{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:54:37Z","timestamp":1793382877542,"version":"4.5.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005416","name":"Norges Forskningsr\u00e5d","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oral Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Individuals with psychiatric and\/or substance use disorders often have poor oral health, yet utilization of dental services remains low. This study examined dental attendance, barriers to care, and factors associated with regular dental care among inpatients in Norway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study included 138 adults hospitalized in specialist mental health and substance use services at the University Hospital of North Norway (median age 35.5 years, range 19\u201370, 60% men, 40% women). Participants completed a structured questionnaire covering various health domains and underwent clinical and radiographic oral examinations. Associations with irregular dental care, defined as attending dental services regularly less than every second year, were examined using block-wise logistic regression guided by Andersen's Behavioral Model of Health Service Use to evaluate the relative contribution of predisposing, enabling, behavioral, and need-related factors. The study was approved by the Regional Committee for Medical and Health Research Ethics, and all participants provided written informed consent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Regular dental care was reported by 28.7%, while 49.3% sought care for acute problems only. Financial constraints and dental fear were the main barriers to regular dental care. Negative experiences with dental care were frequently reported. In multivariable regression, lack of or unknown entitlement to free dental care was strongly associated with irregular care (OR\u2009=\u20093.15, 95% CI, 1.30\u20137.64). Lower toothbrushing frequency (OR\u2009=\u20092.53, 95% CI, 1.06\u20136.02) and low educational attainment (OR\u2009=\u20094.13, 95% CI, 1.03\u201316.62) were also associated with irregular care. After adjustment, neither self-reported dental health nor clinically assessed dental health was associated with regular dental care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Regular dental care was low despite poor oral health and was more strongly associated with entitlement to free dental care, toothbrushing frequency, and educational attainment than with clinical indicators of treatment need. Improving dental service utilization in this population may require not only financial coverage, but also clearer pathways into care and patient-centered approaches that promote safety, trust, and sustained engagement with dental services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/froh.2026.1904583","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T04:21:51Z","timestamp":1786335711000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Dental service utilization among hospitalized patients with psychiatric and\/or substance use disorders: a Norwegian cross-sectional study"],"prefix":"10.3389","volume":"7","author":[{"given":"Kristina G.","family":"Kantola","sequence":"first","affiliation":[{"name":"The Public Dental Health Service Competence Center of Northern Norway","place":["Troms\u00f8, Norway"]},{"name":"Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway","place":["Troms\u00f8, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Wynn","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway","place":["Troms\u00f8, Norway"]},{"name":"Department of Clinical Medicine, University Miguel Hernandez","place":["Alicante, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hege","family":"Nermo","sequence":"additional","affiliation":[{"name":"The Public Dental Health Service Competence Center of Northern Norway","place":["Troms\u00f8, Norway"]},{"name":"Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway","place":["Troms\u00f8, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Are Kolset","family":"Johnsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway","place":["Troms\u00f8, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elin","family":"Hadler-Olsen","sequence":"additional","affiliation":[{"name":"The Public Dental Health Service Competence Center of Northern Norway","place":["Troms\u00f8, Norway"]},{"name":"Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway","place":["Troms\u00f8, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1192\/bjp.bp.110.081695","article-title":"Advanced dental disease in people with severe mental illness: systematic review and meta-analysis","volume":"199","author":"Kisely","year":"2011","journal-title":"Br J Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1111\/add.13754","article-title":"A systematic review and meta-analysis of the association between poor oral health and substance abuse: oral health and substance use","volume":"112","author":"Baghaie","year":"2017","journal-title":"Addiction"},{"key":"B3","doi-asserted-by":"publisher","first-page":"660","DOI":"10.2340\/aos.v84.45205","article-title":"The association between caries experience and demographic, socioeconomic, and psychometric factors among persons with severe psychiatric and\/or substance use disorders: a cross-sectional study","volume":"84","author":"Kantola","year":"2025","journal-title":"Acta Odontol Scand"},{"key":"B4","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1186\/1471-244X-13-227","article-title":"Oral health status and treatment needs among psychiatric inpatients in rennes, France: a cross-sectional study","volume":"13","author":"Bertaud-Gounot","year":"2013","journal-title":"BMC Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1186\/s12903-025-06499-w","article-title":"Oral health status and oral health-related quality of life among a convenience sample of individuals receiving inpatient psychiatric care: a retrospective cross-sectional study","volume":"25","author":"Flavin","year":"2025","journal-title":"BMC