Nihtilä A, Widström E
Espoo City Social and Health Services and Network of Academic Health Centres, Institute of Clinical Medicine, Department of General Practice and Primary Health Care, University of Helsinki, Finland.
Eur J Paediatr Dent. 2009 Mar;10(1):7-12.
Our aim was to identify the heavy use of dental services among children and adolescents in the Public Dental Service (PDS) of one of the biggest cities in Finland, and compare oral health and treatments provided for heavy and low users.
All patients under 18 years of age having had 6 or more dental visits (n. 2,285) in 2004 and a comparison group of those having had 3 or fewer visits (n. 27,957) were selected from the patient register of the PDS of the city of Espoo. A sample of 245 patients was randomly selected from each group and information on age, sex, dental status, number and types of visits and treatments provided was collected from their treatment records.
Seven percent of the children and adolescents who had visited the PDS in 2004 were heavy users according to the definition used. Their visits accounted for 26.3% of all dental visits of children and adolescents. The heavy users were classified as basic care heavy users and orthodontic heavy users. The mean treatment time for the basic care heavy users was 3 hours and 50 minutes, and for orthodontic heavy users 3 hours and 23 minutes; it was 40 minutes for the low users. Heavy users were on average 1.8 years older than low users. The basic care heavy users had more treated and untreated caries (mean DMFT/dmft = 4.0 and D/d = 2.4) than the low users (DMFT/dmft = 0.95 and D/d = 0.4). Of the low users, 43.6% had a healthy periodontium (CPI = 0) compared with 27.4% of the basic care heavy users and with 30.8% of the orthodontic heavy users. The most frequently provided treatments for heavy users were orthodontic care and fillings by dentists and for low users preventive measures and examinations. Most of the heavy users (66.4%) received less complicated orthodontic treatment given by a dentist compared with only 7.9% of the low users. Despite the low users' significantly better oral status compared with basic care heavy users there were only minor differences in the type of preventive measures provided for the two groups. The orthodontic heavy users received fewer preventive measures than low users.
Our study revealed two main reasons for heavy use of dental services: high numbers of orthodontic treatments provided by dentists and high numbers of decayed teeth in a small number of children. To increase productivity, orthodontic care should be provided more efficiently and preventive care needs to be targeted more carefully.
我们的目的是确定芬兰最大城市之一的公共牙科服务（PDS）中儿童和青少年对牙科服务的大量使用情况，并比较大量使用者和少量使用者的口腔健康状况及接受的治疗。
从埃斯波市PDS的患者登记册中选取2004年就诊6次或以上的所有18岁以下患者（n = 2285）以及就诊3次或以下的对照组患者（n = 27957）。从每组中随机抽取245名患者样本，从他们的治疗记录中收集年龄、性别、牙齿状况、就诊次数和类型以及接受治疗的信息。
根据所使用的定义，2004年就诊于PDS的儿童和青少年中有7%为大量使用者。他们的就诊次数占儿童和青少年所有牙科就诊次数的26.3%。大量使用者分为基础护理大量使用者和正畸大量使用者。基础护理大量使用者的平均治疗时间为3小时50分钟，正畸大量使用者为3小时23分钟；少量使用者为40分钟。大量使用者的平均年龄比少量使用者大1.8岁。基础护理大量使用者的已治疗和未治疗龋齿（平均DMFT/dmft = 4.0，D/d = 2.4）比少量使用者（DMFT/dmft = 0.95，D/d = 0.4）更多。少量使用者中，43.6%的人牙周健康（CPI = 0），而基础护理大量使用者中这一比例为27.4%，正畸大量使用者中为30.8%。大量使用者最常接受的治疗是正畸护理和牙医补牙，少量使用者则是预防措施和检查。与只有7.9%的少量使用者相比，大多数大量使用者（66.4%）接受的是牙医提供的较简单正畸治疗。尽管少量使用者的口腔状况明显优于基础护理大量使用者，但两组接受的预防措施类型只有细微差异。正畸大量使用者接受的预防措施比少量使用者少。
我们的研究揭示了牙科服务大量使用的两个主要原因：牙医提供的正畸治疗数量多以及少数儿童龋齿数量多。为提高效率，应更高效地提供正畸护理，并更有针对性地提供预防护理。
