Challenges in Accessing Dental Care for Special Care Populations in Jazan, Saudi Arabia: A Study among Health Professionals and Caregivers

Abstract

Objective

Those with disabilities lack access to adequate dental health care services that are fundamental for maintaining their oral health. The study was primarily conducted to identify the actual barriers to dental care services for disabled patients. The study aimed to find the perfect solution capable of addressing the problems encountered by both dental practitioners and disabled patients.

Materials and Methods

The present cross-sectional study was performed on 160 study subjects, 100 including parents and patients and 60 dental professionals including consultants, dental practitioners, interns, and dental undergraduate students, by using two self-administered structured questionnaires for both groups. The demographic variables and any information by parents and dental professionals that might be helpful in managing the treatment of disabled children were recorded. The data obtained was subjected to statistical analysis using IBM SPSS version 20.0 software.

Results

Note that 56.7% of the dental professionals who participated in the study were dental interns in the age group of 20 to 25 years belonging to the Saudi region. Majority of these dental professionals treated disabled children during their dental practice and even acquired specialized training for their management. While a majority of the hospitals comprise of renowned facilities for managing disabled children, right from parking facilities to wheelchairs, most of them lack special facilities like signboards, special toilets, adequate equipment, trained associates, pharmacy, etc. Most of the parents of these disabled children come from rural areas having only secondary education levels. A majority of the patients were physically disabled and suffered from dental problems, the most prevalent one being dental caries. Most parents discovered that the brushing methodology contributed to such dental problems. Few parents blamed the unavailability of equipment as a barrier to getting treated. Most parents were worried constantly over treatment costs and were fearful to get treated.

Conclusion

Despite dental care provided to parents and caregivers of disabled individuals, it is our observation that the numbers are still inadequate in the Jazan region, Saudi Arabia. The most common barriers for this include treatment cost and the constant fear of getting the dental treatment done by a dental care provider.

Keywords

care provider - dental care - obstacles - oral health - special needs

Introduction

The American Association of People with Disabilities defines special health care needs as “any developmental, physical, sensory, mental, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs.”[1] Around 500 million individuals worldwide are suffering from one or more mental, physical, or sensory disabilities for which special health care facilities are indispensable.[2] It has been reported that in Saudi Arabia specifically, one million individuals are disabled and require special health care needs.[3]

Disabilities can be acquired, congenital, or have developmental origin, with their major risk factors being trauma, disease, and environmental issues. These disabilities have serious effects on the routine activities of individuals. Health care professionals must possess adequate knowledge and awareness to provide adequate health care facilities to disabled individuals. It is indispensable for caregivers of disabled individuals to have keen attention and awareness about all the available facilities and possess knowledge about their use.[4]

Among various health care services available, oral health care has an important role. Unsatisfied dental requirements are because of the complexity of the status of special health care needs.[5] Risk of unmet needs increases in children suffering from more relentless conditions.[6] [7] There have been various reports of structural and motor barriers, including the cooperation level of children, access to dental treatment, expertise and experience of dentist, transportation issues, treatment cost, as well as dependency on and communication with the caregiver regarding the need for oral health care.[8] [9] It is a very common observation that oral health care takes a backseat compared with other health requirements among parents and caregivers.[10] [11]

Various studies have been conducted in Saudi Arabia with the primary intention of understanding the obstacles encountered by disabled individuals requiring dental care.[12] [13] Saudi Arabia is well-known for its diversity in public health and socioeconomic status among the population across cities and areas. Hence, investigating the barriers encountered by both patients seeking oral health care treatment and dental professionals offering services to disabled individuals in different parts of Saudi Arabia is vital.

The present study was predominantly conducted to identify the actual barriers faced by disabled patients in the dental care segment by means of questionnaires provided for both dental practitioners and disabled patients or their guardians—with this, a solution could be obtained to resolve or improve the problems encountered by both dental practitioners and disabled patients in the Jazan region of Saudi Arabia.

