Public Dental Care Research Articles

Caries risk assessment in young adults: A 3-year validation of clinical guidelines used in Public Dental Service

Objectives. To validate a risk classification model according to the Public Dental Service (PDS) guidelines with the actual 3-year caries outcome in terms of predictive values. Materials and methods. All 19-year-old patients registered at eight public dental clinics in Skåne, Sweden were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects, representing 10% of the age group attending the public dental care in the region. A risk classification of each patient in four categories was made by the patient's regular team according to the guidelines. At the follow-up 3 years later, 75.8% were accessible. The final examinations included bitewing radiographs and the actual caries increment for 982 patients was calculated. Results. At baseline, 11.9% were assessed as being at ‘high' or ‘very high' risk. The dropouts had significantly more caries than the remaining patients (p < 0.05). The general disease activity was low, but those grouped into the two highest risk groups displayed significantly more new caries than those at lower risk (p < 0.05). With a cut-off value ΔDFS > 0 vs DFS = 0, the sensitivity was 81% and the specificity 56% for ‘low' risk vs any risk. By combining the ‘low' and ‘some' risk categories, the PDS model generated an improved specificity (94%). Conclusions. The risk assessment scheme used by the Public Dental Service for young adults relied basically on past and current caries activity and 65–70% of the patients were correctly classified. The model was most effective to screen out patients with low caries risk.

Socioeconomic inequalities in the use of dental care services in Europe: what is the role of public coverage?

The aim of this study was to analyse inequalities in the use of dental care services according to socioeconomic position (SEP) in individuals aged ≥50years in European countries in 2006, to examine the association between the degree of public coverage of dental services and the extent of inequalities, and specifically to determine whether countries with higher public health coverage show lower inequalities. We carried out a cross-sectional study of 12364 men and 14692 women aged ≥50years from 11 European countries. Data were extracted from the second wave of the Survey of Health, Ageing and Retirement in Europe (SHARE 2006). The dependent variable was use of dental care services within the previous year, and the independent variables were education level as a measure of SEP, whether services were covered to some degree by the country's public health system, and chewing ability as a marker of individuals' need for dental services. Age-standardized prevalence of the use of dental care as a function of SEP was calculated, and age-adjusted indices of relative inequality (RII) were computed for each type of dental coverage, sex and chewing ability. Socioeconomic inequalities in the use of dental care services were higher in countries where no public dental care cover was provided than in countries where there was some degree of public coverage. For example, men with chewing ability from countries with dental care coverage had a RII of 1.39 (95%CI: 1.29-1.51), while those from countries without coverage had a RII of 1.96 (95%CI: 1.72-2.23). Women without chewing ability from countries with dental care coverage had a RII of 2.15 (95%CI: 1.82-2.52), while those from countries without coverage had a RII of 3.02 (95%CI: 2.47-3.69). Dental systems relying on public coverage seem to show lower inequalities in their use, thus confirming the potential benefits of such systems.

Long‐term effects of maternal prevention on children's dental decay and need for restorative treatment

In a Finnish study carried out in 1990s, high-caries-risk mothers used xylitol gum on daily basis when their child was 3-24-month old, whereas the high-risk control mothers received biannual fluoride or chlorhexidine treatments. The maternal prevention reduced colonization of mutans streptococci and early childhood caries in children. The present retrospective study aimed to extend the post-trial follow-up to 10-year-old children (n = 148). Additionally, the dental health of these high-caries-risk children was compared with a reference group comprising the rest of the children in the same age cohort (n = 359). The annual data on dental health and treatments were gathered from public dental care registers. The median caries-free age (dmft = 0 and DMFT = 0) was 8.2 in the xylitol, 5.8 in the control, and 8.1 in the reference group (xylitol versus control, P = 0.005, HR = 1.75; 95% CI 1.18-2.60, reference versus xylitol, P = 0.410, HR = 1.13; 95% CI 0.84-1.51 Cox regression). Thus, the children in the xylitol group had caries-free teeth longer than the control group. Compared to the reference group, the xylitol group did not show notable difference. Up to 4 years of age, figures for cumulative restorative treatment visits were 0.2 in the xylitol, 0.7 in the control, and 0.4 in the reference group (xylitol versus control P = 0.006, Student's t-test). The reduced mother-child transmission of mutans streptococci seems to have long-term effects on children's dental health. The maternal use of xylitol reduces caries occurrence and need for restorative treatment in assumed high-caries-risk children to the average level of the whole age cohort.

