Inequalities in Dental Diagnosis and Treatment Among People with and without Disabilities

Background

Access to dental care is essential for an equitable health system, yet disparities persist across population groups. We aimed to examine 17-year trends in dental caries (DC), chronic periodontitis (CP), and tooth extraction among people with and without disabilities.

Methods

We conducted a nationwide time-series cross-sectional study using disability registration data linked to National Health Insurance data in South Korea. DC and CP were identified using diagnostic codes (K02.x and K05.3, respectively), and tooth extraction was defined using procedure codes (U4412–U4417). Age-adjusted rates were calculated annually by disability status, type, and severity. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for dental diagnosis and tooth extraction.

Results

Diagnosis rates were lower among people with disabilities than among people without disabilities, particularly among those with severe disabilities (DC: 7,706.9 vs 8,710.9; CP: 26,009.8 vs 31,982.2 per 100,000). Disparities were more pronounced among people with severe disabilities (DC: aOR=0.83, 95% CI 0.82–0.83; CP: aOR=0.74, 95% CI 0.74–0.74) and those with brain injuries (DC: aOR=0.68, 95% CI 0.67–0.69; CP: aOR=0.57, 95% CI 0.56–0.57). However, tooth extraction rates were similar between groups (9,356.0 vs. 9,250.7 per 100,000), but were higher among those with physical disabilities (aOR=1.13, 95% CI 1.12–1.13) and internal organ disabilities (aOR=1.04, 95% CI 1.02–1.06). The mean number of tooth extractions was higher among people with developmental disabilities (1.52±1.04) and mental disabilities (1.46±0.96) than among people without disabilities (1.29±0.63).

Conclusions

Lower diagnosis rates alongside similar or higher extraction rates suggest delayed disease detection and limited access to timely treatment. Reducing these inequalities requires better financial support, timely access to dental care, and oral health education for carers.

Key messages

• Disability-related gaps in dental diagnosis reveal delayed detection and unequal access to oral care in South Korea.

• Similar or higher extraction rates among people with disabilities suggest unmet treatment needs and the need for stronger support.