Heavy consumption of dental services; a longitudinal cohort study among Finnish adults

Abstract

BackgroundA reform to Dental Care legislation in 2002 abolished age limits restricting adults’ use of public dental services in Finland. In the Public Dental Service (PDS) unit of Espoo, the proportion of adult patients rose from 36% to 57%. The aim of this study was to investigate heavy use of dental services by adults and its determinants.MethodsA longitudinal cohort study was undertaken based on a PDS patient register. Of all adults who attended the PDS in Espoo in 2004, those who had six or more visits (n=3,173) were assigned to the heavy user group and a comparison group of low users (n=22,820) had three or fewer dental visits. A sample of 320 patients was randomly selected from each group. Baseline information (year 2004) on age, sex, number and type of visit, oral health status and treatment provided was collected from treatment records. Each group was followed-up for five years and information on the number and types of visit was recorded for each year from 2005 to 2009.ResultsMost heavy users (61.6%) became low users and only 11.2% remained chronic heavy users. Most low users (91.0%) remained low users. For heavy users, the mean number of dental visits per year (3.0) during the follow-up period was significantly lower than initially in 2004 (8.3) (p<0.001) but 74.8% of heavy users had had emergency visits compared with 21.6% of the low users (p<0.001).A third (33%) of the visitors in each group had no proper examination and treatment planning during the 5-year follow-up period and two or more examinations were provided to fewer than half of the heavy (46.1%) or low (46.5%) users.The mean number of treating dentists was 5.7 for heavy users and 3.8 for low users (p<0.001).ConclusionsFrequent emergency visits were characteristic of heavy users of dental services. Treatment planning was inadequate, probably partly due to the many dentists involved and too many patients requesting care. Better local management and continuous education are needed to ensure good quality adult dental care and to reduce heavy consumption.

Dental attendance among adult Finns after a major oral health care reform

“…the use of PDS seems to have become more need-based after the reforms. However, because longer queues for nonurgent care (up to 6 months or more) (27) and longer intervals between visits within a single treatment period (29), and problems in treating high-need patients (30) have been reported in the PDS after the OHCR, it is possible that the observed change in significance of these variables on the use of PDS was partly caused by a decline in the quality of care given by PDS.…”

“…This segmentation is presumably associated with the various problems faced by the two sectors; there has been a shortage of dentists in the PDS system while in the private sector there has been some overcapacity because a high density of private dentists practices in the bigger municipalities (35,36). Furthermore, because personnel resources were not significantly improved in the OHCR, the higher demand for PDS has resulted in long queues for elective (nonurgent) care, prolonged treatment periods and problems in treating high-need patients (28)(29)(30). At the same time, it has been speculated that in the private sector weak competition over patients between private practitioners, recall systems and well-selected and relatively healthy visitors may be creating a risk for supplier-induced demand involving for instance the overtreatment of patients (7,31,37).…”

Frequency of visits and examinations in the Public Dental Service in Finland – a retrospective analysis, 2001–2013

“…The national studies in 2000 and 2011 revealed great treatment needs in the adult population, such as missing teeth needing prosthetic replacements, caries and broken fillings and not least periodontal disease of various degrees and generally bad oral hygiene especially in the low income and low education groups [ 8 , 9 ]. A recent study in the PDS of a bigger city showed that there were high numbers of middle aged and older “heavy consumers” with low socioeconomic background showing up repeatedly for lost fillings and other semi-acute treatment and they were not offered examinations nor regular treatment [ 20 , 21 ]. Most PDS units recall the young only, in contrast to the private sector, which uses recall as one of its most important marketing tools [ 22 ].…”

Oral health and healthcare utilization in Belgian dentate adults

“…Further, oral healthcare utilization was shown to differ according to gender, age, Socio Economic Status (SES) and educational background . Nihtilä et al studied dental attendance following a change in legislation in Finland, showing that attendance increased after extending social security coverage.…”