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.