Oral Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e77","DOI":"10.7417\/CT.2017.1987","article-title":"Oral health Status and oral health-related quality of life in Italian deinstitutionalized psychiatric patients","volume":"168","author":"Corridore","year":"2017","journal-title":"Clin Ter"},{"key":"B7","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1002\/cre2.476","article-title":"Oral health related quality of life and reasons for non-dental attendance among patients with substance use disorders in withdrawal rehabilitation","volume":"8","author":"\u00c5str\u00f8m","year":"2022","journal-title":"Clin Exp Dent Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1080\/00016357.2022.2153736","article-title":"Association between oral and general health related quality of life among Norwegian patients with substance use disorders in opioid agonist therapy","volume":"81","author":"\u00c5str\u00f8m","year":"2023","journal-title":"Acta Odontol Scand"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1805653","DOI":"10.3389\/froh.2026.1805653","article-title":"Oral health-related quality of life in adult inpatients with psychiatric and\/or substance use disorders: a Norwegian cross-sectional study","volume":"7","author":"Kantola","year":"2026","journal-title":"Front Oral Health"},{"key":"B10","year":""},{"key":"B11","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/scs.12960","article-title":"Barriers and facilitators for dental care among patients with severe or long-term mental illness","volume":"36","author":"Bj\u00f8rkvik","year":"2022","journal-title":"Scand J Caring Sci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1186\/s12903-021-01626-9","article-title":"Oral health and use of dental services in different stages of adulthood in Norway: a cross sectional study","volume":"21","author":"Hadler-Olsen","year":"2021","journal-title":"BMC Oral Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1177\/154405910808700110","article-title":"The effects of social class and dental attendance on oral health","volume":"87","author":"Donaldson","year":"2008","journal-title":"J Dent Res"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2307\/2137284","article-title":"Revisiting the behavioral model and access to medical care: does it matter?","volume":"36","author":"Andersen","year":"1995","journal-title":"J Health Soc Behav"},{"key":"B15","first-page":"33","volume-title":"Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management","author":"Andersen","year":"2015"},{"key":"B16","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1111\/cdoe.12284","article-title":"Social and health-related factors associated with refraining from seeking dental care: a cross-sectional population study","volume":"45","author":"Berglund","year":"2017","journal-title":"Community Dent Oral Epidemiol"},{"key":"B17","doi-asserted-by":"publisher","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":"Hajek","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B18","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1111\/cdoe.12753","article-title":"Using Andersen\u2019s behavioural model to examine individual and contextual factors associated with dental service utilization in Brazil","volume":"51","author":"Galv\u00e3o","year":"2023","journal-title":"Community Dent Oral Epidemiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1111\/idh.12657","article-title":"Exploring avoidance of dental care due to dental fear and economic burden\u2013A cross-sectional study in a national sample of younger adults in Norway","volume":"22","author":"\u00c5str\u00f8m","year":"2024","journal-title":"Int J Dent Hyg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1111\/cdoe.12005","article-title":"What goes around comes around: revisiting the hypothesized vicious cycle of dental fear and avoidance","volume":"41","author":"Armfield","year":"2013","journal-title":"Community Dent Oral Epidemiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"207","DOI":"10.2174\/1745017901814010207","article-title":"The association between dental anxiety and psychiatric disorders and symptoms: a systematic review","volume":"14","author":"Halonen","year":"2018","journal-title":"Clin Pract Epidemiol Ment Health"},{"key":"B22","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1186\/s12903-021-01968-4","article-title":"Dental anxiety and potentially traumatic events: a cross-sectional study based on the Troms\u00f8 Study\u2014Troms\u00f8 7","volume":"21","author":"Nermo","year":"2021","journal-title":"BMC Oral Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1002\/cre2.753","article-title":"Are dental visiting patterns and oral pain associated with dental disease among Norwegian adults? A cross-sectional study based on the Troms\u00f8 study","volume":"9","author":"Nermo","year":"2023","journal-title":"Clin Exp Dent Res"},{"key":"B24","doi-asserted-by":"publisher","first-page":"78","DOI":"10.3109\/11038128.2011.552120","article-title":"Loss of activities and its effect on the well-being of substance abusers","volume":"19","author":"Hoxmark","year":"2012","journal-title":"Scand J Occup Ther"},{"key":"B25","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.eurpsy.2014.01.007","article-title":"Impact of primary negative symptoms on functional outcomes in schizophrenia","volume":"29","author":"Fervaha","year":"2014","journal-title":"Eur Psychiatry"},{"key":"B26","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1080\/14789940410001655187","article-title":"Psychiatric inpatients\u2019 experiences with restraint","volume":"15","author":"Wynn","year":"2004","journal-title":"J Forensic Psychiatry Psychol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e296","DOI":"10.1371\/journal.pmed.0040296","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"Von Elm","year":"2007","journal-title":"PLoS Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1111\/j.1600-0722.2008.00542.x","article-title":"The level of exposure-dental experiences questionnaire (LOE-DEQ): a measure of severity of exposure to distressing