Materials and Methods

The present cross-sectional study involved two participant groups. The first group consisted of 100 individuals, including 96 parents of patients with special needs and 4 patients who were able to respond independently. The second group consisted of 60 dental professionals, comprising dental interns, general dentists, and specialists from January 2022 to March 2022. The questionnaire used in this study was developed by the authors based on an extensive review of the literature and adaptation of validated instruments. The self-administered structured questionnaire helped assess the demographic variables and information regarding problems in managing the treatment of disabled children among both parents and dental professionals.

The validity of the questionnaire was assessed and found to be appropriate (α = 0.85). A pilot test was conducted with 10 participants (5 from each group) to ensure clarity and feasibility. Content validity was assessed by three experts in pediatric and public health dentistry. The study was conducted in accordance with the Declaration of Helsinki and approved by the institute's local ethics committee (REC-43/07/155). An informed written consent from all subjects was obtained prior to their enrolment in this study and the demographic data collected included age, gender distribution, and marital status of the participants.

In total, 100 individuals, including parents and patients of both genders, belonging to the Jazan region of Saudi Arabia participated in the study. The second group included dental professionals who were consultants or dental practitioners working in the Jazan region, as well as interns and dental undergraduate students of a medical university in Jazan, Saudi Arabia. To analyze the obstacles related to the dental treatment of disabled children, two different questionnaires were prepared, one for the parents and the other for dental professionals.

A questionnaire containing 19 well-constructed questions was framed and posed to dental professionals regarding the various conditions that could influence the management of a disabled child in a dental setup and the kind of special measures they take to tackle these patients. The second questionnaire containing 24 well-constructed questions was asked to parents and patients regarding the numerous factors that impact the management of dental problems and the types of obstacles faced while getting their disabled child treated. The response to all these questions from both questionnaires was recorded. The questionnaire, besides recording the demographic characteristics of both parents and dental professionals, also had a “yes/no” option or other relevant options according to each question.

The data thus obtained was subjected to statistical analysis using IBM SPSS version 20.0 software. Descriptive statistics, in other words, frequencies and percentages, were computed, and the comparative analysis was done using the chi-square statistical analysis.

Results

Sixty dental professionals participated in the study, out of which a maximum of 60% belonged to the 20- to 25-year age group. Note that 93.3% belonged to the Saudi region, of which 78.3% were from the Jazan area. Also, 61.7% were females and 38.3% were males. Among dental professionals, a maximum of 56.7% were dental interns, followed by consultants, general dentists, and students. A maximum of 32% had less than 5 years of experience ([Table 1]). A well-framed questionnaire comprising 19 questions was posed to dental professionals regarding the obstacles faced while treating individuals needing special health care requirements.

Table 1 Demographic variables

Parameters		Frequency	Percentage
Nationality	Non-Saudi	4	6.7
	Saudi	56	93.3
Age group	20–25 y	36	60.0
	26–30 y	7	11.7
	31–35 y	9	15.0
	36–40 y	5	8.3
	> 40 y	3	5.0
Gender	Female	37	61.7
	Male	23	38.3
Province	Aseer	4	6.7
	Dammam	5	8.3
	Jazan	47	78.3
	Makkah	1	1.7
	Najran	1	1.7
	Riyadh	2	3.3
Educational level	Dental intern	34	56.7
	Dental specialist/Consultant	16	26.7
	Dental student	2	3.3
	General dentist	8	13.3
How many years did you practice dentistry?	< 5 y	32
	5–10 y	12
	> 10 y	16
Total		60	100

While a maximum of 61.7% of dental professionals encountered disabled children during their dental practice and almost 33.3% received specialized training, 75% of dental professionals were educated in managing disabled patients, but 70% still lack the specialist referral circle among them. It is also reported that only 26.7% of specialized dentists are available for managing disabled patients. Around 68.3% ably provide required facilities such as parking and wheelchairs for the disabled, but 73.3% do not come equipped with special facilities, including signboards, special toilets, trained associates, adequate equipment, pharmacy, etc. Lack of facilities, insufficient information, and inadequate training have been quoted as major obstacles for managing disabled patients by 25% of dental professionals ([Table 2]).

