title: Access to dental public services by disabled persons.
abstract: BACKGROUND
  According to the World Health Organization, one in every 10 people has a disability, and more than two-thirds of them do not receive any type of oral dental care. The Brazilian Constitution of 1988 guarantees all civilians including disabled people the right to healthcare, shaping the guidelines of the Brazilian National Health Care System (Sistema Único de Saúde--SUS). However, there is limited information about the true accessibility of dental services. This study evaluated the accessibility of public dental services to persons with disabilities in Fortaleza, Ceará, which has the third highest disability rate in Brazil.
  
  
  METHODS
  A cross-sectional quantitative study using structured questionnaires was administered to dentists (n = 89) and people with disabilities (n = 204) to evaluate the geographical, architectural, and organizational accessibility of health facilities, the communication between professionals and patients with disabilities, the demand for dental services, and factors influencing the use of dental services by people with motor, visual, and hearing impairments.
  
  
  RESULTS
  43.1% of people with disabilities do not recognize their service as a priority of Basic Health Units (BHU), 52.5% do not usually seek dental care, and of those who do (n = 97), 76.3% find it difficult to receive care and 84.5% only seek care on an emergency basis. Forty-five percent are unaware of the services offered in the BHU. Of the dentists, 56.2% reported difficulty in communicating with deaf patients, and 97.8% desired interpreters stationed in the BHU. People with disabilities gave better accessibility ratings than dentists (p = 0.001). 37.3% of the patients and 43.8% of dentists reported inadequate physical access infrastructure (including doors, hallways, waiting rooms, and offices). Dentists (60%) reported unsafe environments and transportation difficulties as geographical barriers, while most people with disabilities did not report noticing these barriers.
  
  
  CONCLUSIONS
  While access to dental services has increased in Fortaleza, the lack of accessibility of health units and their surroundings does not promote the treatment of people with disabilities. Cultural, organizational, architectural, geographical, and communication barriers constrain the demand for and use of oral dental care services by this social segment.
authors.affiliation: Dentist of the Family Health Program - Secretaria Municipal de Saúde - Fortaleza, Ce, Rua do Rosário, 283, Fortaleza, Ce, Brazil. lyanafurtado3@hotmail.com.|Professor at the Public Health Master Program - UNIFOR, Av. Washington Soares, 1321 Sala S1, 60811-905, Fortaleza, Ce, Brazil. lyanafurtado3@hotmail.com.
authors.forename: Lyana
authors.initials: L
authors.lastname: Leal Rocha
authors.affiliation: Professor at the Public Health Master Program - UNIFOR, Av. Washington Soares, 1321 Sala S1, 60811-905, Fortaleza, Ce, Brazil. mvlsaintrain@yahoo.com.br.
authors.forename: Maria
authors.initials: M
authors.lastname: Vieira de Lima Saintrain
authors.affiliation: Researcher at the Oswaldo Cruz Foundation - FIOCRUZ, Av. Santos Dumont, 5753 Sala, 1303, 60175-047, Fortaleza, Ce, Brazil. anya@fiocruz.br.
authors.forename: Anya
authors.initials: A
authors.lastname: Pimentel Gomes Fernandes Vieira-Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001107:Architectural Accessibility / Q000706:statistics & numerical data; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D003469:Culture; D003730:Dental Care for Persons with Disabilities / Q000706:statistics & numerical data*; D005160:Facility Design and Construction / Q000706:statistics & numerical data; D005260:Female; D058016:Health Facility Administration / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D019986:Persons with Hearing Disabilities / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data; D055815:Young Adult