{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T22:40:04Z","timestamp":1783723204621,"version":"3.55.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences","award":["1401-2-238-56146"],"award-info":[{"award-number":["1401-2-238-56146"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>World Health Organization invites the nations to progress towards universal health care coverage. This study evaluated preventive and curative dental services utilization among children aged 12 years and younger in Tehran, Iran, based on the Andersen behavioral model using a generalized structural equation modeling. A phone-based cross-sectional study was conducted in Tehran, Iran, on 886 children in 2023. Information on curative and preventive\/consultation dental service utilization and associated factors was collected by a standard questionnaire. We used a generalized structural equation model (GSEM) to build a model based on Andersen\u2019s behavioral model. Of 886 children, 22.1% used curative dental services, and 19.9% used preventive\/consultation services in the past year. Among children aged 6 years and younger, age (OR = 1.87, p-value &lt;0.001) and parent-perceived oral health need (OR = 54.77, p-value &lt;0.001) predicted curative services utilization and age (OR = 1.45, p-value &lt;0.001), knowledge (OR = 1.36, p-value &lt;0.001), dental visit before the age of one (OR = 6.05, p-value = 0.04), and socioeconomic status (OR = 1.65, p-value = 0.03) predicted preventive\/consultation services utilization. Regarding children aged 7 to 12, knowledge (OR = 1.28, p-value = 0.03), dental visit before the age of one (OR = 11.12, p-value = 0.02), socioeconomic status (OR = 2.53, p-value = 0.01), dental insurance (OR = 4.17, p-value &lt;0.001), and parent-perceived oral health need (OR = 19.48, p-value &lt;0.001) associated with curative dental services utilization, and dental visit before the age of one (OR = 10.05, p-value = 0.02), oral health behavior (OR = 1.25, p-value = 0.04), socioeconomic status (OR = 3.74, p-value &lt;0.001), and parent-perceived oral health need (OR = 4.62, p-value &lt;0.001) related to preventive\/consultation services utilization. The findings of this study underscore the significant influence of predisposing, enabling, and need factors on dental services utilization among children aged 12 years and younger. These results provide a valuable perspective for policymakers, highlighting the modifiable determinants that could be targeted to improve dental services utilization in this age group.<\/jats:p>","DOI":"10.1371\/journal.pone.0312043","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T18:29:47Z","timestamp":1737052187000},"page":"e0312043","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Preventive and curative dental services utilization among children aged 12 years and younger in Tehran, Iran, based on the Andersen behavioral model: A generalized structural equation modeling"],"prefix":"10.1371","volume":"20","author":[{"given":"Elaheh","family":"Amirian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samaneh","family":"Razeghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Molaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad R.","family":"Shamshiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7531-5213","authenticated-orcid":true,"given":"Simin Z.","family":"Mohebbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"pone.0312043.ref001","article-title":"Health in 2015: from MDGs, millennium development goals to SDGs, sustainable development goals.","author":"Organization WH","year":"2015"},{"issue":"10194","key":"pone.0312043.ref002","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0140-6736(19)31146-8","article-title":"Oral diseases: a global public health challenge","volume":"394","author":"MA Peres","year":"2019","journal-title":"The Lancet"},{"issue":"5","key":"pone.0312043.ref003","first-page":"1561","article-title":"Factors associated with the utilization of dental health services by the pediatric population: an integrative review.","volume":"23","author":"DSC Curi","year":"2018","journal-title":"Cien Saude Colet"},{"issue":"1","key":"pone.0312043.ref004","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12903-019-0996-x","article-title":"Utilization of dental services and associated factors among preschool children in China.","volume":"20","author":"X Gao","year":"2020","journal-title":"BMC Oral Health"},{"key":"pone.0312043.ref005","doi-asserted-by":"crossref","first-page":"5027","DOI":"10.19070\/2377-8075-210001013","article-title":"Predictors of Dental Care Utilization in School Children in Al-Madinah, Saudi Arabia.","author":"A. Aqeeli","year":"2021","journal-title":"Int J Dent Oral Sci."},{"key":"pone.0312043.ref006","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1590\/1807-3107bor-2017.vol31.0027","article-title":"Individual and contextual factors influencing dental health care utilization by preschool children: a multilevel analysis.","volume":"31","author":"C Piovesan","year":"2017","journal-title":"Braz Oral Res"},{"issue":"11","key":"pone.0312043.ref007","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.26719\/emhj.20.079","article-title":"Barriers to the use of dental services by children in Lebanon and association with parental perception of oral health care.","volume":"26","author":"I Karam","year":"2020","journal-title":"East Mediterr Health J."