By: Assoc. Prof. Dr Nor Azlida Mohd Nor & Dr Ainol Haniza Kherul Anuwar

In recent years, the rising living costs in Malaysia have emerged as a pressing concern affecting the population. The increase in prices of essential goods, including food, housing, education, and healthcare, has inflicted significant financial strain on individuals and families alike. Within the realm of healthcare, one critical area that necessitates attention is dental care. Scientific studies have highlighted the alarming neglect of dental health when households grapple with financial constraints, as they tend to prioritise other basic necessities. Furthermore, local research conducted has shed light on how socioeconomic factors, such as income and social status, significantly influence access to and utilisation of dental services. Startling statistics from the latest National Health and Morbidity Survey (NHMS) on healthcare demand reveal a concerning trend where only 23% of individuals experiencing dental problems sought treatment. The reliance on public oral healthcare services by a staggering 80.7% of the population stands out, while private services are predominantly accessed by urban residents. Notably, almost two in five individuals paid out-of-pocket for their expenses. These findings underscore the urgent need for enhanced access and affordability of oral healthcare services.

The soaring expense of dental care exacerbates the financial burden already weighing on individuals and families. The escalating cost of dental treatment presents a formidable challenge, hindering access to essential dental care, particularly within the private sector. This predicament is particularly pronounced among local communities, especially those with limited financial resources, who increasingly struggle to secure necessary basic dental treatment. Consequently, some individuals endure pain, neglect dental problems, forgo essential treatment, or, in more concerning cases, seek treatment from unlicensed providers.

While government clinics provide highly subsidised care with minimum fees for basic dental treatments, such as tooth extraction for RM1 and tooth filling for RM2, it is widely known that the waiting times and appointment lists can be quite long. Furthermore, accessing both government and private dental clinics entails additional costs, particularly transportation expenses. Complex treatments like denture fabrication and root canal treatment often require multiple clinic visits, further amplifying the challenges. For residents in rural or remote areas, accessing government clinics poses a transportation hurdle. Expenses such as bus fares, taxi or e-hailing fees, and petrol costs can further strain individuals with low incomes seeking dental treatment at government clinics. Moreover, in urban areas like the Klang Valley, patients contend with the added burden of parking fees, a common complaint among individuals seeking care in major cities. These factors contribute to potential productivity loss and hinder individuals from receiving timely and affordable dental treatment.

Access barriers encompassing both cost and the need for caregiver presence, have a profound impact on individuals with special needs, disabilities, young children, and the elderly. Those facing mobility difficulties or requiring extra support to reach dental clinics encounter tough challenges in accessing essential dental treatment, including both emergency and basic care. This particular group of patients heavily relies on the assistance of caregivers to accompany them for dental check-ups and treatments. However, caregivers who accompany them often face the dilemma of taking leave from work, with some even relying on daily wages for their livelihood. As a result, many individuals may have to defer or neglect necessary dental care due to these added financial burdens, ultimately compromising their oral health and overall well-being.

The significance of practising good oral hygiene habits to prevent dental health Issues like cavities and gum diseases is widely acknowledged. Nevertheless, there are individuals who face the unfortunate reality of “hygiene poverty” due to their inability to afford basic hygiene essentials, including toothbrushes and fluoridated toothpaste. In certain communities, families still resort to sharing toothbrushes and struggle to replace worn-out ones due to financial constraints. This has a negative consequence, as it increases the risk of bacterial infections and transmission between individuals. Neglecting personal hygiene can have serious implications for overall health. In terms of oral hygiene, simple daily routines like brushing teeth twice a day with fluoridated toothpaste are effective in preventing common oral health problems. However, without access to these essential preventive tools, individuals face an increased risk of developing more severe dental problems that require complex treatments, ultimately diminishing their quality of life.

To address these challenges, it is crucial to understand the impact of high living costs on dental care among the Malaysian population. Concrete actions must be taken to alleviate the burden faced by affected groups. Thus, it is imperative for various stakeholders, including the government, private sector, and other relevant parties, to collectively address this issue and work together towards achieving this objective. Initiatives can be implemented to periodically provide basic dental care essentials such as toothbrushes and fluoridated toothpaste to those in need. Additionally, it is important to establish financial assistance programs that enable low-income individuals to access the necessary dental treatment. Tax exemptions for dental treatments or inclusion of dental care in private insurance coverage for other income groups can also play a significant role in reducing financial strain.

Moreover, fostering public-private partnerships is essential to offer affordable dental care options for economically disadvantaged individuals, particularly at private clinics. This approach will expand the availability of affordable dental services beyond government clinics, thus increasing access to private providers. Some private dental facilities already offer instalment and flexible payment options, allowing individuals to better manage their financial burden associated with dental treatment. Furthermore, private companies can make valuable contributions through corporate social responsibility programs. They can support initiatives that aim to deliver affordable dental services and fund free dental services for communities in need. Such contributions will help broaden access to quality dental treatment without compromising individuals’ financial well-being. Effective multisectoral collaboration among the government, healthcare bodies, non-governmental organisations, and the private sector is essential. Through collaborative efforts, we can transform the landscape of dental health, empowering individuals, and communities to prioritise and achieve optimal oral and general well-being. Together, let us build a future where dental care is not a luxury, but a fundamental right for every person, regardless of their economic circumstances.

_{The authors are from the Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya. They may be reached at azlida@um.edu.my}