Access to dental care for Veterans with spinal cord injury: Barriers and limitations

Abstract: Objectives: To observe whether Veterans with spinal cord injury (SCI) are receiving appropriate dental care, and if not, what the barriers are. Design: At a single center, consenting Veterans completed a survey during their annual examination, inpatient stays, or outpatient visits. Analysis was primarily descriptive, but stepwise multivariable logistic regression was used to identify factors predicting dental care utilization. Setting: Single Veterans Affairs (VA) SCI center. Participants: Of those who consented during their annual examination, N=188 Veterans with SCI agreed to participate. Interventions: A prospective survey study design was used to evaluate the barriers and limitations to dental care for 188 Veterans with SCI. Veterans were invited to participate in the study during their annual examinations and inpatient and outpatient visits. Signed consent was required before completing a survey. Main Outcome Measures: Sex, age, and level of injury were not related to care access, but race, insurance, and VA care eligibility were. Similar to the general population, finances were the most-reported barrier to dental care, but most Veterans with SCI who receive dental care do so without having either insurance or VA eligibility for dental care. Physical barriers were reported to hinder access to dental care by <10% of surveyed Veterans. Results: Of the 188 Veterans who agreed to participate, 157 (83.51%) reported having received dental care since their SCI. Most reported receiving post-SCI dental care at a non-VA clinic (63.29%) and are receiving care at least annually (63.29%). Some of these Veterans reported that they had not always been able to receive dental care since their SCI (23.42%). Veterans who had not received dental care since their SCI reported the following barriers: lack of insurance (60.00%), money (30.00%), physical obstacles (6.67%), and “other” reasons (10.00%). Conclusions: Providing a comprehensive list of discounted dental care options during annual examinations for Veterans with SCI who have not received dental care can be beneficial. Integrating dental care into preventive health care by ensuring annual dentist visits for Veterans with SCI, along with promptly applying for Medicaid, if eligible, can significantly improve access to dental services. Educating veterans about available community outreach programs and addressing accessibility issues related to power chairs and transfers into dental chairs can further enhance dental care accessibility. By making dental care a routine part of annual examinations, health care providers can better connect Veterans with community resources and Medicaid and identify medical needs requiring dental attention. Prioritizing early intervention and preventive measures can ultimately enhance the overall health of Veterans with SCI.

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