},{"key":"pone.0312043.ref008","first-page":"1","article-title":"Oral health service utilization patterns among preschool children in Beijing, China.","volume":"18","author":"M Xu","year":"2018","journal-title":"BMC Oral Health"},{"key":"pone.0312043.ref009","doi-asserted-by":"crossref","first-page":"00469580231176855","DOI":"10.1177\/00469580231176855","article-title":"A Description of Theoretical Models for Health Service Utilization: A Scoping Review of the Literature.","volume":"60","author":"JA Gliedt","year":"2023","journal-title":"INQUIRY: Inquiry."},{"issue":"1","key":"pone.0312043.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2307\/2137284","article-title":"Revisiting the behavioral model and access to medical care: does it matter?","volume":"36","author":"RM Andersen","year":"1995","journal-title":"J Health Soc Behav"},{"issue":"3","key":"pone.0312043.ref011","first-page":"123","article-title":"Use of Telephone Interviews for Oral Health Surveys in Iran: A Literature Review.","volume":"41","author":"M Solati","year":"2023","journal-title":"JDS."},{"key":"pone.0312043.ref012","doi-asserted-by":"crossref","DOI":"10.1108\/9781786358820","volume-title":"Applied structural equation modelling for researchers and practitioners: Using R and Stata for behavioural research:","author":"I. Ramlall","year":"2016"},{"key":"pone.0312043.ref013","doi-asserted-by":"crossref","first-page":"181","DOI":"10.2147\/CCIDE.S253242","article-title":"Socioeconomic-related inequalities in dental care utilization in northwestern Iran.","author":"S Rezaei","year":"2020","journal-title":"Clin Cosmet Investig Dent."},{"issue":"3","key":"pone.0312043.ref014","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/jphd.12364","article-title":"Self\u2010reported factors associated with dental care utilization among Hispanic migrant farmworkers in South Florida.","volume":"80","author":"CA Serna","year":"2020","journal-title":"J Public Health Dent"},{"key":"pone.0312043.ref015","first-page":"1","article-title":"Demographic and socioeconomic inequalities in oral healthcare utilisation in Malaysia: evidence from a national survey.","volume":"21","author":"Tan EH Tan YRo","year":"2021","journal-title":"Mohd Yunos MH.BMC Oral Health."},{"key":"pone.0312043.ref016","volume-title":"Oral health surveys: basic methods","author":"Organization WH","year":"2013"},{"issue":"1","key":"pone.0312043.ref017","first-page":"127","article-title":"Ranking of the neighborhoods of Tehran metropolis in terms of development and quality of life: A fuzzy TOPSIS approach","volume":"5","author":"E. Ahmadi AJ","year":"2020","journal-title":"Urban Economics"},{"issue":"1","key":"pone.0312043.ref018","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/BF02294210","article-title":"A general structural equation model with dichotomous, ordered categorical, and continuous latent variable indicators.","volume":"49","author":"B. Muth\u00e9n","year":"1984","journal-title":"Psychometrika."},{"issue":"9","key":"pone.0312043.ref019","doi-asserted-by":"crossref","first-page":"e027101","DOI":"10.1136\/bmjopen-2018-027101","article-title":"Clinical and non-clinical variables associated with preventive and curative dental service utilisation: a cross-sectional study among adolescents and young adults","volume":"9","author":"CE Medina-Sol\u00eds","year":"2019","journal-title":"Central Mexico. BMJ Open"},{"issue":"7","key":"pone.0312043.ref020","doi-asserted-by":"crossref","first-page":"e0250488","DOI":"10.1371\/journal.pone.0250488","article-title":"Predictors of use of dental care by children in north-central Appalachia in the USA.","volume":"16","author":"CI Nelson","year":"2021","journal-title":"PLoS One."},{"issue":"4","key":"pone.0312043.ref021","first-page":"15","article-title":"Factors associated with the use of oral health care services among Canadian children and youth.","volume":"35","author":"K Murphy","year":"2024","journal-title":"Health Rep"},{"issue":"5","key":"pone.0312043.ref022","doi-asserted-by":"crossref","first-page":"2491","DOI":"10.3390\/ijerph18052491","article-title":"Factors associated with dental service use based on the Andersen model: a systematic review","volume":"18","author":"A Hajek","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"suppl 2","key":"pone.0312043.ref023","doi-asserted-by":"crossref","first-page":"s272","DOI":"10.1590\/S0102-311X2011001400014","article-title":"Inequalities in access and utilization of dental services: a cross-sectional study in an area covered by the Family Health Strategy.","volume":"27","author":"MH Baldani","year":"2011","journal-title":"Cadernos de Sa\u00fade P\u00fablica"},{"issue":"3","key":"pone.0312043.ref024","first-page":"183","article-title":"Need for dental care drives utilisation of dental services among children in Saudi Arabia.","volume":"70","author":"DE Al Agili","year":"2020","journal-title":"IDJ"},{"issue":"3","key":"pone.0312043.ref025","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4103\/npmj.npmj_60_19","article-title":"Age and reasons for first dental visit among children in Lagos, Nigeria.","volume":"26","author":"OO Olatosi","year":"2019","journal-title":"Niger Postgrad Med J"},{"issue":"1","key":"pone.0312043.ref026","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1002\/cre2.674","article-title":"Factors associated with the use of oral health services in Peruvian children under the age of 12 years.","volume":"9","author":"JD Torres\u2010Mantilla","year":"2023","journal-title":"Clin Exp Dent Res"},{"key":"pone.0312043.ref027","first-page":"21","article-title":"The importance of preventive dental visits from a young age: systematic review and current perspectives.","volume":"6","author":"V Bhaskar","year":"2014","journal-title":"Clin Cosmet Investig Dent"},{"issue":"Suppl 2","key":"pone.0312043.ref028","first-page":"S413","article-title":"Age and Reasons for First Dental Visit and Knowledge and Attitude of Parents Toward Dental Procedures for Puducherry Children Aged 0\u20139 years.","volume":"11","author":"A Sanguida","year":"2019","journal-title":"J Pharm Bioallied Sci."