Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel

BACKGROUND

To prevent child maltreatment, the identification of vulnerable children is essential. In Norway, public dental health personnel (PDHP) report suspicion of child maltreatment to child welfare services (CWS) at a relatively high rate. However, their reasons for reporting and the response from CWS have not been investigated. The objectives of this study were to (1) explore the reasons that PDHP send reports of concern, (2) examine how CWS responds to PDHP reports, and (3) assess whether different reasons for concern are associated with a given response from CWS.

METHODS

A national cross-sectional study was conducted by an electronic survey distributed to public dental hygienists and dentists in Norway. Descriptive statistics were calculated in terms of mean (SD) distributions and frequency, expressed as % (n). To account for clustering of responses among respondents, binomial generalized estimating equation analysis was used to estimate odds ratios (ORs) and confidence intervals (CIs) of CWS responses across number of reports with different reasons for concern.

RESULTS

Of a total of 1542 questionnaire recipients, 1200 (77.8%) responded to the survey. From 2012 to 2014, 42.5% of the respondents sent 1214 reports to CWS, with a mean number of 2.7 (SD = 2.0) reports per respondent. The PDHP sent the reports due to suspicion of neglect or physical, sexual and/or psychological abuse. Non-attendance at dental appointments and grave caries were reported most frequently. Among the reports, 24.5% resulted in measures being taken by CWS, 20.7% were dropped, and 29.4% lacked information from CWS on the outcome. Reports due to suspicion of sexual abuse, (OR 1.979, 95% CI (1.047-3.742), P = 0.036), grave caries (OR 1.628, 95% CI (1.148-2.309), P = 0.006), and suspicion of neglect (OR 1.649, 95% CI (1.190-2.285), P = 0.003) had the highest association with the implementation of measures.

CONCLUSIONS

PDHP report on several forms of child maltreatment and contributes in detection of victimized children. However, the relatively low number of measures being taken by CWS and the number of reports that lack a response to reporters reveal a need for a closer cooperation between the services, as this would benefit both the children at risk and the services.

An assessment of career satisfaction among Macedonian dentists

AIM

The aim of this study was to assess the level of overall career satisfaction in relation to various personal and work-related factors among the dentists in the Republic of Macedonia.

MATERIALS AND METHODS

The sample comprised 118 registered dentists, working in different conditions (34 public practice dentists, 32 completely private, 42 private dentists who work with a health insurance fund and 10 concessioners). All of them filled in a questionnaire which contained 16 items, divided into five groups. The different clusters of questions were related to various working conditions and personal factors. The first four groups of questions were answered with a--point Likert format with a score range from 1 (very dissatisfied) to 4 (very satisfied). In the fifth group, dentists chose one of four offered answers. The statistical analyses were made by one-way ANOVA and chi-square tests.

RESULTS

Significant differences related to working conditions were found between public practitioners (moderately dissatisfied) and private practitioners (very satisfied) (F=41.41 (df=3); p<0.01). A high prevalence of dentists (89.83%) had felt stressed on their work place and 61.8% of public dental health practitioners had felt stressed at work "very often". The main sources of job-related stress for public dental practitioners were their supervisors (50%) and patients (26. 47%), while private practitioners were mostly stressed by inspectors (76.19%) and patients (21.87%) (χ2=44.5 (df=9); p<0.01).

CONCLUSION

The findings in our study showed overall low levels of career satisfaction among the dentists (public and private) in the Republic of Macedonia. The finding that high percentages of dentists feel stress at their work place very often requires further exploration.

Adverse events in Public Dental Service in a Swedish county--a survey of reported cases over two years

Adverse events cause suffering and increased costs in health care. The main way of registering adverse event is through dental personnel's reports, but reports from patients can also contribute to the knowledge of such occurrences. This study aimed to analyse the adverse events reported by dental personnel and patients in public dental service (PDS) in a Swedish county. The PDS has an electronic system for reporting and processing adverse events and, in addition, patients can report shortcomings, as regards to reception and treatment, to a patient committee or to an insurance company. The study material consisted of all adverse events reported in 2010 and 2011, including 273 events reported by dental personnel, 53 events reported by patients to the insurance company and 53 events reported by patients to the patient committee. Data concerning patients' age and gender, the nature, severity and cause of the event and the dental personnel's age gender and profession were collected and analysed. Furthermore the records describing the dental personnel's reports from 2011 were studied to investigate if the event had been documented and the patient informed. Age groups 0 to 9 and 20 to 39 years were underrepresented while those between the ages 10 to 19 and 60 to 69 years were overrepresented in dental personnel's reports. Among young patients delayed diagnosis and therapy dominated and among patients over 20 years the most frequent reports dealt with inadequate treatments, especially endodontic treatments. In 29% of the events there was no documentation of the adverse event in the records and 49% of cases had no report about patient information. The majority of the reports from dental personnel were made by dentists (69%). Reporting adverse events can be seen as a reactive way of working with patient safety, but knowledge about frequencies and causes of incidents is the basis of proactive patient safety work.

The objective and subjective outcome of orthodontic care in one municipal health center

OBJECTIVE

The aim of this study was to assess the outcome of orthodontic care in one municipal health center.

MATERIALS AND METHODS

The material consisted of one age-cohort of 15-16 year-old adolescents (n = 67). Of them, 97% participated in a clinical examination. The final group included in the study consisted of 61 adolescents (91% of the whole age cohort). The occlusions were evaluated applying the Occlusal Morphology and Function Index (OMFI), the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Moreover, all adolescents filled in a semi-structured questionnaire enquiring about their satisfaction with the function and appearance of their own dentition and self-perceived orthodontic treatment need. They also scored their own dental appearance on a Visual Analog Scale (VAS).

RESULTS

Of the adolescents, 42% had received orthodontic treatment, while 58% were untreated. All morphological criteria of the OMFI were met by 58% of orthodontically treated and 49% of untreated adolescents and all functional criteria by 67% and 57%, respectively. Treatment need was registered in two of the treated adolescents (7%) and five of the untreated adolescents (14%). Treated adolescents were more often satisfied with their dental appearance than untreated adolescents (p = 0.034). In both groups, satisfaction with the function was high (93%).

CONCLUSIONS

Orthodontic treatment seems to improve both occlusal morphology and function. The high satisfaction with one's own dental appearance among the treated adolescents is worth noting.

