Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel.

BACKGROUND: To prevent child maltreatment, the identification of vulnerable children is essential. In Norway, public dental health personnel (PDHP) report suspicion of child maltreatment to child welfare services (CWS) at a relatively high rate. However, their reasons for reporting and the response from CWS have not been investigated. The objectives of this study were to (1) explore the reasons that PDHP send reports of concern, (2) examine how CWS responds to PDHP reports, and (3) assess whether different reasons for concern are associated with a given response from CWS. METHODS: A national cross-sectional study was conducted by an electronic survey distributed to public dental hygienists and dentists in Norway. Descriptive statistics were calculated in terms of mean (SD) distributions and frequency, expressed as % (n). To account for clustering of responses among respondents, binomial generalized estimating equation analysis was used to estimate odds ratios (ORs) and confidence intervals (CIs) of CWS responses across number of reports with different reasons for concern. RESULTS: Of a total of 1542 questionnaire recipients, 1200 (77.8%) responded to the survey. From 2012 to 2014, 42.5% of the respondents sent 1214 reports to CWS, with a mean number of 2.7 (SD = 2.0) reports per respondent. The PDHP sent the reports due to suspicion of neglect or physical, sexual and/or psychological abuse. Non-attendance at dental appointments and grave caries were reported most frequently. Among the reports, 24.5% resulted in measures being taken by CWS, 20.7% were dropped, and 29.4% lacked information from CWS on the outcome. Reports due to suspicion of sexual abuse, (OR 1.979, 95% CI (1.047-3.742), P = 0.036), grave caries (OR 1.628, 95% CI (1.148-2.309), P = 0.006), and suspicion of neglect (OR 1.649, 95% CI (1.190-2.285), P = 0.003) had the highest association with the implementation of measures. CONCLUSIONS: PDHP report on several forms of child maltreatment and contributes in detection of victimized children. However, the relatively low number of measures being taken by CWS and the number of reports that lack a response to reporters reveal a need for a closer cooperation between the services, as this would benefit both the children at risk and the services.

Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey.

OBJECTIVE: Detecting and responding to child-maltreatment is a serious challenge and public health concern. In Norway, public dental health personnel (PDHP) have a mandatory obligation to report to child welfare services (CWS) if they suspect child-maltreatment. This study aimed to assess PDHP's frequency of reporting and failing to report to CWS and whether the frequencies varied according to personal, organizational and external characteristics. MATERIAL AND METHODS: An electronic questionnaire was sent to 1542 public dental hygienists and dentists in Norway, 1200 of who responded (77.8%). RESULTS: The majority 60.0%, reported having sent reports of concern to CWS throughout their career, 32.6% had suspected child-maltreatment but failed to report it in their career and 42.5% had sent reports during the three-year period from 2012 to 2014. The reporting frequency to CWS was influenced by PDHP's personal, organizational and external characteristics, while failure to report was influenced by personal characteristics. CONCLUSIONS: Compared to international studies, PDHP in Norway sends reports of concern and fails to report to CWS at relatively high rates. PDHP's likelihood of reporting was influenced by age, working experience, number of patients treated, size of the municipality and geographical region, while failure to report to CWS was influenced by working experience.

[Reimbursement of public dental care in Germany, the United Kingdom, Hungary and Poland]. / A fogászati ellátás finanszírozása Németországban, az Egyesült Királyságban, Magyarországon és Lengyelországban.

INTRODUCTION: Dental treatments have the highest rate among medical interventions and their reimbursement is also significant. AIM: The aim of the study was to compare the outcome of the reformed healthcare system process on public dental services in four European countries. METHOD: Assessment base for the comparison of reimbursement of dental treatments and dental fee schedules provided by the health insurance funds were used. The following indicators were examined: the ratio of public dental services and the main oral health indicators. Among dental fee schedules, reimbursement of general dental activity, prevention, operative dentistry, endodontic and oral surgery were selected. RESULTS: The lowest value of population to active dentist ratio was found in Germany (population to active dentist ratio: 1247) and the highest in Hungary (population to active dentist ratio: 2020). Oral health indicators showed significant differences between the West-European and East-European countries. On the other hand, the ratio of completely edentulous people at the age of 65yrs did not show great variations. Reimbursement of public dental treatments indicated significantly higher value in Germany and the United Kingdom compared to the other countries. CONCLUSIONS: Reimbursement of public dental services varies considerably in the selected European countries.

