Dental service utilization trends in rural and semiurban health centers of Isfahan, Iran (2016-2021): A retrospective descriptive study

Abstract

BACKGROUND: Iran's oral health reform plan aimed to shift primary dental care toward prevention through the family dentist program, yet longitudinal evidence on real-world service mix is limited. We assessed 6-year trends in dental service utilization in rural and semiurban primary healthcare facilities in Isfahan, Iran. MATERIALS AND METHODS: This retrospective, longitudinal, observational, descriptive study analyzed aggregated service counts extracted from Iran's integrated health system (SIB) for two healthcare networks in Isfahan from 2016 to 2021. We included Level 2 clinical procedures recorded under the family dentist program and categorized them as preventive (fluoride varnish, fissure sealants, and scaling) or curative/treatment (restorations, extractions, and pulpotomy). Trends were summarized using annual volumes, year-to-year percentage change, and the proportional share of preventive versus curative services. Data were analyzed using descriptive statistics; no inferential statistical tests were applied, and a significance threshold was not defined, given the descriptive nature of the study. RESULTS: A total of 133,075 Level 2 dental services were delivered over the study period. Utilization peaked in 2017 (28,290 services) and remained high in 2019 (28,027), suggesting a period of increased throughput during the implementation and maturation of the oral health reform package in primary health care, followed by a sharp decline in 2020 (11,215; -60.0 vs. 2019) and partial recovery in 2021 (20,691; +84.5 vs. 2020). Preventive share dropped to 7.2 in 2017, increased to 21.0 by 2019, and remained near 19 in 2020-2021. Health Center No. 2 delivered a higher cumulative volume than No. 1 (76,697 vs. 56,378 services). Permanent tooth extractions were the most frequent procedure (66,152), exceeding the total number of restorations (28,160). CONCLUSION: Despite a stable preventive component in later years and postpandemic recovery, service delivery remained strongly treatment- and extraction-oriented, indicating a limited shift toward prevention within the primary care dental package.