Abstract
BACKGROUND AND AIMS: Dental attendance is key to the prevention and early detection of oral diseases. In Saudi Arabia (SA), dental care is publicly funded for citizens; however, many families opt for private care through insurance or out-of-pocket payment. This study has twofold: (1) to examine factors associated with regular dental attendance versus non-dental attendance among adolescents, and (2) to explore the indirect financial and non-financial barriers to dental non-attendance, with a particular emphasis on how payment methods influence these barriers. METHODS: An analytical cross-sectional survey was conducted among a convenience sample of adolescents in Al-Madinah, SA. Data collected included socio-demographic characteristics, oral health related variables (e.g., brushing teeth, dental attendance pattern) and barriers to non-dental attendance. Logistic regression identified factors associated with non-attendance for dental care. To analyse non-dental attendance drivers, we organised response into six thematic domains: affordability, availability, accessibility, motivation, perceived need, and fear/anxiety. We then classified affordability-including transportation costs, productivity loss, and childcare expenses-as an indirect financial barrier, whereas the remaining domains (availability, accessibility, motivation, perceived need, and fear/anxiety) were defined as non-financial barriers. These were compared in relation to the participants' payment methods. RESULTS: Among 416 adolescents, (203 males, 48.9%), 315 (75.7%) reported non-dental attendance and 216 (51.9%) used out-of-pocket payment. Regression analysis showed that being male, using publicly funded dental services, and self-rating poor oral health were significantly associated with non-dental attendance (AOR = 2.42; 95% CI: 1.39-4.20; p = 0.002; AOR = 2.00; 95% CI: 1.07-3.75; p = 0.030; AOR = 2.32; 95% CI: 1.05-5.10; p = 0.037, respectively). Indirect financial barriers-such as parental childcare responsibilities and travel costs-were comparable across all payment methods. Fear and anxiety (as non-financial barriers) were more prevalent among adolescents using out-of-pocket or insurance payment methods (p = 0.021). CONCLUSION: A high rate of adolescents dental non-attendance was significantly associated with demographic, economic factors, as well as with perceived oral health. Both indirect financial and non-financial barriers-except fear and anxiety-were frequently reported among adolescents regardless of payment method. This suggests the need for cost-efficient strategies (e.g., transport support), and psychoeducational approaches to improve dental attendance for both adolescents and their families.