Public Oral Health Services Research Articles

Social and behavioural determinants of early childhood caries.

To investigate the association between selected social and behavioural (infant feeding and preventive dental practices) variables and the presence of early childhood caries in preschool children within the north Brisbane region. A cross sectional sample of 2515 children aged four to five years were examined in a preschool setting using prevalence (percentage with caries) and severity (dmft) indices. A self-administered questionnaire obtained information regarding selected social and behavioural variables. The data were modelled using multiple logistic regression analysis at the 5 per cent level of significance. The final explanatory model for caries presence in four to five year old children included the variables breast feeding from three to six months of age (OR=0.7, CI=0.5, 1.0), sleeping with the bottle (OR=1.9, CI=1.5, 2.4), sipping from the bottle (OR=1.6, CI=1.2, 2.0), ethnicity other than Caucasian (OR=1.9, CI=1.4, 2.5), annual family income dollars 20,000-dollars 35,000 (OR=1.7, CI=1.3, 2.3) and annual family income less than dollars 20,000 (OR=2.1, CI=1.5, 2.8). A statistical model for early childhood caries in preschool children within the north Brisbane region has been constructed using selected social and behavioural determinants. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Attitudes and beliefs of oral health professionals regarding their role in health promotion

Issues addressed: The study was designed to gain an understanding of health promotion from the perspective of oral health professionals employed in the public sector during a transition in the focus of services. Methods: A cross sectional survey of oral health professionals employed by Queensland Health was conducted between March and April 2001. Staff were randomly sampled from employment records. A proportionate random sample, stratified across professional groups and geographical zones, was selected. Results: While the majority of the health professionals surveyed perceived oral health promotion to be part of their role, they felt ill equipped to adopt it. Professional groups differed in their confidence and perception of how to promote health in their clinical setting, existing barriers they encountered and their participation in health promotion programs. Conclusions: Strategies to improve the adoption of the oral health promotion role within Queensland public oral health services include: regular in- service and education for all staff regarding health promotion issues; increased cohesion of the oral health team; intersectorial collaboration; supportive district management; and a refocus to primary health care and public health concepts. (author abstract)

Dental caries experience of preschool children from the North Brisbane region.

To report the dental caries experience of preschool children within the north Brisbane region and to investigate the association between selected social and demographic variables and disease presence. A cross-sectional sample of 2515 children aged four to six years was examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) and percentage caries free indices. A self-administered questionnaire obtained information regarding selected social and demographic variables. The data were analysed using the chi-square and one way analysis of variance procedures at the 5 per cent level of significance. Overall, 1668 (66.3 per cent) children were disease free at the examination and mean dmft was 1.4+/-2.77 and dmfs was 2.28+/-6.00. Dental caries occurred more frequently and severely in children from non-Caucasian background (p<0.000), family language other than English (p=0.001) and lower socio-economic status (p<0.000). Significant associations between child ethnicity, language spoken at home, socio-economic status and caries presence have been identified. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Dentists’ perception of their treatment practices versus documented evidence

To compare the quality of real-life treatment practices to dentists' perceptions of treatment rendered. One administrative unit of the Finnish public oral health service. The original oral health records of a randomly selected sample of young adults who received treatment during 1994-1996 provided data on actual clinical examinations (n=208), radiographs (n=312), and root canal treatment courses (n=148) carried out by 50 dentists. Dentists' perceptions of the treatment rendered were obtained through a structured questionnaire completed during their working hours in 1996. Criteria for assessing the quality of treatment practices were based on Finnish health legislation, authoritative instructions, and consensus reports. Based on responses, 77% of the dentists followed the prevailing instructions on oral health record keeping (82%, if partial agreement included). Most dentists (88% fully agreed, 95% at least partly) perceived that their knowledge gained through continuing education was being applied in practice; no one answered no. A gap was found between dentists' perception of the treatment rendered and everyday treatment practices as recorded on patient documents. Overall, dentists' perception of the quality of their treatment practices exceeded that found in patient documents. This gap deserves consideration while planning research, education, or quality-improvement projects that relate to dentists' opinions.

Reasons for replacement and the age of failed restorations in posterior teeth of young Finnish adults

Using dentist characteristics, our aim was to evaluate the reasons for replacements of fillings, the age of failed restorations in the posterior teeth of young adults, and replacement rates. Altogether 205 patient records from the Public Oral Health Service of the City of Vantaa, Finland were evaluated. Patient age was restricted to between 25 and 30 years and type of tooth to posterior teeth only (third molars excluded). Information collected from the records included the patient's date of birth, latest DMFS and DMF, and the code for background data on the dentist. Details of each filled premolar and molar included the restorative material, location, and surface coverage of filling(s). The age of replacement of filling in premolar(s) or molar(s) was screened retrospectively from patient records. The total number of filled premolars and molars was 1873, with 1969 fillings. Forty percent of the patients had undergone replacement of filling in premolar(s) or molar(s). In all, 140 replacements had been made, accounting for 6.9% of amalgam fillings and 8.5% of tooth-colored fillings. Secondary caries, along with fractures, overhangs, and marginal discrepancy, was the most common reason for replacement. The mean age of failed amalgam fillings was 8.9 years (SD 5.2) and of failed tooth-colored fillings 2.4 years (SD 1.6). In the public sector, female dentists form the majority and their replacement rate for amalgam fillings was twice that of male dentists (7.6% vs 3.2%; P = 0.01).

