Estimating the magnitude of different barriers to dental care for special needs patients: A systematic review.

Quite often, it is seen that the number of special care individual in the dental OPD/clinics is quite low, as compared to their population. This can be due to specific barriers that restrict them in availing dental treatment. Our aim was to identify different barriers to dental care of persons with special needs through a systematic review and to quantify them. A systematic review was carried out according to PRISMA guidelines. PubMed data was searched with predefined keywords leading to retrieval of 576 records. Full length studies published in English language from 2010 onwards with mention of proportion of persons citing a barrier to dental care were included. Three studies published in peer reviewed journals from other data sources were also identified while retrieving the full length texts. Out of a total of 576 PubMed and three additional records, a total of 22 studies were included in the systematic review. Cost, communication, physical facilities, fear/uncooperativeness, unawareness, distant location/inaccessibility, unwilling dentist, transportation, and difficulty in getting appointment were identified as nine major barriers. Pooled proportions for different barriers ranged from 22.75% (Accessibility; 95%CI = 19.96-25.54) to 44.35% (Communication; 95% CI = 32.63-56.07A). There was a high heterogeneity across different studies for both fixed effects and random effects models. Communication, physical facilities, and unawareness were identified as the three most common barriers showing minimum heterogeneity in random effects model.