Table 2 Response to questionnaire

Questionnaire		Frequency	Percentage	Statistical analysis
Question	Option			Chi-square	p-Value
Do you have disabled person among your relatives?	No	39	65.0	2.09	0.041*
	Yes	21	35.0
Any previous experience with disabled patients?	No	23	38.3	2.910	0.051*
	Yes	37	61.7
Did you attend any course or workshop related to disabled patients (whether how to deal, communicate, or treat them)?	No	40	66.7	1.991	0.021*
	Yes	20	33.3
Have you been educated or shown how to handle and treat disabled patients?	No	15	25.0	1.908	0.011*
	Yes	45	75.0
Is there any specialized dentist in treating disabled patients at your workplace?	No	44	73.3	1.008	0.012*
	Yes	16	26.7
Do you have adequate consultation network between different specialties at your workplace Including general medicine?	No	42	70.0	0.990	0.031*
	Yes	18	30.0
Do you have separate parking for disabled patients?	No	19	31.7	1.118	0.012*
	Yes	41	68.3
If the answer is yes, then how many disabled parking spaces do you have?	1.00	4	6.7	2.007	1.781
	2.00	11	18.3
	3.00	1	1.7
	4.00	1	1.7
Are they close to the entrance door or not?	No	19	31.7	2.551	0.041*
	Yes	35	58.3
Is there proper access for disabled patients to your workplace (wheelchair, climbing platform, wide doors, etc.)?	No	14	23.3	2.771	0.001*
	Yes	46	76.7
Do you have signage banners (written in both alphabet and braille alphabet), which explain directions, different departments, and biohazard warnings at your workplace?	No	44	73.3	2.413	0.023*
	Yes	16	26.7
Do you have properly prepared waiting area for disabled patients?	No	39	65.0	2.223	0.051*
	Yes	21	35.0
Is there specially prepared toilet setting for disabled patients at your workplace?	No	35	58.3	1.993	1.08
	Yes	25	41.7
Do you have adequately trained personnel to communicate and deal with disabled patients at your workplace (such as person who knows sign language, etc.)?	No	50	83.3	2.331	0.041*
	Yes	10	16.7
Is there adequate equipment and facilities to treat disabled patients at your workplace?	No	43	71.7	2.371	0.026*
	Yes	17	28.3
Do you have nearby pharmacy where patients can get their prescribed medication?	No	36	60.0	3.012	0.032*
	Yes	24	40.0
Did you refuse treating disabled patients due to lack of facilities, information, or training?	No	32	53.3	2.913	1.61
	Yes	28	46.7
If the answer is yes, which one created the greatest obstacle in treating disabled patient (more than one option can be selected)?	Inadequate training	3	5.0	1.112	1.718
	Insufficient information	3	5.0
	Lack of facilities	6	10.0
	Lack of facilities, Inadequate training	6	10.0
	Lack of facilities, Insufficient information, Inadequate training	15	25.0
If you are working in private clinic is there any cost difference between treatments provided to disabled patients and other patients	No	34	56.7	2.17	0.002*
	Yes	12	20.0

Note: Values which are in bold or with Asterix are the ones which shows significance difference statistically between opinion of that question.

A questionnaire with 24 well-defined questions including queries about obstacles encountered while getting their disabled children treated for dental needs, proved handy in understanding the demographic characteristics of parents of disabled children. Among the parents of disabled children, 58% belonged to the rural area, 98% were from Saudi, and 58% of them were females, with 40% of them having a secondary level of education. Almost 48% of the patients were at the primary level of education ([Table 3]).

Table 3 Demographic variables: parents

Parameters		Frequency	Percentage
	Parent	96	96.0
	Patient	4	4.0
Nationality	Non Saudi	2	2.0
	Saudi	98	98.0
Place of residence	City	33	33.0
	Other	1	1.0
	Rehabilitation	1	1.0
	Residence	7	7.0
	Village	58	58.0
Gender	Female	58	58.0
	Male	42	42.0
Educational level of patient	Intermediate	1	1.0
	Primary	48	48
	Under school age	33	33.0
	Uneducated	17	17.0
	University	1	1.0
Educational level of parent	Diploma	7	7.0
	Intermediate	10	10.0
	Primary	14	14.0
	Secondary	40	40.0
	University	29	29.0
Total		60	100

A maximum of 60% of the patients were physically disabled, with 86% bearing congenital anomalies. Close to 43% suffered from dental problems, the most common of which was dental caries (75%). Parental reports showed that 24% of patients were under medical treatment while 97% of patients still needed facilities during travel.

