Saudi Journal of Oral and Dental Research

Abbreviated Key Title: Saudi J Oral Dent Res

ISSN 2518-1300 (Print) |ISSN 2518-1297 (Online)
Scholars Middle East Publishers, Dubai, United Arab Emirates
Journal homepage: https://saudijournals.com/sjodr

Review Article

Utilization of Dental Services in Saudi Arabia: A Review of the

Associated1Factors 2*
Dr. Saud M Orfali , Dr. Mohammed S Aldossary
1
Director General, General Directorate of Dentistry, Ministry of Health, Riyadh, Saudi Arabia
2
Specialist in Pediatric Dentistry, General Directorate of Dentistry, Ministry of Health, Riyadh, Saudi Arabia

DOI: 10.36348/sjodr.2020.v05i03.002 | Received: 26.02.2020 | Accepted: 05.03.2020 | Published: 08.03.2020

*Corresponding author: Dr. Mohammed S. Aldossary

Abstract
Oral health services assessment is an ongoing global challenge for improvement of services, quality enhancement and
preventing oral diseases. One strategy is to investigate the utilization and access to dental care, and exploring the
underlying factors. In Saudi Arabia, only few published studies explored the utilization of dental care services. Hence,
this review attempt focusing on the findings of utilization, including manner of use and the associated factors. Only
certain possible causes have been studied, and there is limited evidence of the utilization of dental care in Saudi Arabia.
Even larger, well-designed studies are needed in order to be a baseline evidence for potential evaluation of progress in
dental services after adopting the necessary acts.
Keywords: Dental health service, Oral health, Dental visits, Saudi Arabia, Dental service utilization, Dental care
barriers.
Copyright @ 2020: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted
use, distribution, and reproduction in any medium for non-commercial use (NonCommercial, or CC-BY-NC) provided the original author and source
are credited.

unequally distributed among populations and

INTRODUCTION consumers [2].
Dental diseases are considered as a worldwide
prominent problem [1]. They are multifactorial and In Saudi Arabia, only few studies, in limited
preventable, thus prevention and early detection with regions, were conducted to investigate the utilization of
management are critical keys toward tackling them. dental services and to determine the influencing factors.
Access to oral health care services is one important Furthermore, some studies were conducted on specified
approach for the prevention and therapy [2,3]. target groups.
The access to dental care includes both the Thus, this literature review focused on the
availability of services and the desire of the patient to disparity in the use of dental services in Saudi Arabia in
seek the care. Access to and utilization of dental care various regions and on the related factors for further
services are multidimensional principles which are studies in the future. This review was performed of
affected by many factors [4]. published studies conducted in a region in Saudi Arabia
between January 2010 and January 2020.
In Saudi Arabia, both government and private
sectors oral healthcare services are provided. All Utilization of dental services in saudi arabia
citizens are entitled to complete and free access to oral In few studies reported in Saudi Arabia, the
health care in primary, secondary or tertiary dental use of dental services varied among different targeted
clinics of government sector [5]. participants.
Globally, inequality in utilization of dental The Saudi Health Information Survey by El
services has been evaluated periodically to determine its Bcheraoui et al., found that only 11.5% of the
extent, to evaluate the underlying factors and to population of Saudi Arabia over the age of 15 visited
examine any improvements over time [2]. dentists for routine check-ups and almost half (48%)
visited dentists during dental problems [6]. The sample
Several studies in various countries showed size was over 10.000 participants.
that the utilization of dental services appears to be
© 2020 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 147
 Saud M Orfali & Mohammed S Aldossary; Saudi J Oral Dent Res, March 2020; 5(3): 147-149
Farsi, in 2010, investigated the utilization of A large range of factors beyond those
dental services among students, n=3090, aged 11-24 evaluated is affected by inequality or is even underlying
years old in Jeddah city, and found only 8.6% visited the observed differences in utilization. Dental anxiety,
dentists for regular check-up. The most common reason for example, has been found to be closely associated
to visit the dentist was pain and dental problems with educational position [2].
(49.4%) [7].
Some potential barriers to access to dental care
On the contrary, Al-Hussyeen in the same would include difficulty in getting appointment, waiting
year, reported that about 75% of adolescent females time, feeling that there is no need for treatment, and
(intermediate students) in Riyadh city, had been visiting dental fear [7,11]. In addition, marital status could have
the dentist more than once over the last two years, and an effect on the use of dental services, because single
most of them (75%) in private clinics, and 63% for participants were more likely to be non-utilizers of
routine treatment [8]. However, the size of sample dental services than married participants [4].
(n=531) would affect the results.
Regarding the gender factor, dental services
Almutlaqah et al., 2018, investigated the utilization was reported to be more in female than male
utilization of dental services in Abha city, among about participants [7], which is in agreement with global
500 adults. About 58% of respondents were dental findings [2,3]. The other studies conducted in Saudi
services users. Of the participants, 57% visited dentists Arabia did not make a comparison between male and
during dental emergencies [4]. female.