Análise de custo de materiais utilizados em restaurações dentárias em resina composta

INTRODUÇÃO: As resinas compostas são materiais usualmente utilizados em restaurações dentárias diretas de dentes posteriores. O custo dos materiais faz parte do cálculo do valor dos honorários odontológicos. OBJETIVO: O objetivo deste trabalho foi determinar e analisar o valor total do custo dos materiais utilizados para a confecção de restaurações dentárias diretas de dentes posteriores em resina composta. MATERIAL E MÉTODO: O cálculo dos custos foi baseado no método de sistema de custeio variável. A lista dos materiais foi obtida por meio de consulta a uma banca de juízes e baseada nos padrões de excelência comprovados na literatura para atendimento em equipe. Os valores dos materiais foram obtidos de uma média dos valores consultados no mercado fornecedor. As repetições foram obtidas de preparos cavitários Classes I e II em dentes pré-molares e molares artificiais pré-fabricados. Os materiais foram quantificados para cada tipo de preparo. As resinas compostas utilizadas foram pesadas em balança de precisão após a sua inserção em cada tipo de preparo. Os dados foram avaliados por estatística descritiva e pelos testes de Mann-Whitney e Kruskal-Wallis. RESULTADO: O custo encontrado para restauração de Classe I foi de R$17,56 e, para a de Classe II, de R$17,73. Não houve diferença estatística no custo entre os tipos de preparo e de dentes, sendo a média total de R$17,65. CONCLUSÃO: Os valores encontrados podem ser utilizados no cálculo do valor final do procedimento restaurador, auxiliando na gestão de serviços odontológicos públicos ou privados.

Three year retrospective analysis of computer-assisted emergency dental triage in Tasmania, Australia

Tasmania is Australia's smallest state measuring approximately 68,000 km2 and separated (by approximately 240 km of ocean) from the mainland of Australia, at the south-east corner of the continent. The total resident population of Tasmania is approximately 500,000 people with the greatest population density in the capital city, Hobart. Adult dental care is subsidised for socioeconomically disadvantaged people and are provided through the State government dental clinics. Emergency demand for adult dental care is rationed through a triage system (mainly by telephone contact with trained receptionists), applied across the State based on universal clinically agreed criteria. The aim of this study was to analyse the outcomes of this triage system in delivering effective public emergency dental care services in Tasmania. The study population consisted of all patients who approached the dental services in Tasmania for emergency care over a period of 3 years. The data were collected from all four major fixed public dental clinics for the calendar years 2009, 2010 and 2011. A total of 56,298 triage events were analysed over the 3 years (2009-2011) of the study. The proportion of each triage outcome category (ie speed to needing to be seen) was stable. Regarding month-to-month variation, December had the lowest overall number of events (n=3921) and August had the greatest (n=5237). There was a tendency mid-year (winter in the southern hemisphere) for triage events to be above the baseline, while in summer (December to February) there were fewer events. Most triage events occurred on the first day of the working week (Monday), and the least occurred on Fridays. Over half the events were driven from two patient symptom sets: (1) pain that woke patients at night; and (2) pain that required analgesics. In order to deal with the current workforce shortage and funding constraints in the public health sector, the peri-operative workforce such as receptionists can be utilized in innovative ways such as triage, and in particular clinical-based systematic telephone-based assistance.