Quality evaluation of young adults' radiographs in Finnish public oral health service

Objective: To evaluate the quality of young adults' radiographs exposed and processed under everyday clinical conditions. Setting: One administrative unit of the Finnish public oral health service. Design: Two reviewers independently evaluated the radiographs by the same written criteria that were designed as a checklist for on-site evaluations, without any further calibration. Sample: In total, 312 radiographs (178 bitewing, 88 periapical and 46 panoramic) from 1990 to 1996, collected from patient documents of a randomly selected sample of young adults born in 1966–1971. Outcome measures: Radiographs were assessed by quality indicators pertinent to the clinical utility as acceptable or unacceptable. If erroneous by some indicator(s) but still contributing to the diagnostic information, a radiograph was rated as diagnostically acceptable. A score of quality points was calculated for each radiograph. Results: The overall kappa statistics for intra-examiner reliability was 0.63, the proportional agreement 83%. For inter-examiner reliability, 0.42 and 71%, respectively. Although the evaluation criteria took the clinical utility of the radiographs into consideration, only 15% of bite-wings, 13% of periapicals, and 2% of panoramics received the maximum quality points. Erroneous film positioning was the most common fault on intraoral radiographs. On panoramics, the most frequent faults were in density and contrast and in patient positioning. The radiological evaluation had only been recorded for less than one fifth of the films. Conclusions: A proportion of radiographs fell short of the ideal. There is room for improvement in the quality of radiography in order to obtain the greatest possible diagnostic yield from the exposed radiographs.

Quality evaluation of process of root canal treatments performed on young adults in Finnish public oral health service

Objectives: To evaluate the quality of root canal treatments performed in every-day practice on young adults. Methods: A quality index related to the treatment process was developed based on the guidelines of the European Society of Endodontology. A random computerised selection of 134 young adults (born 1966–1971) produced 125 (93%) eligible oral health documents, including information on 148 teeth that were root canal treated by 47 dentists. The process of root canal treatment was evaluated according to the original oral health documents. The technical quality of root canal fillings was assessed on postoperative periapical radiographs. Results: The overall Kappa statistics for the inter-examiner reliability of assessments was 0.63; the proportional agreement being 87%. The mean quality index was 6.2, s.d. 2.0, with none of the treatments scoring the maximum 13. On the 56 available postoperative radiographs, 52% of the fillings were optimal, showing a length within 0–3 mm from the radiological apex, no voids in the apical part nor lumen apical to the filling. Of the completed 144 root canal treatments, only 11 included some recorded follow-up information within 15 months from the termination of the treatment. Conclusions: The technical quality of the root fillings was similar to that found in previous studies. However, the quality index, paucity of pre- and post-operative radiographs, and the lack of follow-up all indicated a discrepancy between consensus guidelines and every-day practice.

Oral complications

European Eating Disorders ReviewVolume 8, Issue 2 p. 83-87 Paper Oral complications J. T. Newton, Corresponding Author J. T. Newton Department of Dental Public Health & Oral Health Services Research, Guy's, King's & St Thomas' Dental Institute, London, UKLecturer in Psychology in Relation to Dentistry, Department of Dental Public Health and Oral Health Services Research, Guy's, King's & St. Thomas' Dental Institute, Floor 18, Guy's Tower, Guy's Hospital, London SE1 9RT, UK.Search for more papers by this authorH. C. Travess, H. C. Travess Department of Orthodontics, Bristol Royal Infirmary, UKSearch for more papers by this author J. T. Newton, Corresponding Author J. T. Newton Department of Dental Public Health & Oral Health Services Research, Guy's, King's & St Thomas' Dental Institute, London, UKLecturer in Psychology in Relation to Dentistry, Department of Dental Public Health and Oral Health Services Research, Guy's, King's & St. Thomas' Dental Institute, Floor 18, Guy's Tower, Guy's Hospital, London SE1 9RT, UK.Search for more papers by this authorH. C. Travess, H. C. Travess Department of Orthodontics, Bristol Royal Infirmary, UKSearch for more papers by this author First published: 29 March 2000 https://doi.org/10.1002/(SICI)1099-0968(200003)8:2<83::AID-ERV339>3.0.CO;2-SCitations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume8, Issue2Special Issue: Physical Complications of Eating Disorders: A Clinical ReviewMarch 2000Pages 83-87 RelatedInformation

Dentists' selection of measures for assessment of oral health risk factors for Finnish young adults