Alternative careers in pediatric dentistry: a survey of pediatric dental residents

Pediatric dentistry has enjoyed growing popularity in recent years, yet there remains a need for leadership in academe, research, and public health. In November 2008, the first Maternal and Child Health Bureau-sponsored regional Leadership in Pediatric Dentistry convocation was held at the Columbia University College of Dental Medicine. Seventy-two pediatric dentistry trainees from thirteen programs in the New York City area participated in interactive presentations and exercises. Of the sixty- seven participants who completed a pre-event survey, 93 percent stated they would likely or very likely pursue careers that involved, at least in part, private practice, 55 percent in care of children in Medicaid, 51 percent academics, 36 percent dental public health, and 12 percent research. Barriers related to finances, competence, or work environment/location were perceived by 83 percent for careers involving research, 73 percent for dental public health, 66 percent for providing care to children in Medicaid, 46 percent for academics, and 9 percent for private practice. Results of a pair of pre-event and post-event surveys completed by sixty-three attendees showed no change in reported likelihood to pursue a career alternative except for an increase in the likelihood of working in a practice that accepts Medicaid. The challenge before dental educators is to provide consistent and meaningful opportunities throughout training that encourage residents to consider all career options and to discover how their individual interests mesh with their clinical learning.

Who will serve? Assessing recruitment of underrepresented minority and low-income dental students to increase access to dental care

This article uses data from the 2007 American Dental Education Association survey of dental school seniors to assess their intentions to serve underserved populations according to the students' underrepresented minority (URM) and income status. Dental school recruitment and retention programs that concentrate exclusively on URM students will not benefit most low-income students since 83 percent of them are not URM. Recruiting URM students leads to more graduating students with intentions to serve minorities. Whether the income of URM students was high or low, about half in each income group stated that more than 25 percent of their patients would be underserved minorities, compared to 28 percent of the low-income non-URM students and 17 percent of the higher income non-URM students. However, our multivariable results suggest that recruitment of both low-income groups (URM and non-URM) rather than high income regardless of ethnicity might be especially helpful in producing graduates who choose public service. URM/income status was not significantly related to serving special care or rural populations.

[The dental aspects of public health in Hungary. Review article]

Despite great improvements in the oral health status of the population, public health and dental public health continue to be a major problem in society. A number of epidemiologic studies revealed the importance of the social, behavioral and environmental factors contributing to inequalities in the maintenance and restoration of oral health. Dental public health is the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organized efforts of the public. The aim of the authors was to provide an overview about the development and the functions of the Hungarian public health and dental public health system, its associations with international dental public health organizations and about the present dental public health status of the Hungarian population. According to WHO pathfinder studies, the Hungarian population has a usual cariologic and periodontal status in Europe, but a number of WHO statistical analyses reveal the sad situation regarding the high frequency of oral malignancies in our country. The social support system is given, the tasks are in front of us, and Hungary intends to follow the oral health strategies of the WHO for 2020 in order to improve the dental public health status of the nation, but it is necessary to declare that not only behavioral but also political decisions are necessary for that goal.

Endodontic treatment in young permanent teeth. Prevalence, quality and potential risk factors

National epidemiologic data on oral health in children and adolescents in Sweden are restricted to caries, such as the number of decayed and filled teeth (DFT) and decayed and filled surfaces (DFS). Information about more complicated and time-consuming procedures such as endodontic treatment is scarce. The aims were to study the prevalence, quality and potential risk factors for endodontic treatment in young permanent teeth. The material consisted of dental records and radiographs. The subjects were all 19-year-olds born in 1979 (paper I-III) and all 15-year-olds born in 1990 (paper IV) belonging to the public dental clinics in Malmo. Paper III also included a control group.

[The reasons of tooth extraction taking into consideration the socio economical status during changes in the public health service in the West-Pomeranian voivodeship]

INTRODUCTION

There are many possibilities of diagnosing and treating, but the fact of an increasing number of patients who have resigned from expensive procedures in place of teeth extraction is still noticeable.

MATERIAL AND METHODS

Poll analysis based on the population of a big city--Szczecin and small towns in West Pomerania revealed that one's wealth considerably impacts both the frequency of visits in dental practices and the decisions regarding a mode of treatment.

RESULTS

It further occurs that the most common reason of tooth extraction is caries and its later complications. Over 25% of patients from Szczecin and nearly 20% of interrogated people in provinces had to extract teeth because of an economical reason due to the lack of money for restoring treatment. It also appeared that a majority of people feel unsatisfied with the proceeding reorganization of the national health service and have not observed any positive tendencies effecting from this process so far.

Oral health service systems in Gauteng Province, South Africa

OBJECTIVES

To describe the provision of restorative care and dental operators' opinion about their conditions of service in a South African provincial oral health service system.

DESIGN

Assessment of oral health service over a four-month period.

SETTING

Gauteng Province, South Africa.

SUBJECTS

Dental operators in public oral health service.

INTERVENTIONS

Operator interview, collection of treatment statistics, calculation of the mean score of restoration-extraction ratio per operator.

MAIN OUTCOME MEASURES

Number and type of restorations and tooth extractions rendered, daily patient load, perceived occupational stress level and opinion about main reasons for operator stress.

RESULTS

A total of 88,705 patients had been treated. The mean number of patients treated daily was 26 (SD = 8.4). Operators extracted 39,242 teeth and placed 2992 restorations. The main type of dental treatment was extraction. The mean score of the restoration-extraction ratio per operator was 0.09 in the primary, and 0.07 in the permanent dentition. The mean level of stress was 4.9 (SD = 1.9). The majority of operators regarded patients' high dental anxiety as the main reason for stress, followed by high patient load. The mean level of stress increased with the increase in number of patients treated per day (r = 0.44, p = 0.004) and also with the increase in the number of tooth extractions performed per day (r = 0.41, p = 0.008).

CONCLUSIONS

Restorative dental care in this public oral health service is limited, tooth extraction being the predominant treatment provided. High patient load and high patient levels of dental anxiety determine this situation, according to the operators. The health authority should introduce appropriate solutions in order to address the prevailing situation adequately.

Dental treatment for disabled children in the Spanish Public Health System

The Spanish Public Health System is stepping up its efforts to meet all the medical needs of the population. Oral health is of increasing interest for society, especially for parents who are keen for their children to have healthy teeth. Disabled children with both physical and mental disabilities do not always receive the dental care they need. The purpose of this bibliographical review is to evaluate the services provided by the Spanish Public Health System to such children. We have noted marked differences in the types of dental treatment given to these patients in the different Autonomous Communities of Spain. Some, such as Asturias, Navarra and Extremadura, offer specific care for disabled children. Others, such as Ceuta and Melilla, provide more general care.

