Provision of domiciliary dental care for the older person by general dental practitioners in Scotland.

The databank at the Scottish Dental Practice Board (SDPB) was explored to determine the domiciliary care provided, for those patients over 70 years of age, by general dental practitioners under the National Health Service in one year. Three thousand nine hundred and forty-three (3943) courses of treatment were provided, via domiciliary visits to patients in this age category, by 38 per cent (1012) of dentists registered to provide dental care under the National Health Service. Whereas 34 per cent of dentists under 40 years of age provided domiciliary care, 46 per cent of those over 40 years provided such a service (P less than 0.001). In Scotland, approximately 1 per cent of 70-79-year-old patients and 2 per cent of patients over 80 years received domiciliary dental care over a 1-year period. For those elderly people who received such care, the mean percentage doubled for every 5-year increase in patient age.     

A longitudinal study of young Finnish adults' use of subsidized, private sector dental care, 1986-1997

OBJECTIVES: Finns born after 1956 are now entitled to subsidized private sector dental care, or such persons could be enrolled in the Public Dental Service. Until 1986, eligibility was more restrictive. The purpose of this study was to investigate the use and costs of private dental care and effects of regularity of care on costs and treatment received among young Finnish adults during 1986-1997. METHODS: All 1986, 1990 and 1994 recipients of reimbursement for dental care from the Social Insurance Institution were included in the study. Five separate age cohorts were compared. Using their civil registration numbers, individuals were tracked from their first contact with a private dentist in one of the years 1986, 1990 or 1994 until the year 1997. RESULTS: While the total number of young adults who had received reimbursement for private dental care increased from about 53000 (1986) to 200000 (1994) due to extended eligibility, the number of users in the youngest group decreased from 53000 to 23000. Attending infrequently (1-2 times during the study period) was most common among the youngest adults and frequent attendance (annually) was most common among older adults. The annual mean cost was slightly lower among the frequent attenders in almost every cohort. Variation in the mean number of annual visits was directly correlated with costs. Frequent attenders most often received diagnostic and preventive measures while restorations and surgery were most common for the infrequent attenders. CONCLUSIONS: A substantial decline in the demand for private services among the 19-25-year-olds and stable demand among 26-34-year-olds was detected, indicating falling treatment needs or a preference for the Public Dental Service. All groups had a stable mean number of visits per year and almost constant costs. The mean number of dental visits per year remained steady in all cohorts indicating rigid treatment patterns.     

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 30 years (1973-2003). I. Review of findings on dental care habits and knowledge of oral health

The aim of the present study was to compare data on dental care habits and knowledge of oral health in four cross-sectional epidemiological studies carried out in 1973,1983,1993, and 2003. The 1973 study constituted a random sample of 1,000 individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. The same age groups with addition of a group of 80-year-olds were included in the 1983, 1993 and 2003 studies, which comprised 1,104, 1,078, and 987 individuals, respectively. A questionnaire about dental care habits and knowledge of oral health was used in connection with a clinical and radiographic examination. The same questions were used in all the four studies. An addition to the 1993 and 2003 investigations were questions concerning ethnic background. In 2003 approximately 90-95 per cent of all individuals were visiting the dentist on a regular basis every or every second year. The 30- and 40-yea r-olds, however, did not visit a dentist as regularly in 2003 as in 1993. In these age groups 21-24 per cent of the individuals, respectively, reported that they had not visited a dentist in the last 2 years. Almost all children 3-15 years old received their dental care within the Public Dental Service (PDS). During the period 1973-2003 an increase in percentage of individuals aged 20-50 years treated by the PDS was seen compared to private practice, while among 60-80 year-olds there were only minor changes. Most so-year-olds and older received their dental care by private practitioners. About 70-80 per cent of all adults in 2003 were enrolled in a recall system on the dentist's initiative while in 1973 most appointments were based on the patient's own initiative. The number of individuals who were frightened, 5-17 per cent, or felt discomfort at the prospect of an appointment with the dentist was more or less the same during the whole period. The knowledge of the etiology of dental diseases did not changed much between 1973 and 2003. The frequency of toothbrushing increased since 1973 and in 2003 more than 90 per cent of all individuals brushed their teeth twice or once a day. The use of dental floss and toothpicks decreased in 2003 compared to 1983 and 1993. Almost all individuals in 2003 used fluoride toothpaste. It was obvious that the dental team constituted the main source of dental health information. For the age groups 20 and 30 years information from friends and relatives was also important. In the age groups 3-20 years up to 45 per cent of the individuals were consuming soft drinks every day or several times a week.     