Dentists' selection of measures for assessing oral health risk factors for young adults, in relation to their oral health status and to those dentists' characteristics, was studied in one administrative unit of the Finnish public oral health service. A random selection (n = 239) was made of all young adults born in the period 1966-71 and clinically examined during 1994. On the original oral health records of those selected, all notes were scrutinized concerning the most recent clinical examination and treatment course; in total 208 (87%) records. We found that assessment of risk factors to oral health was rare. The patient's diet had been recorded as assessed in 7% of all cases, use of fluoride in 8%, and oral hygiene habits in 14%. No salivary tests were performed; nor was patients' use of tobacco assessed. No correlation was detected between measures used by these dentists and their patients' oral health status (DMFT and DT scores, number of approximal incipient lesions, and number of healthy sextants by CPITN). The oral health status impelled only slightly assessments by bite-wing radiographs. Fewer than half (44%) of the dentists performed and recorded any kind of assessment measure; 4% assessed diet, hygiene, and use of fluoride for all their patients in our sample. A dentist's gender showed no correlation with number of measures used; younger dentists tended to perform and record assessments slightly more often than did older dentists, but in all age groups there were those who had not done this. The practice of risk-factor assessment should be more widespread and standardized, contributing to needs-based treatment and allocation of resources.

Applicability of SWOT analysis for measuring quality of public oral health services as perceived by adult patients in Finland

Applicability of SWOT analysis for measuring quality of public oral health services as perceived by adult patients in Finland

Quality evaluation of oral health record-keeping for Finnish young adults

The objective of this study was to assess the quality of oral health record-keeping in public oral health care in relation to dentists' characteristics. A random computerized selection of 239 subjects, born in 1966-71 and clinically examined during 1994 in an administrative unit of the public oral health service in southern Finland, included 4-5 cases per dentist, the number of dentists being 50. Data concerning actual clinical examinations and treatment courses carried out in public dental clinics came from original oral health records. Criteria for assessment of oral health record entries were based on Finnish health legislation and detailed instructions of health authorities. The results showed that each patient's identity was available in 90% of documents. Recordings concerning continuity of comprehensive care were infrequent; a questionnaire concerning each patient's up-to-date health history was in only 26% of the oral health records. Notes concerning each patient's bite and function of the temporomandibular joint were in 37% of the records, notes about oral soft tissues were in 11%, and the check-up interval was recorded in 21%. Recording of indices on periodontal and dental status varied greatly; the community periodontal index of treatment need was found in 93% and the index of incipient lesions in 16% of the records. Female dentists and dentists younger than 37 years tended to record more information. Dentists should be encouraged to better utilize the options offered by oral health records for individual treatment schemes.

Outcome of public oral health services in relation to treatment mix.

We evaluated the outcome of public oral health services in relation to the treatment mix in the city of Helsinki, in which 7 independent districts provided dental care to 98,000 patients in 1989. Outcome was defined as the increase in numbers of DMF teeth over the 2 years from 1989 to 1991 in 16,000 patients 8, 10, 12, and 13 years of age. The share of each type of treatment in the treatment mix was calculated on the basis of the market price of the items of service. The greater the share of prevention, the more positive the outcome (p < 0.01)- that is, the lower the increase in numbers of DMF teeth. In a regression model the share of prevention alone accounted for 53% of the variation in the outcome by district. Addition of the share of checkups to the model increased its explanatory power markedly (R2 = 0.74). A positive outcome was seen both in districts with poor and in those with good educational structures.

Decline in dental caries and public oral health care of adolescents

The adequacy and appropriateness of the oral health service were evaluated from patient records of 15-year-olds in Helsinki in 1976 and 1986. The subjects selected for the study represented the whole age group participating in public oral health service in the 2 years in question. During the 10 years, substantial decreases were seen in the mean numbers of dental visits (from 4.0 to 2.4) and fillings (from 2.9 to 1.2). The greatest decrease was seen in the number of fillings made in incisors. Slightly fewer preventive measures were carried out in 1986 than 10 years earlier, but no focusing on risk patients was seen. In the 2 years studied, 15-year-olds in the high-risk group received applications of topical fluorides and instructions on oral hygiene as often as those in the low-risk group. A major problem seemed to be the increasing number of unfinished courses of treatment among high-risk patients. We conclude that patients with a higher risk of caries should receive more attention with regard to both the preventive treatment given and ways of motivating them to complete their treatment courses.

Use of children's oral health services in Finland with special reference to heavy consumption.

The consumption of oral health services among 4-16-yr-old children in Finland is described, including an analysis of heavy consumption. Data representative of all Finnish children were collected for 4518 children from municipal health centers and homes. The response rate was 85%. Children with orthodontic visits during the year were excluded from the analyses. Of the preschoolchildren 12% and of the school-age children 4% did not use any oral health services during the studied year. Non-users did not differ from the others in terms of socioeconomic status, distance to a health center or type of residential area. Public oral health services were used very unevenly. Half of the children consumed only one-fifth of the services and the next one-third used about one-third of the services. The heavy consumers, about one-fifth of the total, used as much as half of all the services. Among preschoolchildren, the heavy consumers were mainly from lower socioeconomic groups. In contrast, no clear predictive factors were found for heavy consumption among the schoolchildren. Heavy consumers had more both treated and untreated caries than the other children did. Their treatment was mainly restorative; at least half of them did not receive adequate preventive care. Finnish public oral health care clearly should make more efforts to ensure that heavy consumers of dental services do not remain so.