Nihtilä A, Widström E, Elonheimo O
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.
Community Dent Health. 2010 Dec;27(4):227-32.
To compare treatment of heavy and low users of dental services among adults in the Public Dental Service (PDS) in one of the biggest cities in Finland and to identify reasons for heavy use and to suggest improvements to care provision.
All adults who attended the PDS in Espoo (pop. 227,500) in 2004 were allocated to a group (n = 3,173) who had made six or more dental visits and a comparison group (n = 22,820) who had three or fewer dental visits. The data were obtained from the patient register of the PDS. A sample of 320 patients was randomly selected from each group. Information on age, gender, number and types of visits, oral health status, treatment provided and fees paid was collected from treatment records.
10.5% of the adults were found to be heavy users and their treatment made up 31.6% of all adult dental visits. The proportion of men was greater among heavy users and the heavy users were on average 6.6 years older than the low users. The mean total treatment time for heavy users was 5.5 hours and 2.0 hours for low users. Heavy users had more untreated and treated caries and more periodontal pockets than low users. Restorative, endodontic and prosthetic treatment needs characterised the heavy user group, while the low users most often received restorative and periodontal treatment only.
Our study indicates that complicated treatment needs of heavy users and lack of experience among the caregivers in dealing with them resulted in high numbers of dental visits for individual patients. The PDS should offer appropriate continuing education for its oral health care teams and organize a referral system offering specialist care for difficult endodontic, periodontal and prosthetic treatments.
比较芬兰最大城市之一公共牙科服务（PDS）中成年重度和轻度牙科服务使用者的治疗情况，确定重度使用的原因，并提出改善护理服务的建议。
将2004年在埃斯波（人口227,500）接受PDS服务的所有成年人分为一组（n = 3,173），即进行了六次或更多次牙科就诊的重度使用者组，以及一组对照组（n = 22,820），即进行了三次或更少次牙科就诊的轻度使用者组。数据来自PDS的患者登记册。从每组中随机抽取320名患者作为样本。从治疗记录中收集有关年龄、性别、就诊次数和类型、口腔健康状况、所接受的治疗以及支付费用的信息。
发现10.5%的成年人是重度使用者，他们的治疗占所有成人牙科就诊的31.6%。重度使用者中男性比例更高，重度使用者的平均年龄比轻度使用者大6.6岁。重度使用者的平均总治疗时间为5.5小时，轻度使用者为2.0小时。重度使用者比轻度使用者有更多未治疗和已治疗的龋齿以及更多牙周袋。重度使用者组的特点是有修复、牙髓和修复治疗需求，而轻度使用者最常仅接受修复和牙周治疗。
我们的研究表明，重度使用者复杂的治疗需求以及护理人员在处理这些需求方面缺乏经验，导致个别患者牙科就诊次数较多。PDS应为其口腔保健团队提供适当的继续教育，并组织一个转诊系统，为复杂的牙髓、牙周和修复治疗提供专科护理。
