What influences the use of dental services by adults in the UK?


Zoe Marshman, Oral Health and Development, School of Clinical Dentistry, Sheffield University, Claremont Crescent, Sheffield S10 2TA, UK

Tel.: 0114 2717893

Fax: 0114 2717843

e-mail: Z.Marshman@sheffield.ac.uk



Optimizing access to and utilization of dental services remains a major public health challenge. The aim of this study was to use Andersen's behavioural model to investigate the factors that influence utilization of dental services and predict oral health outcomes, and to identify how access could be improved.


Secondary analysis was conducted of data from a regional postal survey (n = 10 864) of adults in the UK. Items were chosen to reflect variables of Andersen's behavioural model including predisposing characteristics (deprivation), enabling resources (perceived difficulty accessing a dentist), need (perceived treatment need), health behaviours (reason for attendance and time since the last visit to the dentist) and oral health outcomes (oral health impacts (symptoms, functional limitation and social) and global oral health). Structural equation modelling was used to estimate the direct and indirect pathways between the variables within the model.


When a combination of indirect and direct effects were taken into account, perceived difficulty accessing the dentist was associated with higher perceived treatment need (β = 0.25, < 0.01), increased oral health impacts (β = −0.23, P < 0.01) and worse global oral health (β = −0.21, < 0.01). Overall, the variables included within this model explained 17.4% of the variance for dental attendance, 55.4% of the variance for the length of time since people had last visited the dentist, 21.7% of the variance for oral health impacts and 42.9% of the variance for people's global oral health.


Perceived treatment need and difficulty accessing dental services were found to be key predictors of oral health outcomes. Further research is needed to develop and evaluate effective interventions to improve access to dental services.