Dental caries in a group of 20-year-olds after previous participation in public child dental health services in Copenhagen, Denmark

The present study was undertaken to investigate the prevalence of dental caries in a group of 20-year-olds who had previously participated in Public Child Dental Health Services. Dental caries was related to social status and preventive vists to the private dentist after termination of school. The study population comprised 389 persons aged 20, out of which 313 (80.5%) were examined clinically and radiographically by one dentist according to standardized criteria. Mean DMFT was 10.4 and mean DMFS 16.7. Differences in relation to sex were not significant. The distribution of subjects according to DMFS was uneven. The 20% with the highest DMFS accounted for about 45% of the total amounts of DS. A consistent pattern with higher mean DMFS in the low social groups was found. Attendance to Regular Youth Dental Service was higher the longer the subjects had been students and higher mean DMFS was found in nonregular attenders. The presence of a high caries risk group is discussed in relation to the dental care system received by the study population.     

Utilization of alternative delivery programs in youth dental care in Denmark

Three groups of young adults were offered three different dental programs from ages 16 to 19: one group of 386 persons continued preventive and curative dental care in the Public Child Dental Health Service (Public group), one group of 161 persons was offered dental care with private dental practitioners of own choice with care paid by the municipality and the health insurance (Mixed group), and one group of 261 persons entered the general young adult dental program under the National Health Insurance with free choice of private dental practitioner with reimbursement of about 75% from the insurance (Private group). Almost 100% of the Public group used the dental services continuously. Less than half of the Mixed group and about two thirds of the Private group went regularly to a dentist, women more than men. Discrepancies were found between the expected utilization and actual utilization, and a tendency was noted to overrate self-reported utilization in relation to actual utilization. It is concluded that continuity of dental care and unambiguous organizational affiliation is a prerequisite for a high utilization rate, but it also seems that the outreaching work done by the child dental health service is effective with regard to utilization.     

Dental care of autistic children within the non-specialized Public Dental Service

Children with an autistic disorder may need more dental care and may also be more difficult to treat than healthy children. This study compared oral health in autistic and healthy children. Also explored was the dental management of autistic children within the non-specialized Public Dental Service. The study was designed as a case-control study with all cases of autistic disorders aged 3-19 years identified within a primary care area in southwest Sweden. One dentist did a clinical investigation of cases and one control per case. The patients, or their parents, answered a questionnaire. 28 patients were identified and 20 (71%) agreed to participate in the study. Cases and controls had a similar prevalence of fillings, caries, gingivitis and degree of oral hygiene. However, the need of orthodontic treatment seemed to be greater among the autistic children. According to a standardised assessment, autistic children were less able to cooperate in the dental treatment. Approximately 30% of the cases had occasionally been subjected to specialized dental care. The results of this study indicate that the care provided to autistic children within the non-specialized Public Dental Service is satisfactory, provided that there is access to a paediatric dentist when necessary.     

Longitudinal study and cost-benefit analysis of the effect of early treatment of posterior cross-bites in the primary dentition.

