BackgroundDuring the 2000s, two major legislative reforms concerning oral health care have been implemented in Finland. One entitled the whole population to subsidized care and the other regulated the timeframes of access to care. Our aim was, in a cross-sectional setting, to assess changes in and determinants of use of oral health care services before the first reform in 2000 and after both reforms in 2011.MethodsThe data were part of the nationally representative Health 2000 and 2011 Surveys of adults aged ≥ 30 years and were gathered by interviews and questionnaires. The outcome was the use of oral health care services during the previous year. Determinants of use among the dentate were grouped according to Andersen’s model: predisposing (sex, age group), enabling (education, recall, dental fear, habitual use of services, household income, barriers of access to care), and need (perceived need, self-rated oral health, denture status). Chi square tests and logistic regression analyses were used for statistical evaluation.ResultsNo major changes or only a minor increase in overall use of oral health care services was seen between the study years. An exception were those belonging to oldest age group who clearly increased their use of services. Also, a significant increase in visiting a public sector dentist was observed, particularly in the age groups that became entitled to subsidized care in 2000. In the private sector, use of services decreased in younger age groups. Determinants for visiting a dentist, regardless of the service sector, remained relatively stable. Being a regular dental visitor was the most significant determinant for having visited a dentist during the previous year. Enabling factors, both organizational and individual, were emphasized. They seemed to enable service utilization particularly in the private sector.ConclusionsOverall changes in the use of oral health care services were relatively small, but in line with the goals set for the reform. Older persons increased use of services in both sectors, implying growing need. Differences between public and private sectors persisted, and recall, costs of care and socioeconomic factors steered choices between the sectors, sustaining inequity in access to care.

With data on children’s dental state from 1976 to 1993, we evaluated how the size of the high-caries group has changed concurrently with simultaneously decreasing mean numbers of teeth with past or current caries. Information related to all dental check-ups done for 5- and 15-year-olds in Helsinki, some 4,000 subjects of each age by year, consisted of numbers of teeth with caries experience (dmft or DMFT) and of all decayed teeth (dt+DT). Polarization of dental caries was described as the proportion of high-caries groups in each year, both in terms of caries experience and current untreated caries, diagnosed at subjects’ annual clinical dental check-ups. For 5-year-olds, the high-caries group by caries experience included patients with their dmft ≥ 3. For 15-year-olds the limits were set at DMFT ≥ 6 and DMFT ≥ 15. The high-caries group in terms of untreated caries was similar for both age groups: dt+DT ≥ 3. Furthermore, polarization of caries was calculated as the share of numbers of both dmf or DMF teeth and dt+DT in each high-caries group of the total number of such teeth in the entire age cohort. During the 17 years, mean dmft for 5-year-olds decreased from 4.6 to 0.8 and mean dt+DT from 0.9 to 0.6. In 1993, 78% had their dmft = 0, whereas only 8% of the patients accounted for 76% of all decayed teeth. For 15-year-olds the decrease was even greater: their DMFT fell from 12.1 to 3.0 and their dt+DT from 3.1 to 0.8. However, only 26% had their DMFT = 0 in 1993, with 55% of all dt+DT occurring in 10% of the patients. The present results confirmed a strong polarization in caries for both age cohorts, showing the need for renewed strategies in preventive caries treatment.

The findings were in line with other population-based reports in the 2000s. However, periodontal health in Finland seems not to be as good as in many European countries and in the USA.

Self-assessed good oral health is a fairly good estimate for the absence of clinically determined dental and periodontal treatment need. As implication for practice, self-assessed data could be used for screening purposes for oral health service planning and for priority allocation in large adult populations.

Implementation of caries preventive treatment in relation to the risk of caries was studied among 13-year-olds (n = 132) in two groups treated in the same public dental clinics in Helsinki: caries patients (n = 100) had the greatest numbers of decayed teeth (DT+dt), 5.5 on average, whereas cavity-free patients (n = 32) had intact teeth. Data taken from patients' personal oral health records served for evaluation of individual need for caries prevention, risk of caries, and preventive treatment given to each patient. Patients with any caries lesions or erupting teeth or poor oral hygiene were considered to be at risk of caries and in need of preventive treatment. The more caries lesions a patient had, the more prevention was expected to have been given. Preventive treatment of caries was weakly or only moderately in accordance with patients' individual needs and risk of developing caries, although patients with more caries lesions tended to have been given more preventive treatment than did those with none or only a few lesions. The majority of preventive measures given were applications of fluoride varnish, whereas motivation of and instruction in oral health care habits remained weak. However, patients whom their dentists had judged to be at high risk of caries received more intensified preventive treatment than did other caries patients. As a conclusion, intensification of caries prevention among high-risk patients is still needed. Dentists should always consider each patient's risk of developing caries to improve quality of preventive treatment.