Outcome and long-term stability of an early orthodontic treatment strategy in public health care

Our aim was to evaluate the long-term treatment outcome of a systematically applied orthodontic screening and early treatment strategy in a public dental health care system, with special reference to occlusal stability at least 5 years post-retention. The subjects (N = 68) belonged to one age cohort born in a Finnish rural municipality (N = 85), and they were regularly followed from 8 to 20 years. Persons with malocclusions were screened and treated according to pre-planned protocol. Treatment need was assessed according to the Dental Health Component of the Index of Orthodontic Treatment Need, and treatment outcome using the peer assessment rating (PAR) Index and Little's Index of Irregularity. Eighty-two per cent of the treated participants were out of retention (mean 6.9 years post-retention) at age 20. Definite treatment need in the study population decreased from 37% to 3 %. In the treated group, the mean PAR improvement decreased from 65 % to 63% from age 15 to 20 years. The mean irregularity score for the mandibular incisors was 4.0 [standard deviation (SD) 2.4] and for maxillary incisors 3.7 (SD 2.1) with no significant difference between treated and not treated subjects. The results suggest that definite need for orthodontic treatment may be predominantly eliminated from the target population with a systematically implemented treatment strategy focusing on early treatment with simple appliances. Emphasis on early timing of treatments may have contributed to the good long-term stability of treatment results.

Assessing the community clinic replacement effect on private Medicaid practices in oral health care within rural environments

Children in Medicaid/CHIP public coverage programs who reside in rural counties have limited access to dental care services. Shortages of dental professionals in rural areas impede utilization of dental care. Public and private initiatives are attempting to address this crisis. Missourians instituted deregulatory policies and invested in community-based initiatives. Using a Medicaid/CHIP claims administrative dataset from 2004 to 2007, this research explored patterns of utilization to assess the impact of these efforts. The number of participating private dental office providers declined over the study period, and the number of children utilizing clinics increased. Trends are being observed within the public health dental care market demonstrating clinics are replacing private dentists as providers of Medicaid/CHIP dental services. Allowing greater market entry through deregulation could provide states with greater improvements to their public dental health infrastructure.

Wicked problems: policy contradictions in publicly financed dental care

To review two policy issues that define publicly financed dental care as a "wicked policy problem." Historical review. By demonstrating how governments have shifted their funding focus from direct delivery care, to public third-party financing arrangements in private dental offices, and by their willingness to fund composite restorations in public fee schedules, it is clear that the logic and sustainability of public programming needs reconsideration. The current contradictions in public dental care programs speak to the need for policy makers to reassess their goals, and ask whether decisions are based more on political necessity than on a logical evidence-informed approach to the delivery of publicly financed dental care.

Government spending on dental care: is it a public priority?

The majority of Canadians believe that the government should play some role in providing dental care within Canada's health care system. However, it is unclear whether Canadians consider this as a top public priority. This study determines whether dental care is a public priority among Canadian adults relative to other policy concerns and identifies factors predictive of a first priority ranking for dental care. Data were collected in 2008 from a national random sample of 1,005 Canadian adults through a telephone interview survey. Respondents were asked to rank five spending priorities (dental care, pharmacare, home care, vision care, and child care) in terms of preferences for new government spending. Simple descriptive analyses were undertaken based on sociodemographic characteristics. Logistic regression modeling was conducted to determine which factors are predictive of a first priority ranking for dental care. Comparatively, dental care stands as the third choice among the other spending priority areas. Approximately 21 percent of adults consider dental care a first priority for spending. First priority ranking of dental care appears to be linked to socioeconomic factors: household income, educational attainment, and dental insurance coverage. As a public priority, a moderate level of demand exists for more government spending on dental care in Canada, specifically among those of low income, low educational attainment, and who lack dental insurance coverage. A sustained effort should be made to push forward public dental care policies that target priority population subgroups.

