This study analyzed data from the 6th (2013) to the 9th (2022) National Health and Nutrition Survey (KNHANES) to identify factors influencing dental care utilization among the elderly in Korea and to provide foundational data for elderly health policies.

The analysis of unmet dental care characteristics based on the subjects’ characteristics revealed that gender, health checkup utilization, and chewing discomfort were consistently identified as significant variables. In 2013, significant differences were observed in gender, income, health checkups, stress, and chewing discomfort. In 2016, all these factors, except for income, showed similar results to 2013. Additionally, education level, oral hygiene products (interdental brushes), and oral checkups (within the past year) were added as significant factors. In 2019, the same factors that were significant in 2016 (gender, education level, health checkups, stress, oral hygiene products, and chewing discomfort) remained significant, with income level reappearing as a factor, and aerobic physical activity also added. In 2022, cohabitation status and monthly alcohol consumption emerged as significant variables, while education level, stress, and aerobic physical activity were excluded.

Gender consistently showed significant differences over the past decade. Gender differences in unmet dental care are often attributed to differences in healthcare access, economic conditions, and social roles. Women are more likely to postpone dental treatments due to economic burdens and lack of time, particularly because of caregiving responsibilities, which lead them to prioritize other matters over dental visits. Economic hardship was highlighted as a primary cause of unmet care [15,16]. This study also confirmed that income was significantly correlated with dental care in 2013, 2019, and 2022, reinforcing the notion that both gender and income are key factors in dental treatment. Previous studies have shown that women feel a greater economic burden than men, often leading them to delay preventive dental care and regular checkups due to psychological and financial stress [15,17]. The study found higher unmet dental care rates among women, a trend that has persisted over the last decade. To address unmet dental care for the elderly, it is necessary to examine policy support for gender differences and implement social support measures tailored to each gender.

Oral health examinations were significantly analyzed in the surveys of 2016, 2019, and 2022, confirming that health check-ups and oral health examinations are significant variables in dental treatment. Health checkups are vital for the early detection of diseases and preventive actions. Previous studies have emphasized that preventive health checkups reduce unmet dental care, and comprehensive health checkups, including oral health, are critical in ensuring timely dental treatment for the elderly[18-24]. Several studies suggest that factors such as personal, economic, and geographical barriers to oral checkups need to be analyzed in detail to improve dental visits and encourage preventive care [7,25]. The elderly face significant barriers to dental care due to mobility issues, lack of information, and economic constraints. Therefore, policies such as mobile health checkups or collaboration with local communities to offer checkups in frequently visited places by seniors would be beneficial.

Chewing discomfort has also been a consistent factor influencing unmet dental care over the past decade. Previous studies [16,19] also found that those with chewing discomfort are more likely to have unmet dental care, which aligns with the results of this study. The elderly often lack the resources or information to resolve dental issues such as pain or discomfort, leading to unmet needs [26]. Moreover, the elderly face significant challenges due to physical and mental health decline, loss of economic capacity due to retirement, and higher medical costs [27]. Such unmet healthcare can lower an individual’s quality of life and have negative impacts on mental health. Therefore, chewing discomfort and unmet healthcare go beyond just oral health issues and can significantly affect overall physical, mental, and social well-being. As the elderly population continues to grow, the incidence of unmet dental care will likely rise. Therefore, comprehensive strategies are necessary to improve dental care accessibility for the elderly.

Dental care utilization in Korea has steadily evolved over the past decade, with an increase in elderly utilization due to aging population concerns and the expansion of the health insurance system [28]. Recent trends suggest that access to dental care is influenced by various socio-economic factors. However, elderly populations still exhibit limited utilization of dental care, with factors such as gender, health checkups, and chewing discomfort continuing to have significant impacts. To address this issue, it is necessary to introduce facility-based health check-up or mobile screening vehicles to provide regular oral health check-ups at public institutions, welfare centers, and elderly facilities that seniors frequently visit. Additionally, policies should be strengthened to offer comprehensive screening services, including oral health, as part of existing health check-ups, enabling preventive health management. In the past, elderly dental care utilization was mostly focused on treating symptoms or functional rehabilitation. However, as perspectives on healthy life expectancy change and there is a growing demand for improved quality of life, there is a need to shift from treatment-focused services to a more integrated approach of treatment, prevention, and health promotion for oral health. To increase dental service utilization among the elderly, it is essential to establish a policy support system and reform the system to enhance accessibility and effectiveness.

The limitations of this study include the fact that it is a cross-sectional study rather than a cohort study, making it difficult to establish causality. Additionally, due to changes in survey criteria and items according to the KNHANES cycle, some necessary variables may not have been considered. Therefore, it is deemed necessary to conduct further analyses incorporating a wider range of variables. Nevertheless, this study is meaningful in that it identifies the factors influencing dental care utilization among Korean older adults over a 10-year period from 2013 to 2022 and suggests directions for oral health policy.