A maximum of 48% reported that the dental problems are not linked to the use of medication, while 21% felt that it might be because of excessive salivation. Problems with maintaining oral health were a common complaint in 62% of the population, out of which 49% felt that the methodology of brushing was the root cause of dental problems. While 46% sought the help of dental clinics for treatment, 32% preferred government clinics. Though 33% faced no problems regarding hospital facilities, 27% encountered problems with appointment reschedules, and 22% reported long waiting queues in dental clinics. Fortunately, 68% were never refused dental treatment and 64% never faced issues communicating with the dentist. Few parents mentioned lack of equipment as a major difficulty in getting treated but a majority of the parents were satisfied with the facilities available and with the way patients were managed by dental professionals, but their only obstacles were treatment cost (29%) and the fear (22%) of getting treated ([Table 4]).

Table 4 Response to questionnaire

Questionnaire		Frequency	Percentage	Statistical analysis
Question	Option			Chi-square	p-Value
What is the type of disability?	Attention deficit hyperactivity disorder	3	3.0	2.221	1.617
	Auditory	1	1.0
	Autism	2	2.0
	Down's syndrome	1	1.0
	Deaf	2	2.0
	Hyperactivity disorder	2	2.0
	Mental	39	39
	Physical	60	60
	Visual	7	7
Is the current disability? (congenital disability, disability resulting from injury)	Congenital disability	86	86.0	1.117	0.046*
	Disability resulting from injury	14	14.0
Do you suffer from any other health problems?	No	76	76.0	1.006	0.037*
	Yes	24	24.0
Do you see a doctor about disability on an ongoing basis?	No	18	18.0	2.551	0.002*
	Yes	82	82.0
Does the patient always need facilities when traveling?	No	3	3.0	1.415	0.0001*
	Yes	97	97.0
Have you ever had any problems with your teeth or mouth? (Yes, No)	No	37	37	1.427	1.499
	Yes	43	43
If the answer is yes, choose the appropriate one (Swelling, pain, caries, inflammation in the gums, fever in the mouth	Caries	75	75	1.514	0.998
	Pain	45	45
	Fever in the mouth	9	9
	Swelling	19	19
Do you have oral problems as a result of your use of disability medications? (Yes, No	Do not use medication	43	43.0	2.271	1.881
	No	48	48.0
	Yes	9	9.0
If the answer is yes, choose the appropriate one (dry mouth, heat in the mouth, change in taste, stomach reflux, excessive salivation)	Dry mouth	2	2.0	0.991	0.042*
	Excessive salivation	21	21.0
	Heat in the mouth	2	2
	Stomach reflux	1	1.0
Did you have difficulty in caring for and maintaining your teeth?	No	38	38.0	2.298	0.051*
	Yes	62	62.0
If the answer is yes, what are the reasons for the difficulties you encountered? (difficulty with the way the brush is used, difficulty in finding a suitable brush, difficulty in maintaining brushing)	Difficulty with the way the brush is used	49	49	2.313	0.09
	Difficulty in finding a suitable brush	25	25
	Difficulty in maintaining brushing	52	52
Have you ever been treated in the dental clinic? (Yes, No)	No	54	54.0	3.414	0.077
	Yes	46	46.0
The type of clinic that was treated	College of dentistry	2	2	2.009	0.033*
	Government clinic	32	32
	Private	19	19
Did you encounter difficulty in entering or moving between dental clinic facilities in the hospital? (Yes, No)	No	33	33.0	0.998	0.021*
	Yes	19	19.0
Did you face any problem while scheduling appointments? (Yes, No)	No	26	26.0	2.998	2.078
	Yes	27	27.0
Did you have to wait a long time while you were in the dental clinic? (Yes, No)	No	28	28.0	1.881	0.099
	Yes	22	22.0
Have you ever been refused treatment in the dental clinic? (Yes, No)	No	68	68.0	2.716	0.021*
	Yes	22	22.0
Did you face any difficulty in communicating and dealing with workers in the health center or hospital?	No	64	64.0	2.019	0.051*
	Yes	27	27.0
If yes, the reason for rejection: (Lack of experience of the treating doctor, lack of facilities or tools, not having the treating doctor on time for your appointment, difficulty in communicating)	Difficulty in communicating	9	9	2.871	0.043*
	Lack of experience of the treating doctor	15	15
	Lack of facilities or tools	19	19
	Not having the treating doctor on time for your appointment	17	17
During treatment in the dental clinic, was the dentist able to deal with the problem you were experiencing (yes, no)	No	1	1.0	1.781	0.002*
	Yes	38	38.0
Did you receive the required treatment correctly while you were in the dental clinic? (Yes, No, up to a point)	No	12	12.0	2.441	0.032*
	To some extent	9	9.0
	Yes	29	29.0
How was your experience and satisfaction with the service provided to you? (excellent, good, acceptable, bad)	Excellent	14	14	1.913	0.56
	Good	10	10
	Acceptable	17	17
	Bad	7	7
Would you prefer to receive dental treatment at any of the following locations? (Yes, No) (Primary care center clinic, dental clinic in a public hospital, dental clinic in a dental center, dental clinic in a private center, dental clinic in a college of dentistry)	Dental clinic in a dental center	35	35.0	2.417	0.075
	Dental clinic in a private center	15	15.0
	Dental clinic in a public hospital	27	27.0
	Dental clinic in a college of dentistry	11	11.0
	Primary care center clinic	5	5.0
If the answer is no, what are the reasons? (Fear, transportation, neglect, treatment cost)	Fear	22	22.0	1.781	0.052*
	Transportation	8	8.0
	Treatment cost	29	29.0