},{"issue":"6","key":"pone.0312043.ref029","doi-asserted-by":"crossref","first-page":"e0286945","DOI":"10.1371\/journal.pone.0286945","article-title":"Andersen health care utilization model: A survey on factors affecting the utilization of dental health services among school children.","volume":"18","author":"P Nagdev","year":"2023","journal-title":"PloS one"},{"issue":"1","key":"pone.0312043.ref030","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/j.1752-7325.2007.00056.x","article-title":"Dental health services utilization and associated factors in children 6 to 12 years old in a low\u2010income country.","volume":"68","author":"CE Medina\u2010Solis","year":"2008","journal-title":"J Public Health Dent"},{"issue":"3","key":"pone.0312043.ref031","first-page":"158","article-title":"Dental Caries Status and its Related Factors in Iran: A Meta-Analysis.","volume":"21","author":"MR Soltani","year":"2020","journal-title":"J Dent (Shiraz)."},{"issue":"7","key":"pone.0312043.ref032","first-page":"e13","article-title":"Cultural capital and social inequality in health.","volume":"62","author":"T. Abel","year":"2008","journal-title":"J Epidemiol Public Health."},{"issue":"1","key":"pone.0312043.ref033","first-page":"87","article-title":"Predictors of dental visits for routine check-ups and for the resolution of problems among preschool children.","volume":"46","author":"MB Camargo","year":"2012","journal-title":"Rev Saude Publica"},{"issue":"1","key":"pone.0312043.ref034","first-page":"36","article-title":"Do Early Dental Visits Reduce Treatment and Treatment Costs for Children?","volume":"98","author":"AJ Nowak","year":"2016","journal-title":"J Mich Dent Assoc."},{"issue":"2","key":"pone.0312043.ref035","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1367\/1539-4409(2002)002<0141:DIOHAA>2.0.CO;2","article-title":"Disparities in oral health and access to care: findings of national surveys.","volume":"2","author":"BL Edelstein","year":"2002","journal-title":"Ambulatory pediatrics"},{"issue":"3","key":"pone.0312043.ref036","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/j.1752-7325.2005.tb02803.x","article-title":"Determinants of dental service utilization among 2 to 11\u2010year\u2010old California children.","volume":"65","author":"U Isong","year":"2005","journal-title":"J Public Health Dent"},{"issue":"2","key":"pone.0312043.ref037","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/jphd.12349","article-title":"Predisposing, enabling, and need characteristics of dental services utilization among socially deprived schoolchildren.","volume":"80","author":"F Maffioletti","year":"2020","journal-title":"J Public Health Dent"},{"key":"pone.0312043.ref038","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1007\/s10995-017-2310-3","article-title":"Statewide policy change in pediatric dental care, and the impact on pediatric dental and physician visits.","volume":"21","author":"C Zlotnick","year":"2017","journal-title":"Matern Child Health J"},{"issue":"4","key":"pone.0312043.ref039","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/j.1752-7325.2011.00277.x","article-title":"Income, dental insurance coverage, and financial barriers to dental care among Canadian adults.","volume":"71","author":"D Locker","year":"2011","journal-title":"J Public Health Dent"},{"issue":"1","key":"pone.0312043.ref040","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/j.1752-7325.2007.00056.x","article-title":"Dental Health Services Utilization and Associated Factors in Children 6 to 12 Years Old in a Low-Income Country.","volume":"68","author":"CE Medina-Solis","year":"2008","journal-title":"J Public Health Dent."},{"key":"pone.0312043.ref041","article-title":"The number of fixed landlines with connection and rural areas with landline","author":"Iran Sco","year":"2015"},{"key":"pone.0312043.ref042","article-title":"Possession of households and people\u2019s use of mobile phones in 2017","author":"Iran sco","year":"2017"},{"issue":"1","key":"pone.0312043.ref043","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/1471-2458-6-208","article-title":"Emerging advantages and drawbacks of telephone surveying in public health research in Ireland and the U.K.","volume":"6","author":"M Boland","year":"2006","journal-title":"BMC Public Health"},{"key":"pone.0312043.ref044","first-page":"165","article-title":"Can Telephone Interview Be Considered as an Appropriate Data Collection Method in Health Research?.","author":"M Modi","year":"2012","journal-title":"HSR"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0312043","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T18:30:06Z","timestamp":1737052206000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0312043"}},"subtitle":[],"editor":[{"given":"Isabel Cristina Gon\u00e7alves","family":"Leite","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0312043","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,16]]}}}