In another study, Al-Jaber and Da’ar, reported Education, Income & Insurance
the utilization of dental clinics in Primary Health Care Utilization of dental services was higher in
Centers by adults in Riyadh city. In the last 12 months those with higher educational status or income [4,6].
more than half (53%) of patients visited a dentist once, Thus, education and income are significant predictors
20% twice, and at least three times (25%) [9]. for the dental services utilization. Patients who are
better educated were twice as likely to have regular
Given the limited number of dentists in dental appointments compared to patients who
primary health care facilities, most patients (77%) completed their primary education only [10].
obtain dental treatment in private dental clinics [4,9].
However, insurance status was not investigated which Interestingly, the study by Hamasha et al., on
would affect these results. Dental pain (50%) was the elderly people, found no significant correlation between
most common reason for visiting a dentist, although utilization of dental services and participants' education
regular checkups were counted for only 15% of [11]. However, service utilization was higher among
participants [9]. those with higher incomes (45%) compared with those
with lower incomes (31%). Additionally, in that study,
In Jazan region, Quadri et al., investigated the the greatest barrier reported for accessing dental
utilization of dental services, and found that less than services was a lack of perceived dental needs (70.2%)
half (45.8%) of the sample surveyed indicated that their followed by lack of dental insurance (64.5%) [11].
last visit to a dentist was within a year, and 33% of
them claimed that a dentist should only be visited if The likelihood of attending a dental clinic
they have dental pain [10]. increased with education, among people who have good
oral health practice [6].
Hamasha et al., explored the utilization of
dental care services by elderly people (65 years old and The high cost of dental care has been the most
above) in Riyadh city. Only 37 % of participants restricting factor for dental services utilization for those
(n=350) had proper utilization and access to dental care who visited private dental clinics [8,9].
[11].
Education and awareness are closely linked to
Factors influencing dental services utilization dental literacy and positive oral health habits such as
Various studies investigated the association daily tooth brushing or a healthy diet. Therefore,
between dental services utilization and some factors underutilization of dental care services may result from
(independent variables), such as sociodemographic, a lack of knowledge, which is therefore perpetuated
socioeconomic and educational variables. Wide because oral health education is given in many
variation in participants should be interpreted with countries in dental clinics [2].
caution. Some studies targeted adults or children, or
investigated specific groups (e.g., dental students, On the other hand, similar to global results,
smokers, pregnant women, medically compromised utilization of dental services in those without insurance
patients) [2]. cover was lower than in those with such a status [2,3].

