Hassall D C, Holloway P J
Division of Restorative Dentistry, Leeds Dental Institute.
Br Dent J. 1998 Apr 11;184(7):348-50. doi: 10.1038/sj.bdj.4809621.
A randomised epidemiological study.
Secondary schools in the Wycombe, Doncaster and Hereford/Worcester areas.
Random samples of 14-15-year-old, regularly attending patients treated by dentists practising under capitation in three contrasting areas of England were examined in 1994 for the presence of decayed, missing and filled teeth and fissure sealants. Restorative indices were calculated with and without the inclusion of sealants. The latter were compared with restorative indices calculated without the inclusion of sealants on regularly attending patients of the same age group when the dentists in the same three areas were working under fee-for-service in 1989.
The prevalence of fissure sealants increased between 1989 and 1994 from 16% to 30% in Wycombe, from 13% to 50% in Doncaster and from 25% to 47% in Hereford/Worcester. Without fissure sealants the restorative indices fell between 1989 and 1994 from a range of 76.5-94.4 to 63.3-87.1. When sealants were included in the restorative indices for 1994, they ranged from 79.5-92.9.
There were increases in the prevalences of fissure sealants between 1989-1994. When these sealants were included in the calculation of restorative indices for 1994, the level of restorative care provided by general dental practitioners remained relatively high since the introduction of capitation. Although there has been some increase in the level of untreated disease, if the restorative index is calculated without the inclusion of sealants then there is a risk of underestimating the treatment provided by general dental practitioners to control the carious process. Dentists appear to be redirecting their efforts into newer treatment/preventive items.
一项随机流行病学研究。
怀科姆、唐卡斯特和赫里福德/伍斯特地区的中学。
1994年，对在英格兰三个不同地区按人头付费执业的牙医治疗的14 - 15岁定期就诊患者随机抽样，检查其龋、失、补牙情况及窝沟封闭剂情况。分别计算纳入和不纳入窝沟封闭剂的修复指数。将后者与1989年同一三个地区的牙医按服务收费工作时，同一年龄组定期就诊患者不纳入窝沟封闭剂计算的修复指数进行比较。
1989年至1994年期间，怀科姆窝沟封闭剂的普及率从16%增至30%，唐卡斯特从13%增至50%，赫里福德/伍斯特从25%增至47%。不计算窝沟封闭剂时，1989年至1994年修复指数从76.5 - 94.4降至63.3 - 87.1。当窝沟封闭剂纳入1994年的修复指数计算时，其范围为79.5 - 92.9。
1989 - 1994年期间窝沟封闭剂的普及率有所上升。当这些封闭剂纳入1994年修复指数计算时，自实行按人头付费以来，普通牙科医生提供的修复治疗水平仍相对较高。尽管未治疗疾病水平有所上升，但如果不纳入窝沟封闭剂计算修复指数，则有低估普通牙科医生为控制龋病进程所提供治疗的风险。牙医似乎正将工作重点转向更新的治疗/预防项目。
