Tubert-Jeannin S, Morel-Papernot A, Woda A
Laboratory of Oral Preventive Medicine, School of Dentistry, University of Clermont-Ferrand, France.
Community Dent Oral Epidemiol. 1998 Aug;26(4):272-82. doi: 10.1111/j.1600-0528.1998.tb01961.x.
Usually, the French dental insurance system covers the cost of restorative treatment but does not reimburse the cost of preventive therapies. A French sick-fund covering self-employed persons tested a new dental benefit plan for children intended to provide an incentive to develop office-based preventive activities. The programme, which started in 1992, concerns all 4-year-old children of self-employed workers in a single French region (Auvergne). Participants undergo an annual examination by the dentist of their choice until their 15th birthday. If the child is seen every year, all services related to dental caries (preventive and restorative) are provided free of charge. An ongoing evaluation of the programme was necessary to determine its influence on the development of office-based preventive activities and the dental health of the participants. A cohort of children enrolled in the programme in 1992 was followed over 4 years to examine the patterns of service use. In addition, a cross-sectional study comparing the caries experience of all 8-year-old children participating continuously in the programme (test sample) with that of a sample of control children (n=90) was conducted in 1996. Data from the longitudinal follow-up indicate that 43.37% of the 551 children to whom the programme was offered in 1992 underwent an annual examination in the first year. Of the children enrolled in 1992, 55.2% were still participating in the programme in 1996. Results showed that independent practitioners continued to focus on restorative treatment rather than preventive therapy. Results from the cross-sectional study are in accordance with this trend. The number of caries-free children was identical in test and control samples and the mean dft, DMFT, DT and dt did not vary between the two groups (Student's t-test, P>0.05). However the mean number of filled teeth was significantly higher in the test children than in the controls (P<0.01). For children with caries, the mean dft was 23.5% greater in the test group than in the control group (P<0.05). In Auvergne, a large number of families were not ready to participate in a plan that required them to take their child to the dentist every year. There was not a perceived need for regular preventive dental care, an attitude probably reinforced by the interventionist approach undertaken by the dentists over the survey period. Moreover, the plan did not provide an incentive for dentists to develop office-based preventive activities.
通常，法国的牙科保险系统涵盖修复治疗费用，但不报销预防性治疗费用。一个覆盖个体经营者的法国疾病基金组织对一项针对儿童的新牙科福利计划进行了测试，该计划旨在激励开展基于诊所的预防性活动。该计划于1992年启动，涉及法国一个地区（奥弗涅）所有个体经营者4岁的子女。参与者可选择自己的牙医进行年度检查，直至年满15岁。如果孩子每年都接受检查，所有与龋齿相关的服务（预防性和修复性）都将免费提供。有必要对该计划进行持续评估，以确定其对基于诊所的预防性活动发展以及参与者口腔健康的影响。对1992年参加该计划的一组儿童进行了4年的跟踪，以研究服务使用模式。此外，1996年进行了一项横断面研究，比较了持续参加该计划的所有8岁儿童（测试样本）与对照组儿童样本（n = 90）的龋齿经历。纵向随访数据表明，1992年该计划所覆盖的551名儿童中，43.37%在第一年接受了年度检查。在1992年登记参加该计划的儿童中，55.2%在1996年仍在参与该计划。结果显示，个体从业者继续将重点放在修复治疗而非预防性治疗上。横断面研究的结果也符合这一趋势。测试样本和对照样本中无龋儿童的数量相同，两组之间的平均龋失补牙数（dft、DMFT、DT和dt）没有差异（学生t检验，P>0.05）。然而，测试组儿童的平均补牙数显著高于对照组（P<0.01）。对于有龋齿的儿童，测试组的平均龋失补牙数比对照组高23.5%（P<0.05）。在奥弗涅，大量家庭不愿意参加一项要求他们每年带孩子去看牙医的计划。人们没有意识到定期进行预防性牙科护理的必要性，这种态度可能因调查期间牙医采取的干预方式而得到强化。此外，该计划没有激励牙医开展基于诊所的预防性活动。