The oral health of seniors in Brazil: addressing the consequences of a historic lack of public health dentistry in an unequal society.

OBJECTIVE: National epidemiological data on the oral health of elders was analysed to examine relationships between the need for oral treatment and external environment, the dental care delivery system, personal characteristics and subjective conditions of oral health. BACKGROUND: Brazil's universal public healthcare system is theoretically responsible to provide dental care to Brazilians of all ages. However, as dentists were integrated into public primary care facilities only in 2000, Brazilian seniors have accumulated needs. MATERIALS AND METHODS: Seniors (65-74 years old) were examined and interviewed by calibrated professionals. The association of overall need for oral treatment and component factors were analysed. Associations with socio-demographic factors and self-reported attitudes and behaviours were also calculated. RESULTS: A total of 85.9% of Brazilian seniors demonstrated a need for some oral treatment, 83.8% of the dentate needed periodontal treatment and 57.3% of all seniors needed full or partial prostheses. Social inequalities were also evident as Brazilians using free oral care services demonstrated a higher degree of need, as did elders who had not previously accessed dental services, nonwhites and males. CONCLUSIONS: Our findings demonstrate that the elderly population in Brazil has a very high degree of need in general and that certain subgroups have been especially vulnerable to oral disease.

Adverse events in Public Dental Service in a Swedish county--a survey of reported cases over two years.

Adverse events cause suffering and increased costs in health care. The main way of registering adverse event is through dental personnel's reports, but reports from patients can also contribute to the knowledge of such occurrences. This study aimed to analyse the adverse events reported by dental personnel and patients in public dental service (PDS) in a Swedish county. The PDS has an electronic system for reporting and processing adverse events and, in addition, patients can report shortcomings, as regards to reception and treatment, to a patient committee or to an insurance company. The study material consisted of all adverse events reported in 2010 and 2011, including 273 events reported by dental personnel, 53 events reported by patients to the insurance company and 53 events reported by patients to the patient committee. Data concerning patients' age and gender, the nature, severity and cause of the event and the dental personnel's age gender and profession were collected and analysed. Furthermore the records describing the dental personnel's reports from 2011 were studied to investigate if the event had been documented and the patient informed. Age groups 0 to 9 and 20 to 39 years were underrepresented while those between the ages 10 to 19 and 60 to 69 years were overrepresented in dental personnel's reports. Among young patients delayed diagnosis and therapy dominated and among patients over 20 years the most frequent reports dealt with inadequate treatments, especially endodontic treatments. In 29% of the events there was no documentation of the adverse event in the records and 49% of cases had no report about patient information. The majority of the reports from dental personnel were made by dentists (69%). Reporting adverse events can be seen as a reactive way of working with patient safety, but knowledge about frequencies and causes of incidents is the basis of proactive patient safety work.

Preventive and clinical care provided to adolescents attending public oral health services New South Wales, Australia: a retrospective study.