Oral Health Literacy: At the Intersection of K–12 Education and Public Health

The link between a student's health and their ability to learn is well-established. Schools are the intersection of public health programs, dental care, and self-care. This position affords them a unique role and opportunity to enhance health literacy, including oral health literacy. This paper explores the potential of K-12 school programs and the dental profession to address oral health literacy, and, in so doing, provide future participants with essential skills to promote their oral health.

Assessment of deciduous dentition in 6-10 year old school children

Introduction. The emergence of deciduous teeth in the mouth of a child usually brings a joy to every parent. However, after ?short-time euphoria? deciduous teeth, in most cases, become the cause of pain, swelling, infection and further complications. The aim of this study was to assess the status of deciduous teeth in school children. Material and Methods. The study included children age 6-10 years from four cities in Republika Srpska. All respondents were divided in two groups: Group I included those who voluntarily came to be examined at the dental clinic and the Group II-those who were randomly chosen in schools. The examination was performed using dental mirror and probe. Caries verification was carried out by Klein-Palmer system, dmft (d - decay; m - missing; f - filling), and its related indices: Person caries index (pci) and Average caries index (aci). In addition, a survey was conducted. Results. A total number of 228 respondents were examined. Total pci was 96.1%. On average, each child had aci= 4.17 while 10.52% of the children had fillings in primary teeth. None of the children had sealed fissures on deciduous teeth. Physical examination revealed that 12.2% of the children had submucous abscess in oral cavity. The survey revealed that 3% of children did not have a tooth brush. Conclusion. The prevalence of caries in primary teeth is high, despite the fact that the Health Insurance Fund in Republika Srpska covers full cost for complete restoration of teeth in children up to 15 years old. Responsibility for the low percentage of healthy and filled teeth is relying mostly on parents as well as the entire community that should provide development and availability of public health dental care in all areas.

Utilisation of the Medicare Teen Dental Plan in NSW, 2008 - 2010

To examine the use of the Medicare Teen Dental Plan in NSW, its uptake in the private and public dental sectors and to map the geographical pattern of program use. Data describing the use of the Medicare Teen Dental Plan were assembled from a variety of sources including Medicare, the NSW Oral Health Data Collection and the NSW Teen Dental Survey 2010. In 2010, use of the Medicare Teen Dental Plan across the entire NSW eligible aged population ranged from 20 to 25.5%, with the average usage across all ages being 20.2%. For the period 2002 to 2010, the average utilisation rate for teenagers accessing public dental care was approximately 6.8%. As a single Dental Benefits Schedule item is used for service provided under the Plan, it is difficult to evaluate the mix of dental treatment items and the comparative value of the service provided unless these services are provided in a public dental service with a data collection that can flag care provided under a Medicare Teen Dental Plan voucher.

Access to public dental care facilities in Chandigarh

The objective of the study was to determine the level of dental health care access and associated factors, at various public health facilities in the Union Territory (UT) of Chandigarh. A study was done using a multistage random sampling technique, to interview adult respondents at their homes and to interview the dentists in the public dental clinics and hospitals. The mean composite access score was 59.2 (SD 18.9) in urban areas and 60.5 (SD 20.9) in rural areas (P=0.64) on a scale of 100. The mean score for the self-perceived condition of their oral health was 6.47 (95% CI 6.17 - 6.76). Thirty-four percent of the respondents did not contact a dentist despite having a problem in the last year, primarily because dental problems were not important for them (45%), they lacked time (22%), and took self-medication (16%). Overall 58% of the respondents suggested government clinics and 44% liked private dentists for treatment of dental cavities. The government setup was preferred because the facilities were cheaper and affordable. Dental health care access and only limited dental facilities were available in most of the dental clinics in Chandigarh. Self-reported dental problem was low, and people ignored their dental problems.