Discussion

The present study not only describes the challenges and obstacles faced by caregivers while getting disabled individuals treated for dental ailments but also the challenges faced by dental professionals while managing such individuals. While the caregiver group primarily consisted of parents, a small subset (4%) included patients with special needs who were deemed capable of self-reporting. These patients, selected based on their ability to comprehend and respond to the questionnaire, contributed valuable firsthand insights. Their inclusion, although limited, provided a unique perspective directly from the special care population. Although a significant proportion of our dental professional participants were interns or early-career practitioners, their inclusion provides valuable insight into the preparedness and challenges faced by those entering the profession. These professionals often represent the front-line care providers in government clinics and dental schools in regions like Jazan. Therefore, their perspectives are instrumental in identifying gaps in training and resources available for managing patients with special health care needs. To our knowledge, no previous studies in the region have concurrently assessed both caregiver and dental professional perspectives on this issue. Our study is the first of its kind that provides detailed insight into the obstacles faced by caretakers and dental professionals in the Jazan region of Saudi Arabia.

The study identified shared challenges and differing perspectives between parents of patients with special needs and dental professionals. Notably, professionals reported a lack of training and confidence, while parents highlighted accessibility and communication as major concerns. A collaborative approach involving parent education, provider training, and interdisciplinary coordination may help bridge this gap.

The findings of this study highlight several key areas where policy-level interventions are needed. First, there is an urgent need to integrate comprehensive training in special care dentistry into undergraduate and continuing education programs. Regulatory bodies and academic institutions should mandate modules focused on communication techniques, behavioral management, and clinical protocols for patients with special needs.

Second, health care infrastructure must be upgraded to ensure accessibility, including the installation of signage in braille, wheelchair ramps, designated parking, and sensory-friendly waiting areas. Government funding or incentives could support clinics in meeting these requirements, especially in underserved areas like Jazan.

Third, interprofessional collaboration should be encouraged, particularly between dental professionals and medical practitioners, to create a coordinated care network for disabled individuals. This may involve establishing referral systems, case-sharing protocols, and multidisciplinary case reviews.