dental events","volume":"116","author":"Oosterink","year":"2008","journal-title":"Eur J Oral Sci"},{"key":"B29","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1080\/00952990.2018.1456545","article-title":"A review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United States: past issues and future directions","volume":"44","author":"Higgins-Biddle","year":"2018","journal-title":"Am J Drug Alcohol Abuse"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1001\/archinte.158.16.1789","article-title":"The AUDIT alcohol consumption questions (AUDIT-C)An effective brief screening test for problem drinking","volume":"158","author":"Bush","year":"1998","journal-title":"Arch Intern Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II","volume":"88","author":"Saunders","year":"1993","journal-title":"Addiction"},{"key":"B32","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1080\/08039480310000932","article-title":"Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36)","volume":"57","author":"Strand","year":"2003","journal-title":"Nord J Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1093\/schbul\/sbs068","article-title":"The validity of the 16-item version of the prodromal questionnaire (PQ-16) to screen for ultra high risk of developing psychosis in the general help-seeking population","volume":"38","author":"Ising","year":"2012","journal-title":"Schizophr Bull"},{"key":"B34","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/eip.12446","article-title":"Psychosis risk screening in different populations using the prodromal questionnaire: a systematic review","volume":"12","author":"Savill","year":"2018","journal-title":"Early Interv Psychiatry"},{"key":"B35","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1111\/eip.13147","article-title":"The structure of the Prodromal Questionnaire-16 (PQ -16): exploratory and confirmatory factor analyses in a general non-help-seeking population sample","volume":"16","author":"Howie","year":"2022","journal-title":"Early Interv Psychiatry"},{"key":"B36","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1080\/00016357.2018.1439528","article-title":"Diagnostic accuracy of three screening questions (3Q\/TMD) in relation to the DC\/TMD in a specialized orofacial pain clinic","volume":"76","author":"L\u00f6vgren","year":"2018","journal-title":"Acta Odontol Scand"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.14219\/jada.archive.2011.0088","article-title":"Development of a brief and effective temporomandibular disorder pain screening questionnaire","volume":"142","author":"Gonzalez","year":"2011","journal-title":"J Am Dent Assoc"},{"key":"B38","first-page":"143","article-title":"The modified dental anxiety scale: validation and United Kingdom norms","volume":"12","author":"Humphris","year":"1995","journal-title":"Community Dent Health"},{"key":"B39","first-page":"21","article-title":"Evidence to confirm the cut-off for screening dental phobia using the Modified Dental Anxiety Scale","volume":"1","author":"King","year":"2010","journal-title":"Soc Sci Dent"},{"key":"B40","doi-asserted-by":"publisher","first-page":"140","DOI":"10.4088\/JCP.09m05318yel","article-title":"Determinants of poor dental care in patients with schizophrenia: a historical, prospective database study","volume":"72","author":"Nielsen","year":"2011","journal-title":"J Clin Psychiatry"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1283861","DOI":"10.3389\/froh.2024.1283861","article-title":"Developing oral health services for people experiencing severe and multiple disadvantage: a case study from Southwest England","volume":"5","author":"Paisi","year":"2024","journal-title":"Front Oral Health"},{"key":"B42","year":""},{"key":"B43","year":""},{"key":"B44","year":""},{"key":"B45","doi-asserted-by":"publisher","first-page":"2263","DOI":"10.1186\/s12889-024-19713-1","article-title":"Oral health knowledge, attitudes, and practices of people living with mental illness: a mixed-methods systematic review","volume":"24","author":"Johnson","year":"2024","journal-title":"BMC Public Health"},{"key":"B46","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1097\/PSY.0000000000000135","article-title":"A systematic review and meta-analysis of the association between poor oral health and severe mental illness","volume":"77","author":"Kisely","year":"2015","journal-title":"Psychosom Med"},{"key":"B47","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/1472-6831-9-20","article-title":"The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age","volume":"9","author":"Humphris","year":"2009","journal-title":"BMC Oral Health"},{"key":"B48","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.identj.2022.06.018","article-title":"Methods helping dentists to detect dental fear","volume":"73","author":"Kankaala","year":"2023","journal-title":"Int Dent J"},{"key":"B49","doi-asserted-by":"publisher","first-page":"e70040","DOI":"10.1002\/cre2.70040","article-title":"Exploring the variations in the use of modified dental anxiety scale (MDAS) in literature: a survey of studies published from 2014 to 2023","volume":"10","author":"Yeung","year":"2024","journal-title":"Clin Exp Dent Res"},{"key":"B50","doi-asserted-by":"publisher","first-page":"1655450","DOI":"10.3389\/froh.2025.1655450","article-title":"Oral health care challenges in individuals with severe mental illness: a qualitative meta-synthesis","volume":"6","author":"Afroz","year":"2025","journal-title":"Front Oral Health"}],"container-title":["Frontiers in Oral Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/froh.2026.1904583\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T04:21:54Z","timestamp":1786335714000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/froh.2026.1904583\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":50,"alternative-id":["10.3389\/froh.2026.1904583"],"URL":"https:\/\/doi.org\/10.3389\/froh.2026.1904583","relation":{},"ISSN":["2673-4842"],"issn-type":[{"value":"2673-4842","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"article-number":"1904583"}}