Frequency and distribution patterns of sealants among 15-year-olds in Denmark in 2003

AIMS

To provide information on the frequency and distribution patterns of sealants in the Public Dental Health Service for Children (PDHSC) in Denmark. A further aim was to determine whether there was a correlation between DMF-S and sealants.

DESIGN

A cross sectional survey using data from 15-year-old Danes in 2003. SAMPLE AND SUBJECTS: The sample consisted of 50 randomly selected municipalities from the 204 municipalities with public clinics. Thirty-nine municipalities (78%) forwarded useful data. A total number of 3,184 15-year-olds were involved in the study.

RESULTS

The mean DMF-S was 2.97 (SD = 1.40) and 42% had a DMF-S = 0. The mean number of sealants was 3.06 (SD = 1.60). Two-thirds of all participants had one or more sealed surfaces. At the individual level the correlation coefficient (rs) between sealants and DMF-S was -0.05 (p < 0.01). The mean number of sealants in one municipality was 0.26, in another 6.00. The surfaces most often sealed, were the occlusal surfaces on permanent second molars (35%), closely followed by the occlusal surfaces on permanent first molars (32%). Sealants on premolars were rare (1.5%). At the municipality level there was no significant correlation between mean DMF-S, % 15-year-olds with a DMF-S = 0 and mean number of sealants (rs = 0.02 (p = 0.90) and rs = 0.06 (p = 0.73), respectively).

CONCLUSION

The data indicate a high use of sealants on molar teeth, a very large inter-municipality variation, no correlation between sealants and DMF-S. These findings suggest that there are no clear guidelines for use of sealants in the PDHSC in Denmark.

Zahngesundheit deutscher und türkischer Schüler - Ein 10-Jahresvergleich

The purpose of this cross-sectional study was to assess the changes in dental health in 12- and 15-year-old Turkish immigrants and German students who were included in a school-based caries-preventive programme for ten years (1993-2003). In 1993 352 and 402 12- and 15-year-olds and in 2003 352 and 402 12- and 15-year-olds were investigated, respectively. 23.6% of the 12-year-olds and 21.5% of the 15-year-olds were of Turkish origin. The clinical examination was performed with support of artificial light at school. Caries was diagnosed according to the WHO standard using the DMFT Index for permanent dentition. Within the ten-year period the highest increment of caries-free dentitions was found in 12- and 15-year old Germans attending grammar schools with 41,5% and 27% and secondary modern schools with 22,3% and 17%, respectively. The proportion of caries-free Turkish students attending secondary modern schools, only increased imperceptible in both age groups (1.2%). A significant caries decline of 1.5 DMFT was observed in 12-year old Germans at grammar schools, only. In 15-year olds caries declined in German students at secondary modern schools (2.5 DMFT), and at Grammar schools (2.2 DMFT), significantly, however caries experience in Turkish students remained nearly unchanged (0.3 DMFT). A strong polarisation of dental caries was found in 2003. Among the 12-year-olds 23% of those at secondary modern school accumulated 70% of the total caries experience (>3 DMFT) and at grammar school 9% of students accumulated 76% of the whole amount of caries (>1 DMFT). Among the 15-year-olds 73% of the total caries experience (>3 DMFT) was concentrated in 32% of the students at secondary modern schools, while 25% of the students at grammar schools exhibited 84% of the whole amount of caries (>1 DMFT). Intended concepts in caries prevention in the future should aim to improve dental health especially in Turkish students at secondary modern schools while taking social inequality of this risk group into account.

The Endodontic Workforce

The amount of endodontic care provided in the US requires an understanding of the supply and demand for such care. The supply side includes the number and location of endodontists, type of provider, and productivity. The demand side consists of the changing demographics of the age groups that endodontists predominantly treat along with changes in their dental health. To address these issues, we have compiled and analyzed data from American Dental Association (ADA) with other sources such as US government census data and the National Health and Nutrition Examination Surveys (NHANES). From 1982 to 2002, the supply of endodontists increased at a rate greater than that observed with general practitioners or the other specialty areas. The growth of endodontists in relation to general practitioners is important. The latter are co-providers of endodontic care as well as a primary source for referral of patients to endodontists. Demographic and disease changes are likely to impact the need and demand for endodontic services. Endodontists' patients are generally between the ages of 25 and 64 yrs. Currently, the majority of endodontists' patients are members of the large baby boom generation who in 2000 ranged in age from their late 30s to their late 50s. During the next 20 yrs the Baby Boom generation will be replaced by the numerically smaller Generation-X cohort. This generation has experienced substantially less total caries than baby-boomers and they most likely will have fewer endodontic sequela as they age. A moderating factor that could partially offset the predicted decline in numbers of patients is the increased number of teeth that Generation-Xers are likely to retain. A flexible endodontic workforce strategy must assess the impending demographic and disease trends in relation to future growth rates of both endodontists and general practitioners.

Perception of dental illness among persons receiving public assistance in Montreal

OBJECTIVES

We examined rationales for behaviors related to dental care among persons receiving public assistance in Montreal, Quebec.

METHODS

Fifty-seven persons receiving public assistance participated in 8 focus groups conducted in 2002. Sessions were recorded on audiotape and transcribed; analyses included debriefing sessions and coding and interpreting transcribed data.

RESULTS

In the absence of dental pain and any visible cavity, persons receiving public assistance believed they were free of dental illness. However, they knew that dental pain signals a pathological process that progressively leads to tooth decay and, therefore, should be treated by a dentist. However, when in pain, despite recognizing that they needed professional treatment, they preferred to wait and suffer because of a fear of painful dental treatments and a reluctance to undertake certain procedures.

CONCLUSIONS

Persons receiving public assistance have perceptions about dental health and illness that prevent them from receiving early treatment for tooth decay, which may lead to disagreements with dentists when planning dental treatments.

Changes in caries experience among Australian public dental patients between 1995/96 and 2001/02

OBJECTIVE

Health Card holders are a financially disadvantaged group and are the target population eligible for public-funded dental care. The aims of this study were to describe the oral health status of public-funded dental patients by age, sex, type of care and geographic location, and to compare trends over time.

METHODS

Patients were sampled randomly by State/Territory dental services in 1995/ 96 and 2001/02. Dentists recorded oral health status at the initial visit of a course of care using written instructions. The samples were weighted in proportion to the numbers of public-funded dental patients for each State/Territory.

