Abstract
BackgroundValid estimation of dental treatment needed at population level is important for service planning. In many instances, planning is informed by survey data, which provide epidemiologically estimated need from the dental fieldworkers’ perspective. The aim of this paper is to determine the validity of this type of information for planning. A comparison of normative (epidemiologically estimated) need for selected treatments, as measured on a randomly-selected representative sample, is compared with treatment actually provided in the population from which the sample was drawn.MethodsThis paper compares dental treatment need-estimates, from a national survey, with treatment provided within two choice-of-dentist schemes: Scheme 1, a co-payment scheme for employed adults, and Scheme 2, a ‘free’ service for less-well-off adults. Epidemiologically estimated need for extractions, restorations, advanced restorations and denture treatments was recorded for a nationally representative sample in 2000/02. Treatments provided to employed and less-well-off adults were retrieved from the claims databases for both schemes. We used the chi-square test to compare proportions, and the student’s t-test to compare means between the survey and claims databases.ResultsAmong employed adults, the proportion of 35-44-year-olds whose teeth had restorations was greater than estimated as needed in the survey (55.7% vs. 36.7%;p <0.0001). Mean number of teeth extracted was less than estimated as needed among 35-44 and 65+ year-olds.Among less-well-off adults, the proportion of 16-24-year-olds who had teeth extracted was greater than estimated as needed in the survey (27.4% vs. 7.9%;p <0.0001). Mean number of restorations provided was greater than estimated as needed in the survey for 16-24-year-olds (3.0 vs. 0.9; p <0.0001) and 35-44-year-olds (2.7 vs. 1.4;p <0.01).ConclusionsSignificant differences were found between epidemiologically estimated need and treatment provided for selected treatments, which may be accounted for by measurement differences. The gap between epidemiologically estimated need and treatment provided seems to be greatest for less-well-off adults.
Highlights
Valid estimation of dental treatment needed at population level is important for service planning
Estimation of treatment provided The Department of Social Protection maintains databases of claims for all dental treatments provided under the Dental Treatment Benefit Scheme (DTBS), and the Health Services Executive maintains a database of all dental treatments provided under the Dental Treatment Services Scheme (DTSS)
The percentages of adults estimated as needing specific treatments in the national survey, and the percentages of adults who used the schemes who were provided with these treatments in 2000/02 are presented in Table 3 by age group and scheme
Summary
Valid estimation of dental treatment needed at population level is important for service planning. In many instances, planning is informed by survey data, which provide epidemiologically estimated need from the dental fieldworkers’ perspective. A 'desirable' standard is laid down and is compared with the standard that exists - if an individual or group falls short of the desirable standard they are identified as being in need” [4] It is regarded as most accurate when determining the need for simple dental restorations [5]. Perceived need, reported by individuals, explains care-seeking behaviour, while evaluated need describes the type and amount of treatment that will be provided following assessment of need by the health care provider and consultation with the patient to determine their wants [6]
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