The aim of this study was to follow longitudinally a cohort of preschool children regarding the prevalence of lateral cross-bites and the effect of treatments carried out. Two-hundred-and-twenty-four children were examined when they were 3-5 years old and re-examined at 13-15 years of age. Orthodontic treatment of lateral cross-bites was registered from annual dental records from the Public Dental Service. In the primary dentition, 23.3 per cent of the children showed lateral cross-bites, of whom 5.7 per cent showed a lateral edge-to-edge relation. Selective grinding was carried out in the Public Dental Service in 62 per cent of the cross-bite children. Correction was registered in 64 per cent of these cases. Nine (45 per cent) of the 20 children with untreated lateral deviation showed spontaneous correction. Of the 171 children without cross-bites in the primary dentition, 14 (8 per cent) developed cross-bites in the permanent dentition. Although the benefits of early treatment for the developing dentition are obvious for functional reasons, the effectiveness of grinding, the type of treatment and the timing can be discussed from a cost-benefit point of view.     

Dental treatment provided to young adult Danes enrolled in alternative dental programs during a 3-year period

From age 16 to 19 years three groups of young adults received alternative dental programs on termination of the Public Child Dental Health Service (PCDHS) in different municipalities: public group, n = 386; mixed group, n = 161; and private group, n = 261. During the entire study information on dental service use by the participants was taken from the records and National Health Insurance files. All dental services were calculated relative to a standardized Dental Service Unit defined by the value of a dental examination. During the entire study a mean of 30.53 Dental Service Units were provided, corresponding to 10.18 per year. More than half were of a diagnostic preventive character, and well over one-fourth were fillings. Irrespective of dental program, differences in dental services were noted with regard to utilization of dental services and to initial caries status. Users with high caries experience also received more fillings, but fewer preventive services. No association was found between gingival status and dental services provided.     

Access to dental care by young South Australian adults

BACKGROUND: Despite reported concern over the dental care of young adults little research has been done on their use of dental services in Australia. The aim of this study was to investigate the patterns of dental utilization of young South Australian adults aged 20-24 years. METHODS: A random sample of 2300 young adults was selected from the electoral roll. Partial or complete addresses and possible phone numbers were obtained for 1921 persons. Telephone interviews were conducted for 1261 subjects to obtain information on socio-demographics, health behaviour and dental visiting (response rate 65.6 per cent). RESULTS: One third of young adults (34 per cent) had not made a dental visit in the previous two years and 38 per cent usually visited for a problem rather than a check-up. Making a dental visit in the last two years was significantly associated with a number of socio-demographic variables including age and gender, with holders of private dental insurance and those who have not avoided care because of cost having higher odds of making a visit and males and government concession card holders having lower odds of visiting. Usual reason for visiting a dentist for a problem was significantly associated with no private dental insurance, holding a government concession card, no tertiary education and avoiding care because of cost. CONCLUSIONS: This study suggests that demographic and economic factors influenced use of dental services and reason for visiting of young South Australian adults.     

Experience of dental care for children with congenital heart disease among Swedish dentists

This study was conducted in order to examine the experience of and attitudes to dental care for children with congenital heart disease (CHD) among Swedish general dentists. 183 general dentists employed in the Public Dental Health Service in the counties of V?sterbotten and Uppsala, and private practitioners listed with dentistry for children in the county of V?sterbotten, Sweden, were enrolled in the study. Data were collected with a questionnaire with 18 questions. Eighteen per cent of the dentists stated that they had received special education or information except the graduate training to treat children with CHD. Forty-eight per cent of the dentists had one or more patients with CHD. Seventy-two per cent of these stated that their CHD-patients had a caries problem. Statistically significant differences were displayed between answers on the questions "who in the dental team perform the major part of the dental care for children with CHD" and "what is your opinion on which personal category that should perform the major part of the dental care for this group of children" (p < 0.001). Among dentists whose clinical time mainly was used for dentistry for children, it was more common to treat children with CHD (p < 0.001) than for dentists with a lower degree of dentistry for children. The study showed that the Swedish dental care for children with CHD today mainly is performed by dental nurses, dental hygienists and general dentists. This strongly differs from the dentist's opinion on who should perform the major part of the dental care for this group of children. These findings taken together with the very low number of dentists that had received special education or information except the graduate training to treat children with CHD indicates that the Swedish dentists are unsettled and insecure in the dental treatment of children with heart defects. An early and close cooperation between specialists in pediatric dentistry, dentists with special training and general dentists is strongly desirable to support the dentists and facilitate the dental care for children with CHD.     

