition, among other chronic, inflammatory, and systematic conditions (Wiener & Meckstroth, 2014). In addition to numerous health threats, poor oral health leads to different socioeconomic problems such as a limited chance of finding employment and a decreasing quality of life (Yfantopoulos, Papaioannou, Oulis, & Yfantopoulos, 2015). Moreover, the importance of research in this area is growing in the contemporary world with its tendencies driven by the process of globalization. In particular, the ongoing relocation and displacement of different population groups as a result of social phenomena such as wars and mass migration leads to the formation of a large number of newly established underserved communities and groups (Keboa, Hiles & Macdonald. 2016). The environmental and anthropogenic conditions and disasters such as tornados, hurricanes, floods, fires, oil spills, to name a few, serve as an additional set of factors forcing socioeconomic changes that affect populations depriving them of access to health care and services.
In addition, rural communities tend to be especially vulnerable in regard to the access to oral care as they are associated with a wide range of primary determiners of the discussed limitations – low level of income, remote geographic location, and limited mobility.
Implication
First of all, research focused on the establishment of a deeper understanding of the nature of the access to care limitations and inequalities among the underserved and rural populations could help bring forward the perspectives on the mechanisms involved in the formation of the problem in different environments. Moreover, studying different contributing factors and the potential effects they may inflict or the communities with which they are associated will create a possibility of developing a standardized solution for every particular root cause or their most common combinations, thus facilitating the implementation of the required changes for a faster and more optimized elimination of the problem.
In addition, the upstream approach to the issue that would be potentially enabled by such research would help provide long-term change and create cost-effective strategies of solving the problem of poor access to care for the diverse communities in the most practical manner and preventing them from reappearing in the same areas.
In turn, as the problem of limited access to oral care is connected to a wide range of systematic, chronic, and inflammatory health conditions, addressing the initial contributor would help minimize the prevalence rates of the linked conditions in the affected communities.
Knowledge Gap
The primary gap in knowledge in regard to the problems linked to poor access to oral care is related to the preventative care and health promotion solutions that could work through the complex nature of the access inequalities (Emami et al., 2016). The problem is that even in the populations knowledgeable concerning self-care strategies and dental hygiene, there is a risk of the deterioration of dental health and the development of serious conditions that could eventually be aggravated due to the lack of treatment. As a result, the contemporary research in this area should be directed at the research of the nature of access inequalities and mechanisms according to which they emerge and progress. Bridging this knowledge gap, the modern researchers could foster and facilitate change and address the public health issue that has been persisting for decades.
The number of communities affected by the problem of the impaired access to oral care signifies that the latter required a significant expansion in order to provide inclusion to the underserved groups. However, as it was mentioned previously, the contemporary strategies such as the provision of mobile dental services and the opportunities of flexible, low-cost care do not prove to be effective on a large scale. Differently put, the core of the contemporary problem of oral care access is a large number of the affected communities aided with the help of a small number of suitable strategies most of which are designed only to address the effects of the limited access to care but not its root causes. Studying the latter, the contemporary research could help find solutions facilitating the introduction of policies designed to address the access inequalities as the factors of socioeconomic nature, thus powering the upstream approach to the problem.
Possible Contribution
An improved understanding of and a changed perspective on the problem of poor access to care among rural and underserved populations could potentially become the basis for policies designed to address this issue and improve the overall quality of life in the affected communities. Moreover, the theoretical approach to the problem under discussion as a combination of socioeconomic factors could change the medical view on the causes of different oral and dental conditions, as well as their prevalence rates and persistence. For instance, the common point of view links most of the dental and oral problems to lifestyles and behaviors of an individual powered by their biological predispositions and characteristics; however, a new approach would ensure a broader holistic view on the problem as caused by the factors that are beyond control of the affected individuals (Moysés, 2012). In that way, the major source of the solutions to this problem would be the government and not the communities. In turn, the dental hygiene and health education delivered to the populations suffering from limited access to care could be changed to include the solutions they can implement on a larger scale as additions to the standard set of self-care recommendations.
Conclusion
The problem of limited access to oral and dental care is serious as it is often associated with a number of serious health conditions and threats, some of which are diabetes, heart disease, kidney disease, VAP, the diminished quality of life, and the impaired employment opportunities (Wiener & Meckstroth, 2014; Malecki et al., 2015). This problem has been persisting for many decades and can be observed all around the world due to its complex and multifaceted nature that prevents the researchers and policymakers from finding the effective long-term solutions. The mechanisms and dynamics of the problem are under-researched and require a deeper understanding in order to form strategies addressing the causes of the issue but not only its effects.
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