Lastly, policies should address the financial burden faced by families. Subsidized dental care programs, transportation assistance, and insurance coverage tailored for special care dentistry would significantly reduce access barriers for this vulnerable population. Public awareness campaigns aimed at educating caregivers about available services can further support utilization and continuity of care.

Various studies mention bad oral hygiene status as the primary concern for tooth decay among children with special health care needs—this is mainly because of disturbed muscle coordination, associated medical ailments, and reduced dexterity, all of which make brushing a difficult routine. In our study, parents realized that improper brushing was the primary reason for poor oral hygiene, and dental caries was the most common problem. Similar findings were reported in studies by Gambhir et al,[14] Al Agili et al,[15] Fotedar et al,[16] and Bhaskar et al.[17]

Financial burden, dental fear, transportation, accessibility and availability of dental services, inadequate equipment, and insufficient training among dental professionals are dominant reasons that impact the provision of adequate dental treatment. Besides the financial barrier, we also observed that dental professionals lack the specialized training for managing disabled patients. Alongside this, they also lack adequate knowledge required for the specialized needs of disabled children and the facilities for such patients, including signboards, parking, wheelchairs, etc. Very few specialist dentists are available in the region, practicing and managing these disabled individuals. All these factors contribute to the deprivation of proper oral health care to individuals with special health care needs. The findings of our study are similar to results of other studies by Purohit and Singh,[18] Kenney et al,[19] Onyejaka et al,[20] and Busato et al.[21]

Thus, the overall findings of this study suggest that the present scenario demands the removal of social and physical barriers to provide disabled individuals with appropriate dental treatment benefits. The variations in the population of the Jazan region make it difficult for the recent findings to come to a conclusion regarding the various obstacles involved in utilizing dental treatment for special health care individuals. Different educational and specialized training programs are recommended for dentists so that obstacles to delivering adequate dental care can be removed. Policies should be made to cut down the treatment cost of disabled individuals and adequate knowledge must be provided to caregivers to modify their perception about dental care.

One of the limitations of this study is that it did not differentiate between child and adult patients with special health care needs. We acknowledge that these groups have distinct clinical, behavioral, and caregiver-related challenges. Pediatric patients often present different treatment dynamics compared with adult patients, including behavioral management issues and differing oral health priorities. Similarly, the role and concerns of caregivers vary depending on the age and dependency level of the patient. Future research should consider stratifying participants based on patient age to provide more tailored insights and recommendations for both pediatric and adult special care dentistry. Another limitation of this study is the reliance on self-reported questionnaire data, which can be subject to several forms of bias. Participants may have provided responses they perceived as socially acceptable or professionally appropriate, particularly regarding their level of preparedness or satisfaction. Caregivers might also have been influenced by recall bias when reporting past experiences. These biases may have led to underreporting or overreporting of certain challenges. Future research may benefit from incorporating observational data, interviews, or triangulated methods to validate and deepen the findings. Furthermore, this study relied entirely on self-reported data without clinical validation. The inclusion of objective oral health assessments, such as dental examinations or oral hygiene indices, would have enhanced the robustness of our findings. Future studies should consider integrating such clinical measures to correlate caregiver and professional perceptions with actual oral health outcomes. Other limitations include a small sample size, responses by caretakers based on self-administered questionnaires, and biased responses due to desired responses sought. We need further studies to understand the extent of obstacles faced from the perspective of dental care practitioners and caregivers found in this study.

Conclusion

The present study reveals that although parents and caregivers of disabled individuals are getting dental care, they make up an inadequate proportion in the Jazan region of Saudi Arabia, as the most common barriers involved include the cost of treatment and the fear of getting dental treatment done by the dental care providers. As dental professionals lack specialized training for managing disabled patients, different educational and specialized training programs are recommended for dentists to remove all obstacles involved in delivering adequate dental care to disabled patients. We need policies to cut down the treatment costs involved in treating disabled individuals, and caretakers must be furnished with knowledge to modify their perception regarding dental care.

Conflict of Interest

None declared.

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Publication History

Article published online:
17 June 2025