The influence of examination frequency and changing dentist on dental treatment provision in an Australian defence force population.

During the early 1980s, a number of studies into dental treatment provision in the General Dental Service were conducted in Scotland. These studies indicated that the frequency with which an individual attended the dentist for treatment, or changed their dentist, influenced the amount of dental treatment that they received. The present study was designed to test these findings in an independent population, in this case, 100 members of the Royal Australian Air Force. While the frequency of attending the dentist did not have any significant effect on restoration longevity or the number of restorations a subject received, it did influence the cost of such treatment, indicating that frequent attenders received more expensive treatments rather than more treatment. Changing dentist did not display any significant influence on any of the parameters used in the present study.     

The Swedish patient insurance scheme and guarantee insurance for prosthodontic treatment.

During 1975-76 a no-fault compensation system for treatment injuries in dentistry and failures within prosthodontics was introduced in Sweden. The guarantee insurance scheme for prosthetic treatment has changed somewhat during the years and, in 1987, became mandatory for all dentists in Sweden. All necessary retreatment not included in the National Dental Insurance Scheme (eg allergy to dental materials, all treatment following radiotherapy-related xerostomia) is included. For fixed prosthodontics, all replacements are covered by the scheme for the first 2 years. For removable prosthodontics, this is limited to the first year. A patient may choose any dentist in Sweden to carry out the retreatment. The claim system is simple and the number of cases has steadily increased, probably because dentists are becoming more familiar with the system and are willing to use it. The costs are paid for by private practitioners, the Public Dental Service and private dental laboratories. The insurance files are available for research purposes.     

Cost-effectiveness considerations in planning a preventive dental programme for British Columbia.

The Government of British Columbia, Canada, with organized dentistry, in 1974, sponsored research towards the introduction of a comprehensive children's dental programme. Dental care was at that time primarily provided by private practitioners on a personal fee-for-service basis, which system was working close to capacity. Educational and preventive dental programmes in school and health centres were sponsored by governments. Utilization of treatment services by children was estimated at a maximum of 60 per cent per annum. For the improvement of overall dental health, it was adjudged this should be at least 90 per cent. Approximately 45 per cent of children's treatment was related to dental caries. Four possible dental care delivery systems were costed. It was essential that the comprehensive programmed include proven anti-cariogenic measures and that they be the most effective in cost and in the utilization of professional personnel. Techniques for measurement of effectiveness were reviewed. Using a modified Davies cost-benefit ratio, four professionally applied and four self-administered topical fluoride systems were compared. The Knutson-Szwejda technique scored highest when used by community dental health programmes. In a private practice system or in large paediatric clinics the annual application of acidulated phosphate fluoride would be preferable. In British Columbia, experience has indicated problems with continuing school cooperation in mouth rinse programmes. Statistical proof of the effectiveness of "brush-in" programmes was adjudged as inconclusive but hopeful.     

Oral health of individuals aged 3-80 years in J?nk?ping, Sweden in 1973 and 1983. I. A review of findings on dental care habits and knowledge of oral health

The aim of the present study was to present data from dental care habits and knowledge of oral health in two cross-sectional studies carried out in 1973 and 1983. A random sample of approximately 1000 individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60 and 70 years was studied for each of these two years. In the 1983-year examination 80 individuals 80 years of age were also included. All subjects were inhabitants of the community of J?nk?ping, Sweden. A questionnaire about dental care habits and knowledge was used in combination with a clinical and radiographical examination. The participants answered 23-101 questions. The same questions were raised in 1973 and 1983. For most age groups more then 80 per cent visited a dentist yearly in 1983. This yearly attendance was higher than that for 1973. In the 20-year-old group 14 per cent of the individuals received dental care in the PDS in 1973 compared to 63 per cent in 1983. The main reason to visit a dentist in 1973 was by the patient's own initiative while in 1983 the appointments were based on the dentist's initiative. The number of subjects that felt discomfort in connection with a visit to the dentist had decreased between 1973 and 1983. Knowledge about the etiology of caries had increased between 1973 and 1983 was not the case for gingivitis and periodontitis. An increase had occurred in toothbrushing frequency and the use of toothpicks and disclosing tablets but this between 1973 and 1983. In 1983, 98 to 93 per cent of the subjects in the age groups 10-30 years had been exposed to topical fluorides. The corresponding figure for 30-year-olds in 1973 was 1 per cent. It is obvious that during the period 1973 to 1983 there has been an increase in dental attendance, knowledge of dental diseases, oral health and the use of preventive measures.     

