Adults' dental treatment in 2001-2013 in Finnish public dental service

Survival of endodontically treated teeth in public dental service in Northern Finland: a practise-based register study

OBJECTIVE

The aim of this study was to explore the factors associated with the survival of root canal treated teeth in a practise-based study setting in a 5-year period.

MATERIAL AND METHODS

This retrospective study used data from the electronic patient registration system of the public dental services of the City of Oulu, Finland. The inclusion criteria for this study were patients aged ≥ 20 years who had root canal treatment (RCT) that was initiated in 2014. One RCT per patient was included in the study. A total of 713 patients met the inclusion criteria. The outcome variable for this study was the extraction of the RCT tooth during the 5-year period. Explanatory variables included age, diagnosis, tooth type (incisive, canine, premolar, molar), RCT technique (manual, motorized), time from RCT initiation to final restoration and type of final restoration (composite, glass ionomer, fixed dental prosthesis). To evaluate the association between the outcome variable and explanatory variables, Cox regression analyses were performed.

RESULTS

The overall survival rate was 91%. The middle-aged (40-59-years-old) and the oldest (60 and older) patients had a two-fold risk of extraction compared to younger (20-40-years-old) patients. Similarly, a short length of time from RCT initiation to final restoration (0-14 days) resulted in a nearly three times higher risk of extraction compared to a longer period (≥ 90 days).

CONCLUSIONS

The 5-year survival rate of RCTs seems high. Extractions were more common among patients over 40 years of age and if the RCT was completed shortly after its initiation.

Trend in basic oral treatment needs in relation to taxation of sweets, ice cream, and sugar-sweetened beverages in Finland: a registry-based study

OBJECTIVE

The aims were to explore the trend in basic oral treatment needs and total operating cost of public dental services (PDS) in relation to total excise tax revenue generated from sugary products during 2011-2020 and to evaluate the impact of tax policy in excise tax revenue of sugary products and average sugar consumption.

METHODS

The study comprised longitudinal data retrieved from Finnish registries during the years 2011-2020. Basic oral treatment needs, and total operating cost of PDS, total excise tax revenue generated from sugary products and average sugar consumed (kg per capita) during the years 2011-2020 were obtained. Simplified panel analyses and sensitivity analyses were used to evaluate the effects of explanatory variables on outcomes.  Results: An approximate one EUR 1,000,000 increase in total excise tax revenue generated from sugary products corresponds to a 0.4% increase in total operating cost of PDS. There was a significant positive trend in total operating cost of PDS in Finland over the study period. Similarly, an approximate one EUR 1,000,000 rise in total excise tax revenue corresponds to a 0.2% increase in basic oral treatment needs. Additionally, there was a statistically significant difference in the average excise tax revenue for sugary products between the periods before and after 2017.

CONCLUSION

No change in average sugar consumption was observed despite implementing the new sugar policy. Therefore, it may be worthwhile to reconsider the excise tax on sweets and ice cream as it will significantly increase the total national revenues.

Effects of universal oral healthcare coverage in an adult population: A long-term nationwide natural experiment

OBJECTIVES

A large and long-term natural experiment occurred in Finland from the late 1980s-2000, when adults' entitlement to subsidized oral healthcare was strongly dependent on the arbitrary classification based on their year of birth: people born in 1956 or later were entitled to subsidized care, while people born before 1956 were not. The aim of this study was to investigate the effect of this expanded universal oral healthcare coverage on service use and oral health outcomes.

METHODS

Data from annual nationally representative cross-sectional postal surveys among 15-64-year-olds between 1990 and 2014 were used. For this study, the following outcome variables were formed: experiencing toothache during the past month (yes/no), the number of missing teeth with three different thresholds (over 10, over 5 or at least 1 missing tooth), brushing more than once a day and the number of visits to the dentist. Regression discontinuity plots and bias-corrected local polynomial regression discontinuity estimators measuring the effect of the extended universal coverage on the outcomes at the year-of-birth cut-off of 1956 were generated separately from the data from 1990 to 2000 and from 2002 to 2014.

RESULTS

Between 1990 and 2000, the number of visits to the dentist (0.2 visits, 95% CI, confidence intervals: -0.03; 0.43) and the proportion of those who visited the dentist during the past 12 months (4.2%, 95% CI: 0.1%; 8.3%) increased at the year-of-birth cut-off of 1956. There were minor drops (1.5%-1.9%) in the number of missing teeth across all thresholds (over 10, over 5, or at least 1 missing teeth) at the cut-off. Analyses with the data from the surveys from 2002 to 2014 showed that there were no discontinuities in these outcomes at the cut-off of 1956. Regression discontinuity estimates related to toothache experience and toothbrushing frequency were inconclusive due to high variability in the underlying data and the likely small effect of the more universal coverage on these outcomes.

CONCLUSIONS

The current study provided evidence of the beneficial effects of universal oral healthcare coverage on the oral healthcare service use and teeth preservation from a large and long-term natural experiment occurred in Finland from the late 1980s to 2000.

Direct restorations and enhanced caries prevention among 20- to 60-year-olds attending Helsinki City Public Dental Service - a register-based observation

OBJECTIVE

Our retrospective register-based observational study evaluated age-specific aspects and changes in volume and content of direct restorative procedures, pulp cappings and enhanced caries prevention measures given to adults.

METHODS

Data included all treatments provided for 20- to 60-year-olds visiting the Helsinki City Public Dental Service (PDS) in 2012 and 2017. For both years, the data were aggregated into 5-year age groups. Data included means of DMFT indices, number and size of direct restorations, number of specific codes for pulp cappings and enhanced prevention.

RESULTS

Around half of all patients received restorations, 39,820 (50.9%) in 2012 and 43,392 (45.9%) in 2017. The greatest increase in DMFT means by age cohort was found for the 2012 age cohort of 25- to 29-year-olds and the smallest for the 2012 age cohort of 45- to 49-year-olds. In each same-age group and each age cohort, the enhanced prevention in 2017 was less frequent than in 2012. The proportion of two-surface restorations accounted for 44.7% of procedures in 2012 and 45.9% in 2017, followed by an increasing proportion of one-surface restorations, from 28.3% in 2012 to 32.9% in 2017. Associations between restoration size and age group were highly significant (p < .001).

CONCLUSIONS

The volume of direct restorative procedures and enhanced prevention measures were strongly age-dependent. Restorative treatment procedures were more frequent in older age groups than in younger age groups, and vice versa for enhanced prevention and pulp cappings. The magnitude of restorative treatment decreased slowly from 2012 to 2017, and overall enhanced preventive treatment was limited.

The Provision of Private Healthcare Services in European Countries: Recent Data and Lessons for Universal Health Coverage in Other Settings

Universal Health Coverage (UHC) exists in all of the countries of Europe, despite variation on the ownership structure of health delivery systems. As countries around the world seek to advance UHC and manage the private sector within their health systems, the European experiences can offer useful insights. We found four different models for the provision of healthcare, with the private sector predominant in some countries, and of minimal importance in others. The European experiences indicate that UHC can be effectively provided with, or without, large-scale private sector provision in hospital, specialty, and primary care services, and that moreover it can be provided with high levels of patient satisfaction. These findings offer regulatory models for countries in other regions to review as they advance UHC.