Adults’ dental treatment in 2001–2013 in Finnish public dental service

Abstract

Background All adults over 17 years of age have access to the Public Dental Service after the Finnish Dental Care Reform in 2001–2002. This study aimed to survey the treatment needs and treatment measures provided for adult patients and changes in these during the period 2001–2013. Methods Sing each person’s unique identifier, demographic data on dental visits during the period 2001–2013 were collected from municipal databases in five PDS-units covering 320,000 inhabitants. The numbers of visitors, those in need of basic periodontal or caries treatment (CPI > 2 and D + d > 0) were calculated for three age groups. Treatment provided was also calculated in 13 treatment categories. Trend analyses were performed to study changes during the study period. Results Restorative treatments (968,772; 23.6%), examinations (658,394; 16.1%), radiographs taken (529,875; 12.9%) anaesthesia used (521,169; 12.7%) and emergency treatments (348,229; 8.5%) made up 73.8% of all treatment measures during the entire study period. Periodontal treatment (7.8%) and caries prevention (3.9%) made up a small part of the care provided and prosthetics and treatment of TMJ disorders were extremely uncommon (fewer than 1%). Treatments related to caries (restorative treatment, examinations, endodontics, emergencies, anaesthesia and radiographs) made up 60.4% of the dental personnel’s treatment time. During the study period, statistically significant increasing trends were found for radiographs (p < 0.001***), anaesthesia (p = 0.003**) and total number of treatments (p = 0.009**). There was a slight decreasing trend in treatment need among the youngest adults (18–39 years; p = 0.033*). Conclusion Compared with the results of national epidemiological studies, insufficient periodontal treatment is provided and prosthetic treatment is almost totally neglected in the PDS. Rather, adults’ dental treatment concentrates on treatment of caries. The unmet needs may be due to tradition, inadequate treatment processes or a lack of resources or failed salary incentives.

Effects of universal oral healthcare coverage in an adult population: A long‐term nationwide natural experiment

“…In contrast, the (arbitrary) natural experiment with the application of regression discontinuity design minimizes confounding bias and thus makes compared populations exchangeable 29,30 ; the current study provides valuable knowledge about the population level effects of expanding oral health coverage on oral health outcomes in a general adult population otherwise nearly impossible to study in randomized experiments. Our findings about the effectiveness of more universal oral healthcare are likely still generalizable to today's Finland because, except from continuously decreased reimbursement level for private oral healthcare costs, 26 no major changes have occurred in oral healthcare provision provided for adults in Finland 50 . In addition, the authors do not expect that there have been dramatic improvements in effectiveness of oral healthcare services on oral health in Finland recent decades.…”

“…Our findings about the effectiveness of more universal oral healthcare are likely still generalizable to today's Finland because, except from continuously decreased reimbursement level for private oral healthcare costs, 26 no major changes have occurred in oral healthcare provision provided for adults in Finland. 50 In addition, the authors do not expect that there have been dramatic improvements in effectiveness of oral healthcare services on oral health in Finland recent decades. For instance, wide adoption of risk-based recall intervals in Finland during last 30 years 51 may not have resulted in considerable improvements or deterioration of population oral health.…”

The Provision of Private Healthcare Services in European Countries: Recent Data and Lessons for Universal Health Coverage in Other Settings

“…The exceptions are few. In Finland private practitioners represent just more than half of all dentists and provide approximately one half of all dental care ( 38 , 39 ). While there is some concern within the dental profession regarding how the growth in third-party payments will affect practices, most dental services across Europe continue to be funded by a mix of direct patient payment and government subsidy ( 40 ).…”

Survival of endodontically treated teeth in public dental service in Northern Finland: a practise-based register study

“…Generally, in Finland almost two-thirds of the dentate adult population have at least one RCT tooth [24]. Of all the treatment provided in the PDS in Finland, approximately 5% was endodontic treatment in 2013 [25]. A recent study from southern Finland reported a success rate of 67% for RCTs performed by general dental practitioners [26].…”

“…were not evaluated. The explanatory variables for this study were age(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) years, 40-59 years, & ≥ 60 years), gender (male & female), RCT type (primary & secondary), number of dentists involved in treatment (1 clinician, 2 clinicians & ≥ 3 clinicians), education level of dentists involved (undergraduate dental student, general practitioner, specialized dentist), number of visits taken for RCT completion (1-2 visits, 3-4 visits & ≥ 5 visits), days from the first RCT visit until the root canal filling (0-14 days, 15-90 days & > 90 days), days from the first RCT visit until the final restoration of the tooth (0-30 days, 31-90 days & > 90 days), diagnosis to initiation of RCT (ICD 10 codes & written in patient register), instrumentation type (hand instrumentation & rotary instrumentation) and tooth types (incisors/canines, premolars & molars). If the tooth was re-treated by RCT within the follow-up time, it was registered.…”