Long-term evaluation of a fissure sealing programme in Public Dental Service clinics in Sweden

The aim of the present study was to evaluate the long-term results of a systematic fissure sealing programme of the occlusal surfaces of newly erupted permanent first molars. All 15-year-olds (n=815) who had been regularly treated at seven Public Dental Service clinics in J?nk?ping County, Sweden, since the eruption of their permanent first molars participated in the study. Data on fissure sealing and restorative treatment were extracted from the dental records of the patients. When the patients were 15 years of age, it was found that 6% of the original 2456 sealed occlusal permanent first molars had received Class II restorations. Seventy-eight per cent of the remaining 2322 sealed occlusal surfaces were judged to be caries-free by the child's ordinary dentist. This long-term retrospective study indicates that a structured fissure sealing programme is of great benefit for oral health.     

A report on the feasibility of establishing a paediatric emergency dental service at Glasgow Dental Hospital.

A six-month pilot emergency service for children was established at Glasgow Dental Hospital to provide care for patients in pain, offer preventive advice and ensure ongoing dental care. The service was staffed by experienced community dental officers. In the main study period 2965 patients were seen. The majority (54 per cent) were referred from general dental practitioners; however, 27 per cent came directly to the hospital without seeking dental advice in their locality. The most common problems were toothache (55 per cent), occasional pain (28 per cent) and swelling (14 per cent). Eighty per cent of the patients were directed to oral surgery for extractions under general anaesthesia and six per cent for extractions under local anaesthesia. Dental caries still causes pain and distress to a large number of Glasgow school children. Clearly water fluoridation would greatly improve dental health and in so doing reduce the proportion of children requiring extractions under a general anaesthetic. The emergency service is currently being reorganised so as to place more emphasis on following up those patients who do not have a dentist, or who presented for care without a referral letter.     

Provision of orthodontic care to adolescents in South Australia: The type, the provider, and the place of treatment

There are many pathways involving different providers and locations that individuals may take in obtaining orthodontic services. The aim of this study was to document the provision of orthodontic services and establish the pathways taken toward fixed orthodontic treatment by adolescents in South Australia. Data were collected on the use of orthodontic services by a cohort of adolescents enrolled in the School Dental Service at age 13 years and again at age 15 years. By age 15 years, 83.2 per cent of the adolescents had received orthodontic consultations, 27.3 per cent had received fixed orthodontic treatment and 41.4 per cent had received other forms of orthodontic treatment (extractions, space retainers or removable appliances). The majority of fixed orthodontic treatment was supplied by orthodontists in the private sector, while extractions and removable appliances were provided mainly by public sector general dentists. Most individuals used services in both the public and private sectors and the most frequent pathway taken by the adolescents receiving fixed orthodontic treatment involved consultation in both the public and private sectors, non-fixed orthodontic treatment in the public sector and fixed orthodontic treatment in the private sector. The findings indicate wide access to orthodontic consultation and a high uptake of fixed orthodontic treatment once the adolescent sought private sector orthodontic consultation. Orthodontic care was seen to be an interactive process between public sector general dentists and private sector orthodontists.     