RESULTS

Multiple linear regression analysis indicated that caries experience measured by the DMFT index increased across older age groups (p<0.05). For male compared with female patients mean numbers of decayed teeth were higher (beta=0.74), and filled teeth lower (beta=-1.16). For emergency compared with general care, mean numbers of decayed and missing teeth were higher (beta=0.52 and beta=0.76), and filled teeth lower (beta=-1.08). For major city compared with regional/remote patients, mean numbers of decayed (beta=-0.35) and missing teeth were lower (beta=-0.34). Between 1995/96 and 2001/02 numbers of decayed teeth were higher (beta=0.81) while numbers of filled teeth were lower (beta=-0.55).

CONCLUSIONS

There was variation in oral health among public dental patients by sex, type of care and location, and there was a trend towards lower numbers of filled teeth but higher numbers of decayed teeth and higher overall caries experience over time.

IMPLICATIONS

Despite population trends towards improved oral health, levels of untreated decayed teeth have increased among public dental patients.

The impact of a brief tobacco-use cessation intervention in public health dental clinics

BACKGROUND

Public health dental clinic patients use tobacco at disproportionately high rates. The purpose of this study was to evaluate a tobacco-use cessation program delivered via public health dental practitioners.

METHODS

Two public health dental clinics participated in this quasiexperimental design study. First, all patients in one clinic who used tobacco (n = 178) received usual care. Next, the authors trained all practitioners to conduct a tobacco-use assessment and provide a brief cessation intervention. Subsequently, all patients in both clinics who used tobacco (N = 190) received the intervention. All enrolled patients had an income at or below the federal poverty level. The authors conducted follow-up assessments at six weeks and three and six months after enrollment.

RESULTS

Differences in self-reported quitting by condition between participants in the two groups were significant across all endpoints. Patients in the intervention group were more likely to quit than those receiving usual care (15.5 versus 4.3 percent) and after 12 months (18.8 versus 4.6 percent). Controlling for enrollment differences between patients in the two groups (age, race/ethnicity, time to first cigarette after waking), the authors found that differences between groups were significant for quitting at three months (P < .05; odds ratio [OR] = 4.85; 95 percent confidence interval [CI] = 1.20, 19.60), and six months (P < . 01; OR = 5.25; 95 percent CI = 1.35, 20.36).

CONCLUSIONS

The results of this study suggest the viability and effectiveness of delivering a tobacco intervention to low-income smokers via public dental practitioners. A randomized clinical trial is warranted.

CLINICAL IMPLICATIONS

The potential reach of public health dental clinics is great. Because of the high percentage of tobacco-using patients in these clinics, the public health impact of a program such as the one reported here would be significant.

Service provision by patient and visit characteristics in Australian oral and maxillofacial surgery: 1990 to 2000

This study was set-up to describe main areas of service by patient and visit characteristics and compare trends in services between 1990 and 2000. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Service provision data were collected from a one-week log. Data were available from 79 surgeons from 1990 (response = 73.8%) and 116 surgeons from 2000 (response = 65.1%). Service distributions were dominated by dentoalveolar surgery in 1990 (66.6%) and 2000 (63.5%). Multivariate analysis showed: patient age, location of visit (office/theatre/inpatient facility) and referral source (general/specialist and dental/medical) were associated with all five main areas of service; type of visit (consult/operation/review) was associated with four main areas; patient sex and place of visit (private/public) was associated with three main areas; the only significant change over time was an increased percentage of orthognathic surgery, odds ratio = 1.4 (95% CI: 1.1-1.7) times higher in 2000 compared to 1990. Main areas of service were associated with a range of explanatory variables such as age and sex of patients, and place, location and type of visit, and referral source. However, the distribution of services remained relatively stable over time.

Rural versus urban analysis of dental procedures provided to Virginia Medicaid recipients

PURPOSE

The purpose of this study was to report the distribution of procedures provided to Virginia Medicaid children by 3 types of dental providers in rural and urban areas.

METHODS

Medicaid claims filed for dental patients less than 21 years old were obtained and analyzed for fiscal years 1994-1995. Dental providers were categorized according to their practice type: (1) general practice (GP); (2) pediatric (PD); and (3) public health (PH) dentists. Each type of practice was categorized as practicing in a metropolitan, urban, rural, or completely rural location and evaluated for percentages of preventive, diagnostic, and corrective services provided.

RESULTS

Rural areas had a higher percentage of significant providers than did metropolitan or urban areas. General dentists performed more diagnostic and preventive but fewer corrective procedures than pediatric dentists. Pediatric dentists and general dentists in completely rural areas performed more corrective procedures than their counterparts in metropolitan or urban areas.

CONCLUSIONS

General, pediatric, and public health dentists in metropolitan and urban areas perform slightly more diagnostic services and fewer corrective services than practitioners in more rural areas.

Practice patterns of oral and maxillofacial surgeons in Australia: 1990 and 2000

This study was undertaken to describe practice patterns of oral and maxillofacial surgeons in Australia and compare trends over time. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). In both 1990 and 2000 the majority of surgeons worked 80+% of the time in the private sector (64.1 and 71.4%), had 80+% referrals from dental versus medical sources (74.0 and 74.7%), and had 80+% of patients from dentoalveolar rather than major maxillofacial surgery (70.7 and 69.7%). The percentage of dual qualified (dental plus medical degree) surgeons increased from 2.5% in 1990 to 17.1% in 2000 (P < 0.05; chi2). In 2000, surgeons who worked less than 80% in the private sector were more likely to report being overworked (57.9%) and that more surgeons were required in the public sector (65.0%) than those who worked 80% or more private (17.0 and 24.0%, respectively). Multivariate linear regressions of annual non-dentoalveolar surgical procedures per surgeon showed (P < 0.05) higher provision of implant (beta = 0.362), TMJ (beta = 0.267) and bone graft surgery (beta = 0.208) in 2000 compared to 1990, and higher provision of orthognathic (beta = 0.199), implant (beta = 0.194) and bone graft surgery (beta = 0.289) by dual qualified surgeons compared to those with only dental qualifications. Despite the mix of cases remaining predominantly dentoalveolar there was some change over time for selected non-dentoalveolar surgical procedures, with growth in the percentage of medically qualified surgeons and differences in surgery rates by qualification.

Establishing a Dental Practice in a Rural, Low-Income County Health Department

Historically, county health departments have not been responsible for providing dental care to needy citizens. However, as the need for dental care among indigent and low-income citizens has grown health departments are being called on to provide these necessary services. This article describes one local board of health's effort to establish a dental program within a large rural county. The board of health directed the local county health department to purchase and operate a mobile dental clinic, build a permanent dental facility, recruit a dental staff, and most important, provide the financial resources to pay for the program.

