Understanding the complexities of oral healthcare delivery in correctional settings: a qualitative exploration of barriers, facilitators, and opportunities

Amaya et al. BMC Public Health (2025) 25:3039 https://doi.org/10.1186/s12889-025-24447-9 BMC Public Health Open Access RESEARCH Understanding the complexities of oral healthcare delivery in correctional settings: a qualitative exploration of barriers, facilitators, and opportunities Arianna Amaya1, Ivan Medina2, Farimah Rezaei3, Pegah Soleimani4, Rebecca Bosworth5,6,7,8, Heino Stöver9 and Babak Moazen1* Abstract Background People living in prison face exceptionally high prevalence rates of tooth decay, periodontal disease, and poor oral health-related quality of life. Despite its importance, various aspects of oral healthcare in prison settings remain understudied. The present study investigates the barriers and facilitators associated with providing and utilizing oral health services in prison settings, drawing on insights from prison health experts, managerial and custodial staff, healthcare providers, and individuals with lived experience of imprisonment. Methods From March to June 2023, a total of fifteen participants participated in semi-structured in-depth interviews. Interviews were conducted until data saturation to identify barriers and facilitators of oral health services in prisons. Potential areas for improvement were also explored. Thematic analysis was used to analyze the data. Themes and subthemes were derived from the dataset and converted into preliminary codes which aligned with research objectives. Results The first topic, barriers, included two themes: organizational barriers related to the provision of services, and individual barriers related to the utilization of services. The second topic, facilitating factors, included six themes: funding, community partnership, substance use treatment, communicating with policy makers, transportation, and education. Conclusion Ensuring the oral health of incarcerated individuals is a fundamental aspect of their right to health and a crucial factor in their successful reintegration into society. Formerly incarcerated people are often hard to reach in the community, making the period of confinement a unique opportunity to deliver quality oral healthcare. Given that most incarcerated individuals will eventually return to their communities, providing comprehensive healthcare, including oral health interventions, represents a valuable public health investment. Keywords Oral health, Oral health-related quality of life, Prisons, Public health, Health promotion *Correspondence: Babak Moazen Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Amaya et al. BMC Public Health (2025) 25:3039 Introduction According to the World Health Organization (WHO) “Oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompasses psychosocial dimensions such as selfconfidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment.” [1] Oral disorders, including dental caries, periodontitis, and tooth loss, are among the most common chronic health conditions affecting nearly half of the global population [2]. Oral health is not solely determined by individual dental hygiene habits, it is also influenced by population, social, psychological, and systemic factors [3]. Despite being a key component of quality of life [4], many people worldwide, especially priority populations, lack access to adequate oral health services [5]. People living in prisons (PLP) are a high-priority group that experience significant challenges with poor oral health outcomes [6]. Currently, over 11 million people are held in prison settings worldwide [7], many of whom experience poor general and oral health conditions. According to WHO, people in contact with criminal justice systems experience high levels of tooth decay, with prevalence rates ranging up to 67% [8]. They also face a high prevalence of periodontal disease, oral cancers, and poor oral health-related quality of life, all of which impact their daily functioning [8]. Oral health among the prison population is more than just an aesthetic concern, as poor oral health can hinder the reintegration of PLP into society upon release [6]. This aligns with evidence from the literature showing a higher prevalence of missing and decayed teeth among unemployed individuals compared to their employed counterparts [9–11]. Oral diseases are associated with various modifiable risk factors, including excessive sugar intake, substance use, poor oral hygiene, and the underlying social and economic determinants which magnify these risk factors [12]. In prisons, additional risk factors for poor oral health include high levels of illicit drug use, widespread interpersonal violence, deprioritization of personal hygiene, and the limited availability, accessibility, affordability, and quality of oral health prevention and treatment interventions [6]. Substance use, a key contributor to poor oral health, is notably higher among prison populations than in the general population. For instance, in Europe, the lifetime prevalence of illicit drug use prior to incarceration has been estimated to reach up to 90% among PLP [13]. Health professionals such as dentists, nurses, doctors and allied health, as well as non-health professionals, such as prison officers and food service workers, are essential in promoting oral health within custodial facilities. However, the scope and impact of their roles Page 2 of 10 in relation to oral health promotion are not well understood. The role of prison officers has been underexplored and, in some cases, ignored, in implementation of policy to create health promoting prisons [14]. In relation to oral health, the stark deficit of oral health professionals in custodial settings has been documented [8]. This uneven distribution of oral health professionals calls for an interprofessional approach to oral health promotion, where a range of non-dental professionals can work collaboratively to address the various factors that impact oral health outcomes among PLP [15] (...truncated)