BACKGROUND: Dental Therapists and Oral Health Therapists (Therapists) working in the New South Wales (NSW) Public Oral Health Service are charged with providing clinical dental treatment including preventive care for all children under 18 years of age. Adolescents in particular are at risk of dental caries and periodontal disease which may be controlled through health education and clinical preventive interventions. However, there is a dearth of evidence about the type or the proportion of clinical time allocated to preventive care.The aim of this study is to record the proportion and type of preventive care and clinical treatment activities provided by Therapists to adolescents accessing the NSW Public Oral Health Service. METHODS: Clinical dental activity data for adolescents was obtained from the NSW Health electronic Information System for Oral Health (ISOH) for the year 2011. Clinical activities of Therapists were examined in relation to the provision of different types of preventive care for adolescents by interrogating state-wide public oral health data stored on ISOH. RESULTS: Therapists were responsible for 79.7 percent of the preventive care and 83.0 percent of the restorative treatment offered to adolescents accessing Public Oral Health Services over the one year period. Preventive care provided by Therapists for adolescents varied across Local Health Districts ranging from 32.0 percent to 55.8 percent of their clinical activity. CONCLUSIONS: Therapists provided the majority of clinical care to adolescents accessing NSW Public Oral Health Services. The proportion of time spent undertaking prevention varied widely between Local Health Districts. The reasons for this variation require further investigation.

The objective and subjective outcome of orthodontic care in one municipal health center.

OBJECTIVE: The aim of this study was to assess the outcome of orthodontic care in one municipal health center. MATERIALS AND METHODS: The material consisted of one age-cohort of 15-16 year-old adolescents (n = 67). Of them, 97% participated in a clinical examination. The final group included in the study consisted of 61 adolescents (91% of the whole age cohort). The occlusions were evaluated applying the Occlusal Morphology and Function Index (OMFI), the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Moreover, all adolescents filled in a semi-structured questionnaire enquiring about their satisfaction with the function and appearance of their own dentition and self-perceived orthodontic treatment need. They also scored their own dental appearance on a Visual Analog Scale (VAS). RESULTS: Of the adolescents, 42% had received orthodontic treatment, while 58% were untreated. All morphological criteria of the OMFI were met by 58% of orthodontically treated and 49% of untreated adolescents and all functional criteria by 67% and 57%, respectively. Treatment need was registered in two of the treated adolescents (7%) and five of the untreated adolescents (14%). Treated adolescents were more often satisfied with their dental appearance than untreated adolescents (p = 0.034). In both groups, satisfaction with the function was high (93%). CONCLUSIONS: Orthodontic treatment seems to improve both occlusal morphology and function. The high satisfaction with one's own dental appearance among the treated adolescents is worth noting.

The burden of early childhood caries in the Western Cape Public Service in relation to dental general anaesthesia: implications for prevention.

INTRODUCTION: Multiple extractions under Dental General Anaesthesia (DGA) are frequently performed on pre-school children treated in the public sector in the Western Cape. There s a need to examine current public health strategies in relation to Early Childhood Caries (ECC) in order to provide a framework for both the improvement of treatment and the prevention of ECC in general. METHODS: This retrospective descriptive study reviewed the records on the Department of Health (DoH) database of 16 732 pre-school patients treated under Dental General Anaesthesia over a three year period. RESULTS: Of the 58 255 procedures recorded for these preschool patients in the district health clinics in the Western Cape, 99.94% were for extractions and 0.0001 for restorations. The average rate of DGA per 1000 of the population was 1.06. Only 9% (i.e.: 2/22) of dentists at district clinics reported that pre-DGA prevention was provided. CONCLUSION: The demand for DGA was found in this study to be relatively high and the associated treatment was almost exclusively by means of extractions. The lack of preventive measures could possibly result in a need for retreatment under DGA. Therefore, preventive guidelines are recommended for use in the Public Service.

Changes in the treatment concept for approximal caries from 1983 to 2009 in Norway.