Public health model for Dental Specialty MEDRETE

OBJECTIVE

Dental readiness training exercises constitute one form of a specialty medical readiness and training exercise (MEDRETE). Traditional dental missions have been a part of general MEDRETEs and have focused care on extractions and the provision of oral hygiene instructions. This article describes the tenets of a prevention-based dental humanitarian mission to Honduras in 2002.

MATERIALS AND METHODS

The U.S. Army Southern Command requested a Dental Specialty MEDRETE for fiscal year 2002. A site visit revealed the absence of water fluoridation, high levels of dental disease, and a desire to have an American dental team perform the dental readiness training exercises at the Escuala Lempira, a low-income elementary school in the Honduran capital city of Tegucigalpa.

RESULTS

The U.S. Army Dental Command in conjunction with the 257th Medical Company (Dental Services) performed a pediatric dental readiness training exercises in Tegucigalpa March 4-15, 2002. In over 9 treatment days, there were 369 patient encounters totaling 1,593 treatment procedures. In keeping with the preventive focus of the mission, 514 dental occlusal sealants were provided compared with only 90 extractions. Over dollar 76,000 in dental services was provided.

CONCLUSIONS

The 2002 Honduran Dental Specialty MEDRETE represented a changing paradigm from extraction-based dental missions toward prevention-based missions. With this philosophical shift in focused care, Dental Specialty MEDRETEs have the ability to enhance the oral health of children, including those not fortunate enough to have received direct interventional dentistry.

Changes in dentists' attitudes and practice in paediatric dentistry

AIM

The purpose of the study was to determine if there had been any changes in the clinical practice and attitudes to the care of children by general dental practitioners over a ten year period from 1986 to 1996, following the introduction of a system of capitation payments in the United Kingdom.

METHODS

A questionnaire was mailed to 1,290 general dental practitioners practicing in Yorkshire (UK) in an identical way to a previous survey ten years before. Practitioners were asked questions concerning their practice of dental caries prevention, behaviour management, restoration of primary teeth and pulp therapy. Responses were compared with the results of the 1986 survey.

RESULTS

Of the total of 687 replies (53.2% response) 61% practiced, or said they practiced, diet evaluation and gave dietary advice. Oral hygiene instruction was reported by 87% and 57% used fissure sealants. The routine use of amalgam, previously 80%, had declined to 35% in favour of glass ionomer cements (57%). There had been a significant improvement in the use of pulp therapy for primary teeth at 35% compared with previous 3%. The use of rubber dam also increased, but only from 0% before to 9% in the present study. The usage of stainless steel crowns had changed from 2% over ten years to 8% and strip crowns from 1% to 5%.

CONCLUSION

The use of paediatric dental techniques by general dental practitioners had generally increased, particularly in preventive measures and pulp treatment. Restorative techniques had marginally changed, but a dramatic shift away from amalgam had occurred. There was still a very low usage of stainless steel crowns and rubber dam was also not used to the extent that it should be.

Influence of different variables on the inter-municipality variation in caries experience in Danish adolescents

This investigation sought to estimate the influence a number of variables had on the inter-municipality variation in caries experience across Denmark. Unit of measurement was the municipality with public clinics. Mean DMF-S and %DMF-S = 0 of 15- and 18-year-olds in 1999 were obtained from 204 and 143 municipalities, respectively, out of a total number of 206 municipalities with public clinics. The independent variables were: cost per child per year; children/dentist ratio; auxiliary personal/dentist ratio; fluoride concentration in the water supply [F]; average personal income; % of mothers of the 15- and 18-year-olds with < or =10 years education (EDU-15 or EDU-18); proportion of immigrants; and size of the municipality. Multiple regression analyses disclosed that [F] (p < 0.001) and EDU-15 (p < 0.001) were significant variables among the 15-year-olds explaining 45% of the variation in mean DMF-S and 31% of the variation in % DMF-S = 0. With respect to the 18-year-olds, [F] (p < 0.001) and average personal income (p < 0.001) explained 53% of the variation in mean DMF-S and 30% of the variation in %DMF-S = 0. Few municipalities were characterized as outliers with significantly lower or higher observed caries experience than expected. It is concluded that there is room for other explanatory factors--first and foremost the professional effort made in the individual Public Dental Health Service to control caries.

Ethnic disparities in the prevalence of dental caries and restorative dental treatment in Brazilian children

AIM

This study assesses disparities in the oral health status of Brazilian black and white children.

PARTICIPANTS

11- and 12-year-old schoolchildren living in 131 cities of the State of São Paulo, Brazil.

METHODS

Spatial data analysis of city-level indexes of oral health, socio-economic status and provision of dental services.

MAIN OUTCOME MEASURES

Ethnic ratios of the DMFT and the care index.

RESULTS

White children had higher indexes of caries in permanent teeth than their black counterparts, concurrent with a higher utilisation of dental attendance. The gap of caries prevalence between black and white children was reduced in cities with a better profile of socio-economic status. Cities with higher per-capita yearly budget, expenditure in health, and provision of public dental services presented reduced indications of ethnic inequality in dental care.

CONCLUSION

The knowledge of conditions associated with a lower ethnic discrepancy in the risk of caries and in the incorporation of dental services can be used to design socially appropriate dental services. An improved community dental service, higher public expenditure in health and per-capita municipal yearly budget contribute effectively to reducing inequities in oral health by allowing an incorporation of restorative dental treatment more equitably distributed between black and white children.

[Dental care for young people insured by health insurance fund 1. Prevalence and treatment of dental caries between 1987 and 1999]

In 1987, 1993 and 1999 an epidemiological study was performed on oral health in youngsters, aged 5, 11, 17 or 23 years, in whom oral health care was covered by a health insurance fund. The prevalence of caries in the deciduous teeth of the 5-year-olds (examined without radiographs) did not change significantly between 1987 and 1999. Only a small proportion of dmfs was filled. Caries prevalence in permanent teeth of the 11-, 17- and 23-year olds decreased significantly. The number of filled surfaces decreased also. Between 1993 and 1999 the number of clinically found DS increased. However, this rise in dentinal caries lesions was not confirmed by similar findings in a simultaneous performed study with bitewing radiographs.

Survey of radiography and radiation protection in general dental practice in Uganda

OBJECTIVES

To carry out the first survey in Uganda of all dentists and all public health dental officers (PHDO) to assess the status of dental radiography and radiation protection.

METHODS

All 74 dentists and 76 PHDOs in Uganda were sent a postal questionnaire including 33 questions relating to various demographic details, radiographic equipment and radiographic techniques, including processing and radiation protection. A second questionnaire was sent to non-respondents after 3 months.

