Aspects of planning and evaluation of children's dental care in Appalachia

Can questionnaires replace clinical surveys to assess dental treatment needs of adults?

OBJECTIVE

The purpose of this study was to ascertain whether questionnaires can be used to replace clinical surveys by comparing normative and perceived caries status and treatment needs in a sample of adults living in East London, UK.

METHODS

A cross-sectional study was conducted in two stages: a structured interview inquired about perceived dental caries status and treatment needs, and dental examinations were performed to determine oral health status and normative treatment needs. Perceived and normative assessments were compared for overall proportions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), using the dental examination as a gold standard.

RESULTS

Of 139 people examined, 122 were dentate. The PPVs for perceived caries and treatment need were 0.58 and 0.67, respectively. Overall agreement was 65.4 percent for the presence of caries and 64.7 percent for the presence of treatment need. However, no net error was found between the proportions of participants with decay, and a small net error (7.4%) was found between perceived and normative treatment need.

CONCLUSIONS

Self-assessment is not useful to assess individual dental treatment need, but is of possible value in assessing the needs of adult communities.

A review of methods to forecast restorative treatment needs

Decision makers in the areas of health policy, resource allocation, and manpower requirements rely implicitly on estimations of treatment needs on which to base their forecasts. The less specific the treatment-need estimate, the less precise the forecast. In previous decades, high caries rates were so prevalent that the dental profession could risk having inexact projections because overwhelming need and demand existed. However, rampant decay is no longer a common occurrence. Decay levels are declining in our nation's children and adults have fewer missing teeth. Therefore, restorative treatment needs and patterns in adult populations are transforming at a time when health care costs are spiraling and budget analysts at all levels of government are questioning the priority of continued support of dental care, dental education, and dental research at current levels. The purpose of this review is to present the existing methods of forecasting restorative treatment needs and to postulate the development of a new method based on the collective experiences of practicing dentists nationwide, an empirical method, to convert surface-specific oral health status data to restorative treatment need information. Need estimations based on empirical data would more accurately reflect the actual distribution of services that practicing dentists provide.

Dental health personnel planning: a review of the literature

Dental personnel planning is important in formulating policy in dental education, dental public health programs, and dental care delivery systems. The purpose of this literature review is to illustrate the use of dentist-to-population ratios, need-based models, and demand-based models in the determination of appropriate supply of dental personnel. A historical perspective is provided that demonstrates how political manipulation and subjectivity have characterized the use of these models by organized dentistry, the federal government, and others. The lack of pertinent data and the inability to predict economic, social, political, and epidemiologic trends weaken the applicability of each model in determining future personnel levels. Considering the long-term consequences of the use of each model in personnel planning, caution is urged in using any of the presently available models.

The estimation of need for dental care

This paper presents a background discussion of the estimation of normative need for dental care. Definitions are given which differentiate normative need for dental care from perceived need, demand, or utilization. Four different approaches to obtaining estimates of normative need for dental care are outlined. They are the translation of data from surveys of dental status, surveys of need for dental care, analyses of service or treatment records, and best judgment of dental practitioners. Present limitations within the four aproaches to estimating need to include factors such as objectivity, directness, completeness, precision, and extent of population coverage. Applications of estimates of need for dental care are identified in the areas of evaluation, setting of priorities, and planning of dental health programs. Current developments in the area of health services, including the concepts of an adequate minimum standard for personal health services, quality assurance, and rationing by need, are seen as providing some impetus for greater interest in need for dental care. Future directions in the estimation of dental needs will depend upon the validation of the approaches outlined, as well as general factors including costs of collecting data on dental status and need for dental care in population.