Influence of the method of funding on the age of failed restorations in general dental practice in the UK

OBJECTIVE

This study examined the effect of the method of funding treatment on the age of restorations at the time of replacement.

METHOD

A group of general dental practitioners were recruited to take part in the study. Each participant was asked to record the reason for placement and replacement of restorations. The age and class of the restoration being replaced was also recorded, together with details of the material being used and the material being replaced. Details of the method of payment of the failed restoration were recorded.

RESULTS

Details of the reason for placement/replacement were received for 3,196 restorations from 32 GDPs. Of the restorations placed, 54% were amalgam, 32% composite, 8% compomer and 7% glass ionomer. The age of restorations at the time of replacement was significantly associated with the method of payment for the restoration, with restorations placed in the Armed Forces having been in service significantly longer at the time of their replacement than restorations placed under NHS regulations.

CONCLUSION

Statistical analysis indicated that restorations placed within the NHS regulations were replaced at a significantly lower age than restorations placed under the other funding arrangements investigated.

Pressures on dental education--a personal view

Dental schools and hospitals currently find themselves in the awkward position of being expected to be more productive whilst suffering a shortage of resources. In essence, they are expected to provide both education and NHS healthcare, yet scant attention is paid to the urgent issue of the resources required to achieve this. The same is true in medicine where the Government has promised 2000 more medical school places by 2005, a rise of almost 60%, to guarantee a decade of unprecedented expansion in doctor numbers in the NHS. However, the country's ability to train doctors is compromised by a shortage of academics available to teach them.

Why undertake outreach into general dental practice?

There are many reasons why patients are referred to consultants in restorative dentistry and these range from general practitioners requiring treatment planning advice, to the desire for the consultant to undertake the treatment. The consultation process should be seen as an opportunity to educate the patient about the nature of their dental problem, to make them aware of the various treatment alternatives as well as to inform them of their role in the prevention of further disease. The nature of the hospital-based consultation means that the general dental practitioner is to a large extent a passive onlooker. The educational value for the practitioner will be dependent upon the nature of the written report (or other forms of communication) sent to the general dental practitioner following the consultation. In some cases this may be very limited, so when the practitioner is faced with a similar case, because they have not been actively involved with the previous examination and consultation, they will have no alternative but to also refer the new case for treatment planning advice.

Changing patterns and the need for quality

This series of articles is aimed at anybody who places crowns and other extra-coronal restorations (ie veneers and shims) on individual teeth. We hope that everyone from experienced practitioners to undergraduate students may find something of value. Whoever reads them, we would ask to do so with an open mind. We have tried not to be dogmatic, and the techniques and materials described are not the only ones available, but are the ones which accord with the principles we describe.

General dental practitioners' beliefs on the perceived effects of and their preferences for remuneration mechanisms

OBJECTIVE

To identify GDPs preferences for differing remuneration mechanisms and their beliefs on the effect of the mechanisms in care provision.

DESIGN

Postal questionnaire survey of 300 GDPs holding an NHS contract with a London Health Authority.

RESULTS

GDPs perceive that remuneration mechanisms are important in determining the provision of care but not overall disease levels. There were differences in the preferred remuneration mechanisms when working under the NHS compared with the non-NHS sector. When providing care under the NHS, either the current remuneration system or a salaried plus bonus would be the preferred choice, while for non-NHS care a fee-per-item mechanism is preferred. Fee-per-item arrangement was the preferred choice of younger general practitioners compared with older practitioners. Females showed a greater preference for a salaried with bonus arrangement compared with males.

CONCLUSIONS

If policy makers are to use remuneration mechanisms to influence the provision of care effectively, the beliefs that care providers hold about various mechanisms are important to understand how they would respond to changes in the system.

Case study of an anxious child with extensive caries treated in general dental practice: financial viability under the terms of the UK National Health Service

This case study describes the management of Callum, an anxious 7-year-old boy with extensive caries. Callum's dental care was carried out in a general dental practice in the North of England under the terms of the National Health Service. A preventive programme was carried out in conjunction with the restorative philosophy according to guidelines published by the Dental Practice Board in 1997.

An introduction to economic evaluation of health care

Economic evaluation is an accepted method for the appraisal of health care programmes. Although it is used widely in medicine, its use in the field of dentistry has achieved popularity more recently. Economic evaluation in dentistry is likely to become increasingly important in the future and this paper introduces readers to some of the basic concepts.

Capitation registration and social deprivation in England. An inverse 'dental' care law?

OBJECTIVE

To examine associations between NHS child dental registration data and area deprivation scores of English Health Authorities (N= 100) in 1996/97 and 1997/98.

METHOD

The Department of the Environment index of local conditions and the Jarman Underpriviledge Area Score from the 1991 census were used to measure deprivation. Prior to September 1997, children got free dental treatment under a capitation scheme with an NHS dentist. If they did not attend within 24 months their registration lapsed on the last day of December of the second registration year and they were deleted from the capitation list. After September 1997 the registration period was reduced to 15 months.

OUTCOME

Curve-linear regression of the Health Authority (HA) percentage of children registered, lapses in capitation registrations and deprivation scores.

RESULTS

In England 68% of children were registered in December 1996. The percentage registered in each Health Authority was associated with deprivation (DoE, r2=0.33, Jarman, r2=0.27 p<0.01). In January 1997, 17.8% (1,345,142) of children registered lapsed (HA range 12.8% to 30.3%) and this was also significantly associated with deprivation (DoE r2=0.66, Jarman, r2=0.51 p<0.01). Similar results were found in 1997/98.

CONCLUSIONS

Registration and lapse rates were significantly associated with social deprivation confirming that there is an inverse 'dental' care law for children in England. NHS capitation may widen dental health inequalities.