Year: 2026
Type: article
Abstract: Introduction: Oral health is an essential component of overall well-being; however, access to dental care in Ecuador is conditioned by social, economic, and territorial inequalities. Objective: To identify the influence of social determinants (education level, type of insurance, socioeconomic status, area of residence, and vulnerable groups) and systemic barriers (costs, waiting times, and availability) on access to and use of dental services in primary care. Methodology: A cross-sectional analytical study was conducted using secondary analysis of microdata from the 2018 National Health and Nutrition Survey (ENSANUT), with national representativeness. Access to dental care in the past year was defined as the dependent variable, and sociodemographic, socioeconomic, and geographic determinants were included as independent variables. Descriptive analyses and binary logistic regression were applied to estimate crude and adjusted odds ratios (95% CI). Results: In the adjusted model, females were more likely to have access than males (aOR=1.19; 95% CI: 1.09–1.29) and residing on the Coast was associated with less access than in the Highlands (aOR=0.73; 95% CI: 0.66–0.81). Afro-descendant and white individuals showed greater access than the Indigenous population and married or cohabiting individuals had lower utilization than single individuals. A socioeconomic gradient was observed favoring the highest quintiles and the population not poor according to the Unsatisfied Basic Needs (UBN) index; urban-rural location, education level, and income poverty did not maintain an independent association after adjustment. Conclusions: Access to dental services remained inequitable and depended on structural social determinants, highlighting the need to strengthen equity policies with territorialized and intercultural strategies, and financial protection mechanisms.
Institution: Universidad Católica de Santiago de Guayaquil
Language: Spanish
Subfield: General Dentistry
Field: Dentistry
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7218366147