Oral Health Program in Rural and Underserved Areas


Healthcare systems all around the globe are focused on the monitoring, research, and maintenance of oral health and the issues related to it as some of the major dimensions of public health (Maxey, 2014). Oral health is a broad field of medicine that covers a wide variety of problems, theories, and approaches to care. Moreover, the target populations have rather diverse needs in regard to dental and oral care services and treatments. As a result, access to care is recognized as one of the persisting issues in the field. There exists a number of communities and groups of the population that cannot receive all the required services. The limitations in access to oral care are determined by several different factors, some of which are geographic location of the target populations, their social status, and level of income. Since the problem has a complex and multifaceted nature, there is a need for research in this area that could shed light on the causes, mechanisms, and outcomes of the limited access to oral care. A better understanding of the problem could further serve as the basis for policies and strategies addressing the issue. This paper provides the statement of the selected problem and explores its different aspects; it also outlines the purpose of the research and a set of research questions, as well as a theoretical framework and a literature review.

Problem Statement

Poor dental and oral health that usually results from versatile periodontal conditions is recognized as a serious health threat and associated with the prevalence of such conditions as chronic kidney disease, CVD, cerebrovascular disease, impaired cognition, and VAP (ventilator associated pneumonia), among other diseases of systematic, inflammatory, and chronic nature (Wiener & Meckstroth, 2014). In that way, the groups and individuals facing limited access to oral health services represent a significant public health problem since the inequalities in access to dental and oral care result in the diminished quality of life in the affected populations (Yfantopoulos, Papaioannou, Oulis, & Yfantopoulos, 2015).

Exploring the problem in a more detailed manner, it is possible to notice that the populations with limited access to oral and dental care can be characterized by three major features such as the level of income (Wallace & Macentee, 2012), social status (jail inmates, older adults on institutional living) (Wendling, 2016; Wiener & Meckstroth, 2014), and geographic location (Emami, Khiyani, Habra, Chassé, & Rompré, 2015). In particular, one of the communities frequently facing the challenges of being underserved in terms of oral care is represented by the populations dwelling in rural areas. This group tends to combine the limitations in access to care caused by the remote geographical position and a low level of income (Emami et al., 2015). Not only are the residents of rural areas unable to afford the same services as ones the urban dwellers access on a regular basis but also the oral care services available in the remote locations tend to be of lower quality (Lutfiyya, 2013; McKernan, 2012). Moreover, as indicated by Cheema and Sabbah (2016), the individuals and groups located at the lower levels of social hierarchy tend to seek for the oral care services more rarely than the communities at the top of the hierarchy. Also, dues to the set of costs and tasks associated with the dental visits (transportation costs, the need for time off work) low-income populations face difficulties accessing care when needed (McKernan, 2012; Cheema & Sabbah, 2016). These issues can be observed in the territory of the United States and also are present in most countries around the world (Emami et al., 2015).

Purpose of Research

Since the explored issue is not a local or unique problem for the United States but persists globally, there have been developed multiple methods and approaches aiming at the minimization of the problem or its complete elimination. Some of the strategies addressing the issue of limited access to oral care are based on the engagement of the dental students and volunteer practitioners thus forming the systems helping to provide affordable and flexible types of services to the underserved populations (Razdan, Degenholtz, & Rubin, 2016). Also, another model addressing the problem of the inequalities in access to oral care is based on the organization of portable centers helping the healthcare practitioners reach remote areas and provide care to the displaced groups and individuals in homebound settings (Ganavadiya, Chandrashekar, Goel, Hongal, & Jain, 2014).

The fact that the inequalities continue to persist even though the strategies addressing the problem are applied indicates that there is the need for more refined and, possibly, unique solutions targeting the specific populations and the individual factors contributing to their inequalities in access to oral and dental care. In that way, the purpose of the proposed research is to identify the specific traits in the environments of different types of underserved populations in the USA and around the world in order to enable more effective strategies targeting the issue. In addition, the study is also focused on finding the connections and relationships between the identified factors contributing to the prevalence of inequalities and the outcomes that follow. This approach would help assess and evaluate the contributing factors based on their significance according to the outcomes they inflict.