© 2020 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 148
 Saud M Orfali & Mohammed S Aldossary; Saudi J Oral Dent Res, March 2020; 5(3): 147-149
Education and economic status, which are Fleming, T. D., Reynolds, A. E., Vos, T., ... &
interlinked together and often, decide the financial GBD 2015 Oral Health Collaborators. (2017).
means of a person. This will have an effect on Global, regional, and national prevalence,
utilization in countries where dental care is not provided incidence, and disability-adjusted life years for oral
free of charge, especially when one considers the conditions for 195 countries, 1990–2015: a
potentially catastrophic impact of dental expenses [2]. systematic analysis for the global burden of
diseases, injuries, and risk factors. Journal of
Place of Living dental research, 96(4), 380-387.
Dental services utilization was reported 2. Reda, S. F., Reda, S. M., Thomson, W. M., &
globally to be lower in those living in rural than those Schwendicke, F. (2018). Inequality in utilization of
living in urban places [2]. Al-Hussyeen reported that dental services: a systematic review and meta-
the most discouraging factor was the far geographic analysis. American journal of public health, 108(2),
location of the dental clinics [8]. e1-e7.
3. Curi, D. S. C., Figueiredo, A. C. L., & Jamelli, S.
Due to either physical access (e.g., lack of R. (2018). Factors associated with the utilization of
transportation), or limited availability of dental services dental health services by the pediatric population:
in rural areas, the place of living, rural versus urban, an integrative review. Ciencia & saude
may impact the utilization of dental services. coletiva, 23, 1561-1576.
Almutlaqah et al., found that transport difficulties and 4. Almutlaqah, M. A., Baseer, M. A., Ingle, N. A.,
health-related participants (related to movement Assery, M. K., & Al Khadhari, M. A. (2018).
difficulties) were the major predictors and barriers to Factors affecting access to oral health care among
access to dental care [4]. In elderly people, adults in Abha City, Saudi Arabia. Journal of
transportation was identified as barriers to dental International Society of Preventive & Community
services by 44.2% of participants [11]. Dentistry, 8(5), 431.
5. Alshahrani, A. M., & Raheel, S. A. (2016). Health-
Quality of Dental Services care System and Accessibility of Dental Services in
Obviously, meeting patient needs and dental Kingdom of Saudi Arabia: An Update. Journal of
care standards would impact patient behavior in terms International Oral Health, 8(8).
of better compliance, less missed appointments and less 6. El Bcheraoui, C., Tuffaha, M., Daoud, F., Kravitz,
stress and anxiety. Some studies have indicated H., AlMazroa, M. A., Al Saeedi, M., ... & Mokdad,
disappointment with quality; have been correlated with A. H. (2016). Use of dental clinics and oral hygiene
generally poor compliance with standards for care, low practices in the Kingdom of Saudi Arabia,
utilization or cessation of treatment [4,8]. 2013. International dental journal, 66(2), 99-104.
7. Farsi, J. M. A. (2010). Dental visit patterns and
Quality of dental care has been found to be the periodontal treatment needs among Saudi
most motivating factor for the use of dental services in students. EMHJ-Eastern Mediterranean Health
private dental clinics [8]. Journal, 16 (7), 801-806, 2010.
8. Al Johara, A. (2010). Factors affecting utilization
CONCLUSIONS of dental health services and satisfaction among
 Inequalities in the utilization of dental services are adolescent females in Riyadh City. The Saudi
significant and common across the globe, and have dental journal, 22(1), 19-25.
consequences for services and health care systems. 9. Al-Jaber, A., & Da’ar, O. B. (2016). Primary health
 Access to dental care is not a simple issue, and it care centers, extent of challenges and demand for
requires multiple strategies and approaches to oral health care in Riyadh, Saudi Arabia. BMC
address it. health services research, 16(1), 628.
 In Saudi Arabia, more studies are needed to 10. Factors influencing Patients’ Utilization of Dental
evaluate possible factors associated with inequality, Health Services in Jazan, Kingdom of Saudi Arabia
and to assess whether inequalities have increased or 11. Quadri, F. A., Jafari, F. A., Albeshri, A. T., &
deteriorated over time. Zailai, A. M. (2018). Factors influencing patients’
utilization of dental health services in Jazan,
Kingdom of Saudi Arabia. International journal of
REFERENCES clinical pediatric dentistry, 11(1), 29.
1. Kassebaum, N. J., Smith, A. G. C., Bernabé, E.,

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