van der Zande M M, Exley C, Wilson S A, Harris R V. Disentangling a web of causation: An ethnographic study of interlinked patient barriers to planned dental visiting, and strategies to overcome them. Community Dent Oral Epidemiol 2021; DOI: 10.1111/cdoe.12586.

Interventions which address only one issue may not be successful.

Previous studies of barriers to obtaining dental care have been carried out amongst specific groups (eg the homeless, migrants, children) and have identified barriers such as anxiety, costs, embarrassment and (lack of) trust in dentists. However, the interrelation of the various factors has been little researched.

Using a purposive sample of attenders at six different urgent dental care provision settings in the UK, 97 participants were interviewed. Interviews revealed the interlinking of the issues which prevented routine attendance. One interviewee, for instance, identified fear and anxiety, which worsened when a trusted dentist left a practice, suffering a dry socket from the next dentist, thus losing trust, embarrassment at the consequent state of her teeth and finally mentioning being unable to afford the cost of dentures. Barriers are not necessarily fixed over time, as changing family circumstances such as bereavement may affect attendance patterns.

Interventions to address barriers to dental care need to take into account their changing nature as well as the socio-economic, emotional and cultural aspects of the issues.