Letter to the editor concerning Parrott LA, Ng SY. A comparison between bitewing radiographs taken with rectangular and circular collimators in UK military dental practices: a retrospective study published in Dentomaxillofacial Radiology (2001;40:102–109)

Free AccessLetter to the editorLetter to the editor concerning Parrott LA, Ng SY. A comparison between bitewing radiographs taken with rectangular and circular collimators in UK military dental practices: a retrospective study published in Dentomaxillofacial Radiology (2001;40:102–109)L Flygare, A Öhman and L KullL FlygareSearch for more papers by this author, A ÖhmanSearch for more papers by this author and L KullSearch for more papers by this authorPublished Online:5 Mar 2014https://doi.org/10.1259/dmfr/38497493SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutDear madam,We would like to comment on the recent Dentomaxillofacial Radiology article: “A comparison between bitewing radiographs taken with rectangular and circular collimators in UK military dental practices: a retrospective study”.1Firstly, we would like to congratulate the authors on a well performed study and a conclusion with which we wholeheartedly agree.Our comment concerns the increase in incidence of cone cut errors from 3.3% to 20.9% when rectangular collimators were used as reported by the authors.1 Whilst the errors in general were small and did not influence the diagnostic value enough to change the recommendation of using rectangular collimators, we would like to offer a potential explanation for many of the cone cut errors. Most dental X-ray tubes supplied with a rectangular collimator also exhibit a primary collimator close to the focus in order to prevent extrafocal radiation. Usually this collimator is placed in the bottom of the aiming device. If misaligned, this collimator will create cone cut errors in the image even if the clinical aiming is perfect. The same reasoning would also apply to a circular collimator but in that case there is usually so much superfluous X-ray field that minor misalignment of the primary collimator will not cause cone cut errors.Misalignment of the primary collimator can be easily checked by simple inspection of the collimating device and by performing a low-dose exposure with the image receptor kept in contact with the end of the cone. Any cone cut error will readily show up on the images (Figure 1). In Sweden such controls should be performed annually according to the legislation.2 However, in our experience this is often neglected in general dentistry practices.Figure 1 a,b Two examples of cone cut errors created by misaligned primary collimators found at inspection of dental X-ray tubes in public dental health care in the county of Norrbotten, Sweden in Janaury 2011 Download Figure In the county of Norrbotten, the public dental health care has used rectangular collimators for the last 12 years. In recent weeks we have made visits to public dental clinics within the county and examined their equipment; in total we looked at 165 units of 4 different brands and 6 different models. We then found that 41 (25%) of the dental tubes with rectangular collimators demonstrated cone cut errors of magnitude 1 or 2 as defined in the study by Parrott and Ng.1 Many of these misalignments of the primary collimator were easily fixed and seem to stem from less than optimal assembly at the manufacturers. The figure 25% is close to the amount of cone cut errors reported by Parrot and Ng.1 As this factor doesn't seem to have been investigated by them we are led to believe that misaligned primary collimators can be one of the reasons for the increase of cone cut errors found in their study. If so, then this problem, which is possibly universal, can be easily overcome by a simple check of the primary collimator when changing from circular to rectangular collimators, further strengthening the conclusion of their study that all practitioners should adopt rectangular collimation.References1 Parrott LA , Ng SY . A comparison between bitewing radiographs taken with rectangular and circular collimators in UK military dental practices: a retrospective study. Dentomaxillofac Radiol 2011;40:102–109. Link ISI, Google Scholar2 SSMFS 2008:31. Strålsäkerhetsmyndighetens föreskrifter om röntgendiagnostik. Solna: Swedish Radiation Safety Authority 2008;ISSN:2000–0987. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byComparison of technical errors in pediatric bitewing radiographs acquired with round vs rectangular collimationOral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Vol. 133, No. 3 Volume 40, Issue 4May 2011Pages: 199-264 2011 The British Institute of Radiology History Published onlineMarch 05,2014 Metrics Download PDF

Rationalisation in public dental care – impact on clinical work tasks and mechanical exposure for dentists – a prospective study

