Planning a dental prepayment program for children in an area of low caries prevalence

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The reduction in the intensity o f caries attack in areas with fluoridated water has important implications for both pri­ vate and public health dental practice. Although it is difficult to assess the im­ pact o f the lowered caries incidence on the lifetime treatment needs o f an indi­ vidual, it is apparent that the treatment needs o f residents in areas with and with­ out fluoridated water differ considerably. Certainly, a reduction o f 60 to 70 per cent in the incidence o f caries in children brings about a concomitant reduction in the amount o f operative dental services needed for this segment of the popula­ tion. For the dentist in private practice, this reduced attack rate offers the oppor­ tunity to provide complete care more readily and to enjoy a more satisfying type of practice. For the public health dentist this reduction requires a re-evalu­ ation o f the present ideas of community oral health activities and offers the op ­ portunity to develop programs which will capitalize on the lowered treatment re­ quirements to attain complete main­ tenance care for a majority o f children in a community. T he growing interest in voluntary pre­ payment health insurance coverage in recent years is a development which may have even greater impact on the prac­ tice o f dentistry. Recent events have fo ­ cused particular attention on the need for community-wide prepayment plans for dental treatment o f children in the offices o f private practitioners. A n important consideration in the organization o f such a program, as in any dental program, is the caries attack rate in the area of op ­ eration. This paper is an attempt to ex­ plore the effect o f a reduced caries inci­ dence (due to the presence o f fluorides) on the organization o f a dental prepay­ ment program for children, and to sug­ gest the type o f program that might be organized successfully in an area with fluoridated water.