The importance of research in this sphere is particularly high in the contemporary globalizing world characterized by the ongoing relocation of large population groups and communities (Keboa, Hiles & Macdonald. 2016). Differently put, the inequalities in access to dental and oral care could have dynamic causes that change over time due to the shifts in the social, economic, and environmental conditions in the regions where the affected populations dwell.

Research Questions and Theory

The research questions that serve as the basis for this project are focused on the root causes of the unequal opportunities in the access to oral care in different underserved populations. Additionally, the outcomes of the factors contributing to the persistence of the poor access to care are another focus of the research questions of this project that are listed below:

  1. What are the most common reasons of the impaired access to oral care globally?
  2. What are the most common reasons of the impaired access to oral care in the United States?
  3. What are the outcomes of the poor access to care in the underserved and rural communities in the United States?

The theoretical framework for this research is grounded in the understanding of the limitations to access to oral care as caused not by the individual behaviors, decisions, or psychological and biological factors specific to the affected people but a combination of collective socioeconomic conditions (Moysés, 2012). In other words, the theory is that the status of oral health in different communities is related to their socioeconomic environments and factors. In that way, the potential changes in the approaches and strategies of oral and dental care delivery and policies addressing the socioeconomic factors contributing to the access inequalities could promote dental visits in the populations with limited care opportunities and thus enable preventive treatments and care reducing the prevalence and severity of dental health problems (Cheema & Sabbah, 2016).


Research aimed at a deeper understanding of the nature of inequalities in access to oral care among the rural and underserved populations could potentially shed light on the mechanisms according to which the problem forms and how it develops. As a result, solutions and strategies could be developed allowing an upstream approach to the problem targeting the elimination of the root causes instead of focusing on the outcomes. In that way, a more effective strategy could be developed in order to tackle the public health problem that has been persisting for decades.


In conclusion, the problem of limited access to oral care tends to persist all around the world and is recognized as a serious public health issue due to its connection to the affected populations’ health status and quality of life. The factors contributing to the inequalities in access to care are diverse and may differ from one community to another. As a result, the development of systems and strategies for the minimization of the negative outcomes is complicated. In order to ensure effective solutions, an upstream approach is required that should be based on a deep understanding of the true socioeconomic root causes of the problem.


Cheema, J., & Sabbah, W. (2016). Inequalities in preventive and restorative dental services in England, Wales and Northern Ireland. British Dental Journal, 221, 235-239.

Emami, E., Khiyani, M. F., Habra, C. P., Chassé, V., & Rompré, P. H. (2015). Mapping the Quebec dental workforce: Ranking rural oral health disparities. Rural and Remote Health, 16, 1-12.

Ganavadiya, R., Goel, P., Hongal, S., Jain, M., & Chandrashekar, B. (2014). Mobile and portable dental services catering to the basic oral health needs of the underserved population in developing countries: A proposed model. Annals of Medical and Health Sciences Research, 4(3), 293.

Keboa, M., Hiles, N., & Macdonald, M. (2016). The oral health of refugees and asylum seekers: A scoping review. Globalization and Health, 12(1).

Lutfiyya, M. N., Gessert, C. E., Lipsky, M. S. (2013). Nursing home quality: A comparative analysis using CMS nursing home compare data to examine differences between rural and nonrural facilities. Journal of the American Medical Directors Association, 14, 593–598.

Maxey, H. L. (2014). Understanding the influence of state policy environment on dental service availability, access, and oral health in America’s medically underserved communities. Web.

McKernan, S. C. (2012). Dental service areas: Methodologies and applications for evaluation of access to care. Web.

Moysés, S. J. (2012). Inequalities in oral health and oral health promotion. Brazilian Oral Research, 26(1), 86-93.

Razdan, M., Degenholtz, H. B., & Rubin, R. W. (2016).Oral health outreach programs – can they address the disparities in access to dental care? Journal of Oral Health and Community Dentistry, 10(1), 14-19.

Yfantopoulos, J., Oulis, C., Yfantopoulos, P., & Papaioannou, W. (2014). Socio-economic inequalities in oral health: The case of Greece. Health, 06(16), 2227-2235.

Wendling, A. L. (2016). Oral health status and oral hygiene knowledge, attitudes, and practices of jail inmates. Web.

Wiener, R. C., & Meckstroth, R. M. (2014). The oral health self-care behavior and dental attitudes among nursing home personnel. Journal of Studies in Social Sciences, 6(2), 1-12.