Swedish dentistry has been exposed to frequent rationalisation initiatives during the last half century. Previous research has shown that rationalisation often results in increased risk of developing work-related musculoskeletal disorders, thus reducing sustainability in the production system. In this prospective study, we assessed mechanical exposures among Swedish dentists in relation to specific rationalisations of clinical dental work during a six-year period. Body postures and movements of 12 dentists were assessed by inclinometry synchronised to video recordings of their work. No rationalisation effects could be shown in terms of a reduction in non-value-adding work (‘waste’), and at job level, no major differences in mechanical exposure could be shown between baseline and follow-up. Conclusion: The present rationalisation measures in dentistry do not seem to result in rationalisation at job level, but may potentially be more successful at the overall dental system level. Practitioner summary: In contrast to many previous investigations of the mechanical exposure implications of rationalisation, the present rationalisation measures did not increase the level of risk for dentists. It is highlighted that all occupations involved in the production system should be investigated to assess production system sustainability.

Public primary oral health care: a bioethical reflection

In Brazil, a reduction in the prevalence of tooth decay has been observed recently. However, the distribution pattern of oral diseases still reflects widespread inequality in the access to public preventive and dental care. The oral health status of certain populations highlights the differences in the availability, accessibility and acceptability of education and oral health care. In this context, bioethics can be used as a concrete tool for the discussion, improvement and consolidation of citizenship, human rights and social justice. The purpose of this review is to reflect on Brazilian public primary oral health care from a bioethical standpoint. To do so, it is necessary to start with an analysis of the role of bioethics in public health in Brazil and to approach some of the ethical issues surrounding dental care in the Brazilian public health system.

Dental caries experience among young Australian adults

Dental caries experience among young Australian adults

Measuring Service Quality of Public Dental Health Care Facilities in Kelantan, Malaysia

This study investigates patients' expectations and perceptions of service quality in public dental health care and measures their "satisfaction gap." This descriptive study involved 481 dental outpatients in Kelantan, Malaysia. A modified SERVQUAL 20-item instrument was used to assess patients' expectations before and perceptions after receiving dental treatment. The "satisfaction gap" was then measured. showed that patients visiting for management of dental pain were more satisfied (P = .007) than those visiting with appointment. The most significant service quality dimensions were related to responsiveness, assurance, and empathy of the dental health care providers. There was a significant difference between the patients' expectations and their perceptions of service provided (P < .01) with regard to all dimensions. In conclusion, dental service providers should give emphasis to the compassionate and emotional aspects of care and to remember that they are integral components of quality service.

Public preferences for seeking publicly financed dental care and professional preferences for structuring it

To test the hypotheses that socially marginalised Canadians are more likely to prefer seeking dental care in a public rather than private setting, and that Canadian dentists are more likely to prefer public dental care plans that approximate private insurance processes. Data on public opinion were collected through a weekly national omnibus survey based on random digit dialling and telephone interview technology (n = 1005, >18 years). Data on professional opinion were collected through a national mail-out survey of a random selection of Canadian dentists (n = 2219, response rate = 45.8%). Dental and socio-demographic data were collected for the public, as were professional demographic data for dentists. Descriptive and basic regression analyses were undertaken. The majority of Canadians surveyed, 66.4%, prefer to seek dental care in a private setting, 19% in a community clinic, and 7.6% in a dental school; those that are younger and of lowest incomes are most likely to prefer seeking dental care in a public setting. Most Canadian dentists, 80.9%, believe that governments should be involved in dental care, yet only 46% believe this role should include direct delivery. A third of dentists have also reduced the amount of publicly insured patients in their practice. Canadian dentists are more likely to prefer those public plans that most closely reflect private insurance mechanisms. There appears to be a policy disconnect between the preferences of those populations where governmental involvement is most warranted, and the current mechanisms for financing and delivering dental care in Canada. By concentrating almost exclusively on third-party-type financing and indirect delivery, public dental care policy may not be adequately responding to those most in need, especially in an environment where dentists are largely dissatisfied with public plans.

Periodontal diseases in the Australian adult population

Periodontal diseases in the Australian adult population