RESULTS

Eighty-two per cent of dentists responded and 83% of PHDOs. Seventy per cent of the dentists and 100% of the PHDOs were trained in Uganda. Seventy-five per cent of the dentists and 30% of the PHDOs had access to one of the approximately 30 X-ray machines in the country. The majority of the equipment did not comply with current recommendations in Europe. Fifty-one per cent of dentists used machines with mechanical timers, 28% used machines with no visual warning signal and 17% used equipment with no audible warning signal. Most of the equipment was over 30 years old and only 15% of dentists knew when the equipment was last serviced. The most relevant finding of the surveys was the level of 'don't know' responses to many questions from both groups.

CONCLUSIONS

The lack of knowledge regarding dental radiography and radiation protection plus the condition of most equipment in Uganda is a matter of concern. Standards of care are considerably lower than in developed countries requiring improved undergraduate training, provision of postgraduate courses and Ugandan governmental or international financial assistance.

Oral hygiene instructions and dietary sugar advice received by adolescents in 1989 and 1997

OBJECTIVES

The aim of this study was to find out how commonly adolescents receive oral hygiene instructions and dietary sugar advice in the Finnish public oral health care system and whether there have been any changes between 1989 and 1997.

METHODS

The data were collected as part of a nationwide research program, the Adolescent Health and Lifestyle Survey. Since 1977, a questionnaire has been sent every second year to a representative sample of 12-, 14-, 16- and 18-year-old Finns eligible for free comprehensive oral health care. The sample size was 3105 in 1989 and 8390 in 1997.

RESULTS

Almost all adolescents (95-96%) had visited a dentist during the last 2 years. In all age groups, boys reported having received tooth cleaning instructions during their dental visit more often than girls did (40%/35%). There was only a minor decrease in instructions received between 1989 and 1997. Boys and those who brushed their teeth once a day or less often were the most likely to receive instructions in 1997. Only one-fifth of adolescents reported having received dietary sugar advice, and there was a slight decrease between 1989 and 1997. In 1997, the groups of adolescents most likely to be advised were 12-16-year-old-boys, those using sweets daily and those living in Central Finland.

CONCLUSIONS

Oral health instructions were only given to a minority of adolescents. The targeting of adolescents with health-damaged behavior is therefore important.

Utilization of dental health services by Danish adolescents attending private or public dental health care systems

The objectives of the study were: 1) to describe the choice of dental care system among 16-year-olds, 2) to describe the utilization of dental services among 16-17-year-olds enrolled in either public or private dental care systems, and to compare the dental services provided by the alternative systems. The study comprised 1,245 adolescents from 3 municipalities; the historical cohort study design was applied; and data were collected from dental records (public dental service) and dental claims (private practice). At age 16, 12% preferred being enrolled in the private practice system, while 88% remained in the public dental care system. During the 2-year study period the attendance rate was 99% for the public system, while 90% attended the private practice system (P< 0.001). Preventive dental services were provided more frequently by the public than the private system (P< 0.001). Despite the fact that the economic barrier was eliminated a lower attendance rate was observed for patients transferred to the private practice system.

Effects of dental attendance frequency in heavy and low private care-using young adults

In Finland, adults born in 1961 or later were progressively entitled to subsidies for dental care from private practitioners during 1986-90, while at the same time having access to care in the Public Dental Service. The aim of this study was to compare the effects of attendance frequency of private dental care on treatment costs and treatment spectrum for the heaviest and lowest users over a period. Three separate cohorts of recipients of reimbursements were formed, using the Social Insurance Register. The highest and lowest cost groups in 1986, 1990, and 1994 were followed up to 1997. Initially, the mean numbers of visits were 1.2-1.3 and 5.2-5.6 and cost Euro 48 53 and Euro 358-379 among low users and heavy users, respectively, in all cohorts. Among the heavy users (the high-cost category) infrequent attendance was related to higher and frequent attendance to lower mean annual costs of care. Among the low users (the low-cost category the opposite was true. Those who initially belonged to the high-cost category received in 1997 significantly more (P < 0.01) restorative treatment and, to a lesser extent, more (P < 0.01) preventive and periodontal treatment than those belonging to the low-cost category. Frequent dental care seemed to benefit those who received a lot of care. Frequency of attendance was not associated with being a low or a heavy user, indicating rigid check-up routines. The inclusion of simple oral health data would greatly improve the usefulness of the register as an evaluation tool for health-political decisions.

Equity in access to public dental services: the experience from Norway

The aim of this study was to identify possible factors associated with the marked geographical variation in supply of public dental services in Norway. We identified three sources for this uneven distribution: differences in dental care needs, differences in revenue levels between counties, and differences in the party composition of the county councils. Analyses were undertaken to ascertain whether these factors were related to the variation in the number of man-labor years of public dental officers. The analyses were performed on a set of data from Norwegian counties for the period 1985-92. There was an association between the number of man-labor years of public dental officers and our indicators of dental care needs, county revenue, and party composition of the county councils. Our findings are encouraging, as they indicate that the county councils seemed to respond to the dental care needs of the local population. On the other hand, there were inequalities in supply of public dental services that were due to differences in revenue between counties. From an equity point of view, this inequality is undesirable. The inequality could most likely be reduced by decreasing the variation in revenue between counties. Differences in party composition of the county councils had only a small effect on the geographical variation in the number of man-labor years of public dental officers.

Procedures provided to Medicaid recipients by pediatric, general and public health dentists in the commonwealth of Virginia: fiscal years 1994 and 1995

PURPOSE

The purpose of this study was to report any differences found among the mean percentages of procedures performed by three types of dental providers for each type of service performed. The study focused on the types of services provided by dentists to Medicaid children in Virginia.

METHODS

Medicaid claims field for dental patients younger than age 21 were obtained and analyzed for fiscal years 1994 and 1995. Dental providers were categorized according to their practice: general practice (GP), pediatric dentist (PD) and public health dentist (PH). Each type of practitioner (GP, PD, and PH) was evaluated for percentages of diagnostic, preventive, and corrective services provided to their Medicaid patients. The preventive category was subdivided into preventive services (scaling, prophy, fluoride and oral hygiene instruction) and sealant services.

RESULTS

For each type of service, the mean percentages of procedures performed were compared among the three types of dental providers. The evaluation of the diagnostic procedure variable resulted in the finding that GP practitioners performed a significantly greater percentage of diagnostic procedures to their Medicaid patients than do PD and PH dentists (p < 0.0001). The percentage of preventive procedures performed by PD and GP dentists was not significantly different but was significantly lower than those performed by PH dentists (p < 0.0001). Finally, PD dentists performed a significantly greater percentage of corrective procedures than both GP and PH dentists (p > 0.0037).

