Dental visits in crisis: analyzing dental service utilization amidst the pandemic

Oral health problems pose a significant challenge to public health and quality of life, affecting nearly half of all children and the majority of adults worldwide. The COVID-19 pandemic has notably disrupted health-seeking behaviors, particularly in dental care, due to heightened fears of infection. This study aims to identify factors influencing dental service utilization during the pandemic in Kermanshah City, using the framework of the Theory of Planned Behavior (TPB). TPB was employed to systematically examine the psychological and behavioral determinants-such as attitudes, subjective norms, and perceived behavioral control (PBC)-that may influence individuals' decisions to seek dental care during the pandemic.

A cross-sectional study was conducted in Kermanshah, western Iran, from October 2021 to March 2022. A total of 209 adults aged 18 years and older were recruited using a non-probability snowball sampling method. Based on pilot study, the required sample size was calculated as 384 participants using the population mean formula (Z = 1.96, σ = 2.0, d = 0.2). Data collection was carried out via a structured online questionnaire disseminated through social media platforms. The instrument included items assessing demographic variables, dental service utilization during the COVID-19 pandemic, and TPB constructs (attitude, subjective norms, PBC, and intention), all rated on a five-point Likert scale. The questionnaire demonstrated acceptable internal consistency. Data were analyzed using SPSS version 16, employing descriptive statistics, Pearson's correlation, and linear regression. Statistical significance was defined as p < 0.05.

The mean age of participants was 29.45 years, and 64.1% were female. Approximately 48.3% of respondents reported fear of visiting the dentist during the COVID-19 pandemic. Utilization rates for dental services included 66% for tooth extraction and 58.4% for restorative procedures. Multiple regression analysis revealed that education level (β = 0.190 and P < 0.001), PBC (β = 0.323 and P < 0.001), intention (β = 0.292 and P < 0.001), and attitude (β = 0.207 and P = 0.004) were significant predictors of dental service utilization, collectively explaining 41% of the variance in behavior.

This study highlights key psychological and demographic factors influencing dental service utilization during the COVID-19 pandemic, particularly PBC, attitudes, and education level. To improve access and utilization, it is essential to implement targeted educational campaigns, community-based outreach initiatives, and adaptable clinical practices that address patient concerns and foster trust in dental care environments.