A Three Delays theoretical framework to describe social determinants as barriers to dental care.

OBJECTIVES: The Three Delays model is a well-established global public health framework for the utilization of obstetric services where each delay represents a series of factors affecting utilization: (1) Delay #1-Deciding to seek care, (2) Delay #2-Reaching an appropriate facility and (3) Delay #3-Receiving adequate care. The aim of this qualitative study was to explore the application of the Three Delays model to dental service utilization and describe factors attributed to delayed utilization within this framework. METHODS: This study utilized a framework analysis, underpinned by the Three Delays model, to examine delays in dental care utilization. A criterion purposive sample of English-speaking adults (18+ years) in Massachusetts and Florida, USA with limited dental care access was recruited. Data were collected via semi-structured interviews conducted in two phases: 17 individual interviews, followed by interviews with a subset of five participants over 3 months (a total of 18 interviews). The analysis involved inductive thematic coding and systematic organization within the framework. RESULTS: Major themes and subthemes were constructed from the participants' narratives, identified and categorized as factors in the Three Delays framework. Each of the delays was interrelated to the other two, and Delay #1 was the most common delay based on the participants' interviews. The themes and subthemes contributing to one or more delays included interpersonal communication, prior dental experience, financial considerations, childcare costs, social connection, technology literacy, time constraints, competing priorities, stressors such as eviction and immigration status and microaggressions including racism and stigma. CONCLUSION: The Three Delays model was applicable to the study of dental care utilization and factors that impact the decision to seek dental care, reaching an appropriate dental facility and receiving adequate dental care in this study context.

A survey of dental therapists' practice patterns and training in Minnesota.

BACKGROUND: Expansion of the dental team may play a role in increasing access to oral health care. In 2009, Minnesota became the first state to formally license dental therapists (DTs). METHODS: The authors surveyed DTs and advanced dental therapists (ADTs) in Minnesota to gain a better understanding of those who enter the profession and their motivation for doing so, as well as to solicit their opinions on the overall structure of dental therapy education and the regulatory aspects of the profession. RESULTS: The response rate was 53.1%. DTs and ADTs were split on whether a dental hygiene degree should be required. Primary reasons for entering dental therapy included more autonomy and a larger scope of practice. Respondents expressed a desire for broadened prescribing rights. The median annual income was in the $81,000 through $90,000 bracket. CONCLUSIONS: Minnesota DTs and ADTs must practice in underserved communities. However, their ability to expand access to oral health care is affected by their licensure requirement, scope of practice, and prescription rights. PRACTICAL IMPLICATIONS: Policy makers considering dental therapy legislation must consider educational requirements and scope of practice when crafting state legislation. Broadening the scope of practice may allow for more impactful care for at-risk communities.