CONCLUSION

Differences were found among the mean percentages of procedures performed by the three types of dental providers for each type of service performed.

Caries data collected from public health records compared with data based on examinations by trained examiners

Collecting data for dental caries studies is costly. In countries where uniform patient records are available for virtually the whole population, it is tempting to use them as a data source. Our aim was to compare data collected from patient records to those obtained by trained examiners. In 1992 and 1995, dentists who were specially trained and calibrated examined random samples of 12- and 15-year-olds living in two towns in Finland. The dental record of each child was obtained from public dental clinics, the dental status was entered into a computer file, and the DMFS value was calculated. Data were available for 824 children. In the two data sets, 1.3% of the tooth surfaces were recorded differently (DMF vs. sound) with the related kappa value being 0.70. In two thirds of the discrepancies, the reason was that a filling was marked in only one of them, which confirms the known difficulty in discerning a white filling. For 48% of the subjects, the DMFS values calculated from the two sets of data were equal. The difference was 1 and 2 surfaces for 28 and 11%, respectively. Public health dentists had almost equally often registered more and less DMF surfaces compared to trained examiners. The results suggest that data collected from public health records are not decisively inferior to those obtained from examinations by trained examiners. In large enough settings, data obtained from patient records could possibly be used as a replacement for separate surveys.

Patterns of access to public oral health care in Queensland by gender, indigenous status and rurality

Data were collected on courses of care from all attendances at public sector dental clinics between July 1994 and June 1996 and examined by gender, rurality and indigenous status. Males and indigenous people were more likely to attend dental clinics when a problem with pain existed, resulting in a high need for emergency services, more diagnoses of dental caries, and treatment more often involving oral surgery, including extractions. Similarly, remote area dwellers had more diagnoses of dental caries and oral surgery, although their attendance at clinics was complicated by access.

Emergency dental service is still needed--also for regular attenders within a comprehensive insurance system

The aim of this study was to describe types of, and reasons for, emergency visits for regular dental attenders in the Public Dental Health Services (PDHS). The study was based on data from 895 consecutive emergency episodes collected from four PDHS clinics in the county of Ostergötland, Sweden, during a six-month period in 1994/95. Forty per cent of the dental emergency visits included children and adolescents. The most common reasons for attending were material fractures (29%), tooth fractures (19%), pain (19%) and dental traumas (12%). Seventy-three per cent of all patients and 60% of children and adolescents knew the next scheduled revision appointment. In 85% of the cases care-givers and patients were in agreement regarding the urgency of the visit. The care-givers considered 14% of the visits non-urgent, only in 1% they felt that the patient should have come earlier. The results show that emergency visits are common among regular dental care patients, but are dominated nowadays more by answering patients' questions and less by pain relief. Via systematic follow-ups and better learning from the experiences of those who seek emergency dental care, routines could be further developed and considerable benefits achieved concerning both perceived service quality and cost-effectiveness.

Dental public health for the 21st century: implications for specialty education and practice

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6-8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.

Outcome of a scheme for specialist orthodontic care

With the purpose of examining the outcome of specialist orthodontic care on a population level (Halland, Sweden), a random sample of previously treated 19-year-olds (n=118) was clinically examined and interviewed. Thirty-three per cent of the cohort (n=1554) had received treatment, and mean treatment time was 19 months requiring 20 visits. Changes in occlusion were assessed using the PAR Index applied to dental study casts representing the pre- and post-treatment and follow-up (19 years) condition. The subjects' responses to questions addressing their past and present attitudes to dental appearance and orthodontic treatment were combined to represent "orthodontic concern", at the pre-treatment stage and at 19 years of age. A mean reduction in weighted PAR scores of 83% was observed from pre-treatment to post-treatment, whereas at follow-up, the net improvement was 69%. A significant shift in attitudes was observed, as 72% of the individuals expressed orthodontic concern pre-treatment compared to less than 10% at 19 years. The improvement obtained was similar to other studies on outcome of orthodontic treatment provided by specialist orthodontists. Compared to most PAR-studies providing information about orthodontic services, the present scheme appeared to be efficient on the assumption that duration of treatment and number of visits are expressions of costs.

Outcome of a scheme for orthodontic care: a comparison of untreated and treated 19-year-olds

The organization of the orthodontic service within the Public Dental Health Service in the southern part of the county of Halland, Sweden is described, and data for the provision of treatment are presented. The aim of this study was to examine the outcome of this service by studying the prevalence of malocclusion and residual need, as well as attitudes to treatment in previously treated and untreated individuals. Three samples of 19-year-olds were established: patients treated by specialists (n=132), patients treated by general practitioners (GP) (n=132), and untreated individuals (n=492). All samples were examined clinically, and radiographs, photographs, and study casts were obtained from the two treated groups. Attitudes to own teeth and orthodontic treatment were recorded by use of questionnaires. Deviant occlusal traits were recorded, and all the individuals were categorised according to a treatment need index. Generally, good occlusal conditions were observed in all samples. More deviant traits were observed in individuals that had been treated by GPs, and significant differences were observed for overjet, overbite, and crowding compared to the other samples. The majority of individuals belonged to the little/no treatment need index categories. Of those treated by GPs, one third belonged to the moderate (22%) or urgent (11%) need categories. About 10% reported dissatisfaction with their dental appearance, but only 2% expressed a desire for (further) orthodontic treatment.

Disparity in our nation's health: improving access to oral health care for children

The American public and its policymakers are beginning to recognize oral health as an integral part of overall health. Utilization of new technologies and preventive treatments has set a higher standard in the public's expectations of oral health and dentistry. There have been marked improvements in oral health indicators in the United States during the past century. However, some populations have not enjoyed the benefits realized by most Americans.

Prioritisation of research recommendations from a national needs assessment programme

OBJECTIVE

To gain consensus on and rank research and development recommendations from a series of Scottish Needs Assessment Programme (SNAP) reports.

DESIGN

A two stage Delphi questionnaire was used and participants were asked to rank the recommendations in terms of potential health gain, practicality and priority.

SUBJECTS

Views were sought from all consultants in dental public health in Scotland and from non-consultant members of the SNAP oral health steering group.

RESULTS

Of the 17 individuals eligible, 16 participated in the study. Fifty four recommendations for research and development were identified in seven SNAP reports. Recommendations relating to the prevention of dental caries in young children, the organisation and delivery of dental care to disadvantaged groups and increased understanding of the aetiology and pathogenesis of oral cancer in younger people were seen as of highest priority.