Metamorphosis of dentistry. Update on alternative delivery systems

In 1985, Americans spent $27.8 billion for dental care. Patients paid $18 billion out-of-pocket, while private health insurance paid about $9.2 billion. Public programs paid approximately $600 million primarily through Medicaid. Commercial insurance carriers have increased their market share to more than 80 million subscribers, or more than 70 per cent of the total market. Dental service corporations and Blue Cross/Blue Shield plans cover more than 30 million subscribers, while independent plans have policies with more than 6 million customers. Dentistry today is a big business, and Big Business wants to make it their business. What makes health care vastly different from the manufacture and sale of microwaves, furniture and clothing, or the production and serving of fast foods is that the provider is in a unique relationship with the consumer/patient and will always have a large measure of control for this reason. Receiving dental care is not the same as purchasing a new pair of tennis shoes, but good business practices from other business arenas can make it possible for greater numbers of people to have greater access to it. Over the past 25 years a metamorphosis of dentistry has been generated by a rather constant interplay between the various involved parties to obtain a position of least financial risk. Insurance carriers and/or administrative intermediaries want the risk placed on the dentist, employers want the administrators to take it, and dentists want employers, administrators, or patients to assume it. The future will see the gradual evolvement of equitable plans dividing the risk among the four principle parties. Plans are being put in place today that already reflect this. A viable alternative delivery system means: Dental care providers who have the knowledge and incentive to perform quality care; administrators willing to share some of the risk; and employers and consumers who are sophisticated and realistic in their demands in today's marketplace. All these factions are currently interacting to create the new dental picture we see today--and will see in the future.     

Attitudes to oral health, preventive practices and dental services in a Thai population

1500 subjects aged 15-18 and 35-44 years, providers of oral health care and village headmen from 6 north Thailand districts with different dental services were interviewed about their knowledge of and attitudes to oral health, preventive practices and oral health services. Current oral symptoms mentioned by the 1500 subjects included pain (20.7 per cent), holes in teeth (10.5 per cent), ulcer, lump or swelling (5.9 per cent), loose teeth (5.2 per cent), calculus (2.9 per cent) and bleeding gums (1.3 per cent). Those complaining of holes in teeth had a significantly higher mean number of DMFT (2.05) than those who had no current problem (0.60). There was a general lack of appreciation of periodontal disease as a clinical problem. 57.5 per cent of those with a current problem did nothing about it because of lack of time or because they did not know where to go. 98 per cent said they used a toothbrush and 75.1 per cent used it two or more times a day. 58 per cent said that oral disease was preventable. Virtually all methods mentioned referred to dental caries which was a minor problem in this age group. A significant number had received advice on oral health from primary health care workers. In two districts primary oral health care workers trained at the Intercountry Centre for Oral Health for two weeks to do superficial tooth scaling provided care for 110 subjects, 85-88 per cent of whom were satisfied with the care received. Village headmen were sceptical about preventing oral disease and wanted more frequent visits from mobile dental units. The dentist and dental nurses were unable to cope with the range of work required and wanted additional training. Sub-district health workers and primary oral health workers were frustrated by the limitations of their work and wanted additional training to do fillings and extractions.     

Does dental service utilization drop during economic recession? The example of Finland, 1991–94

After enjoying rapid economic growth in the 1980s, Finland suffered a deep economic recession that began in 1990. It has been claimed that recession and uneven subsidies influence the use of dental services negatively. Finnish adults born after 1956 and world war veterans are entitled to subsidized dental care either in the Public Dental Service (PDS) or in the private sector. Other adults pay their treatment costs. Objectives: The purpose of this paper is to determine whether the economic recession in Finland during the early 1990s affected the use of dental services. Methods: The data were collected by the National Research and Development Centre for Welfare and Health using a method called CATI (Computer Assisted Telephone Interview). The target population was non-institutionalized persons aged 25–79 years. Results: About one-third of those interviewed had visited a dentist during the previous 6 months and this proportion was stable during the years studied. Number of teeth, length of education, income and sex had the highest predictive values for use of dental services as analyzed by multiple logistic regression. Two-thirds had visited a private practitioner, one-third a PDS clinic and a small percentage some other dentist or denturist. Conclusions: The results showed that the dental service utilization by Finns was stable during this period of economic downturn and only minor changes occurred in the mean number of visits. The most prominent change was seen in the youngest age group, among whom dental utilization decreased by almost 10%. The study indicated that subsidies do not strongly affect dental utilization today.