CONCLUSIONS

This study has drawn together and prioritised a series of recommendations, and will help inform future oral health research needs in Scotland.

Dental care of young adults in west Sweden

107 Swedish subjects, all 20 years old, were studied for the first three years (1990-1992) after they had left the organised dental care for children and adolescents (which is free of charge for all youth through the age of 19). They were registered in four different risk-grouping systems in order to estimate the amount of their future dental care. Three of the systems used registrations from the Public Dental Service records and in the fourth one a dentist made a subjective estimation. The follow-up used dental insurance claims to study performed treatments, courses of treatments and cost. The risk group system that used subjective estimations appeared to be the one that most accurately predicted the actual dental care consumption. Approximately 70% of the subjects received some kind of dental care during the three years. The distribution was not confined to any particular risk group. Ten per cent had received complete dental care annually. Twenty-five per cent went to a private dentist and 75% continued to go to the Public Dental Service. Those who went to a private dentist received substantially more treatment and the annual cost was a little more than twice as much as in the Public Dental Service.

Evaluation of three years of dental care of adolescents in the Public Dental Service in west Sweden

107 individuals, randomly selected from the County of Göteborg and Bohuslän, all born in 1970 were followed regarding the dental care received 1987-1989. The records of each individual from the actual time were collected and information on diagnosis and treatment measures was gathered. Radiographs from the actual time were studied by one of the authors. Sixty-two per cent of the adolescents had been examined and treated all 3 years. Six percent had not been seen at all. The sample was divided into three groups depending on the patient's DFSa value at the examination the first year. This classification appeared to correlate well with caries development in the following years. One-fourth of the sample was responsible for the major part of the non-attendance and late cancellations. The dental health of these subjects was below average, and non-attendance seemed to be a further risk factor. The preventive measures undertaken during the study appeared to correlate poorly with the actual situation of the patient and the presence or absence of potential risk factors.

Applicability of SWOT analysis for measuring quality of public oral health services as perceived by adult patients in Finland. Strengths, weaknesses, opportunities and threats

OBJECTIVE

To determine the applicability of SWOT analysis for measuring the quality of public oral health services from the adult client's perspective.

METHODS

Data were collected using a structured questionnaire developed in an earlier study. The study group consisted of all adult (over 18 years of age) clients (n = 256) using public municipal oral health services in Kirkkonummi, Finland, during 2 weeks in 1995. Before treatment, patients filled out a questionnaire that measured the importance of their expectations in different aspects of oral care. After the appointment, they filled out a similar questionnaire that measured the enactment of these expectations in the treatment situation. The response rate was 51%. The difference between subjective importance and enactment of expectations was tested by Wilcoxon's signed rank test. Results were interpreted using both a conventional analysis of "expectation enacted or not" and SWOT analysis, which is used in strategic planning to identify areas of strengths (S), weaknesses (W), opportunities (O) and threats (T) in an organisation.

RESULTS

In 28 statements out of 35, the two analyses revealed similar interpretations. In most areas the patient-perceived quality of the services was good. Weaknesses were found in the following areas: communicating to patients the causes and risk of developing oral diseases, informing them about different treatment possibilities, and including patients in decision-making when choosing restorative materials.

CONCLUSION

SWOT analysis provided more structured interpretation of the results, and can be more easily transferred to development of services.

On the reporting of dental health, time for dental care, and the treatment panorama

The thesis included five methodological studies and one caries epidemiological investigation, the general aim being to study how to measure and report dental health, time for dental care, treatment panorama, and dental care outcomes, within a Public Dental Service organization. The specific aims were to monitor dental clinic activities using a time study method, to apply time study results of a dental health-related patient group system for the 3-19 year age groups, and to compare time study results with corresponding results from computerized systems used for reporting dental care. Other specific aims were to compare longitudinal caries index data results between cohort and cross-sectional samples, to analyse caries index for extreme caries groups among adolescents leaving organized dental care, and--using time series methods--to analyse dental health development of the 15-19 year age groups. Results from the time studies portrayed the dental clinic as a working unit, showed that reported values can represent dental care only for intervention procedures, and indicated that clinic patterns were not adapted to the health situation of the patient groups. Longitudinal cohort attempts gave different values from those of the cross-sectional year classes, which should be the primary focus when presenting caries index mean values in dental health reviews. Caries-free groups from 15 to 19 years of age seem to be stable in their caries development in about 60%-80% of cases; while the 20% groups with the highest index values accounted for about 80% of all approximal lesions. In times of major economic adjustment, dental health for adolescents in Göteborg was an example of sustainable dental health development. A model system for monitoring, analysing, and reporting dental health and dental care outcomes within a dental care-giving organization calls for several conditions, for example, a dental health-related patient group system, and a rationale for the choice of dental team models. These areas could be gathered into a system where contemporary socio-economic factors and dental research results interact with performed dental care, and also with different methods for reporting and evaluating dental health, dental care costs, and the demand for dental care competence.

Evaluation of service provision patterns during a public-funded dental program

OBJECTIVE

The Commonwealth Dental Health Program was introduced in 1994 to reduce geographic and financial barriers which prevented adult health card holders receiving timely and appropriate dental care. This paper compares the pattern of service provision over the first three years of the program.

METHOD

Cross-sectional surveys of adult public-funded dental patients in Australia in 1994 (17,653 visits), 1995 (n = 80,098 visits) and 1996 (n = 69,159 visits).

RESULTS

There was some reduction in emergency visits, changing from 38.9% in 1994, to 33.6% in 1995 and 35.6% in 1996 (p < 0.05; chi-square). Services were associated with age of patients, visit type, geographic location and year of the program. Poisson regression analyses controlling for patient age, visit type and geographic location showed that between 1994 and 1996 there were significant differences (p < 0.05) in rates (rate ratio: 95% CI) of: restorative (1.27; 1.23-1.31), prosthodontic (0.90: 0.85-0.96), periodontic (0.72; 0.68-0.75), preventive (0.43; 0.40-0.45) and endodontic (1.88; 1.67-2.11) services. The total number of services per visit declined over the period of the program (0.87; 0.86-0.89).

CONCLUSIONS

Over the three years, the service pattern changed to include higher rates of restorative and endodontic services, and lower rates of prosthodontic services. Rates of preventive and periodontic services declined, and there was no reduction in extraction rates.

IMPLICATIONS

Continued improvement in service patterns may require longer programs, incorporating structural changes, to shift the type of care further away from emergency visits, and towards prevention and maintenance.