The aim was to measure variations in threshold for operative treatment of approximal caries in permanent teeth and the use of restorative materials, compared with results from studies conducted in Norway in 1983 and 1995. In 2009, a precoded questionnaire was sent electronically to 3,654 dentists with E-mail addresses in the member register of the Norwegian Dental Association. The questions were related to caries, treatment strategies and choice of dental materials. Replies were obtained from 61% of the dentists after two reminders. Restorative treatment of approximal lesions confined to enamel, based on radiographic appearance, was proposed by 7% of the dentists, compared with 66% in 1983 and 18% in 1995. Younger dentists, significantly more often than older, would defer operative treatment of approximal lesions until the lesion was visible in dentine. While tunnel preparation most often was the preparation of choice in 1995 (47%), saucer-shaped preparation was most favoured in 2009 (69%). Tunnel preparation was only preferred by 4% of the dentists. Resin composite was the restorative material preferred by 95%, compared with 16% in 1995. The corresponding values for conventional glass ionomer cement (GIC) were 1 versus 22%, for resin-modified GIC 1 versus 7%, and for a combination of GIC and resin composite 2 versus 22%. Compomer was preferred by 1% of the respondents. The authors conclude that treatment concepts for approximal caries have changed considerably during the last 26 years. In 2009, only 7% of dentists reported that they would treat approximal caries operatively before the lesion reached dentine.

Strategies for caries risk assessment in children and adolescents at public dental clinics in a Swedish county.

BACKGROUND: Since caries prevalence has decreased and become polarized, high-risk preventive strategies have been widely adopted. The underlying factors leading to assessment and management of caries risk are poorly understood. AIM: The aim of this study was to identify the factors forming the basis for dentist's caries risk assessment in dental care for children and adolescents. DESIGN: From all 3372 children in a Swedish county identified as at high risk for developing caries, a sample of dental records from 432 children, aged 3-19 years, were randomly selected to be analysed in the study. Information about medical and social history, dental status, dietary habits, oral hygiene, and salivary data was obtained from the records. RESULTS: The results show that the only data registered in the majority of the dental records were dental status from the clinical examination and bitewing radiographs. In approximately half of the dental records, medical history and data concerning oral hygiene were registered. Dental history and dietary habits were noted in approximately 25% of the dental records, whereas other risk factors/indicators were occasionally registered. CONCLUSIONS: Dentists mainly base their caries risk assessments on past caries experience, a reliable risk indicator for assessing the risk of being affected by caries again. In children with no experience of caries, knowledge of other risk factors/indicators needs to be available to perform a caries risk assessment. In this study, documentation of such knowledge was strongly limited.

[The dental aspects of public health in Hungary. Review article]. / Magyarország népegészségügyi helyzetének fogorvosi vonatkozásai. Osszefoglaló közlemény.

Despite great improvements in the oral health status of the population, public health and dental public health continue to be a major problem in society. A number of epidemiologic studies revealed the importance of the social, behavioral and environmental factors contributing to inequalities in the maintenance and restoration of oral health. Dental public health is the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organized efforts of the public. The aim of the authors was to provide an overview about the development and the functions of the Hungarian public health and dental public health system, its associations with international dental public health organizations and about the present dental public health status of the Hungarian population. According to WHO pathfinder studies, the Hungarian population has a usual cariologic and periodontal status in Europe, but a number of WHO statistical analyses reveal the sad situation regarding the high frequency of oral malignancies in our country. The social support system is given, the tasks are in front of us, and Hungary intends to follow the oral health strategies of the WHO for 2020 in order to improve the dental public health status of the nation, but it is necessary to declare that not only behavioral but also political decisions are necessary for that goal.

[Presence of Specialized Dentistry Centers and the relationship with dental extractions in the oral healthcare network in Brazil]. / Presença de Centros de Especialidades Odontológicas e sua relação com a realização de exodontias na rede de atenção de saúde bucal no Brasil.

This study aimed to assess the association between the presence of Specialized Dentistry Centers and dental extractions as a proportion of all dental procedures in public services in Brazil. This was an ecological study that assessed sociodemographic data, oral health services, and outpatient production in 5,333 municipalities in 2000-2001 and 2015-2016. The principal exposure variable was the presence of Specialized Dentistry Centers, and the outcome was the mean national proportion of dental extractions in relation to all preventive and curative dental procedures. Interaction and multiple regression analyses were performed using a binomial model with log link function. The mean national proportions of dental extractions in relation to preventive and curative dental procedures were 27.07% and 15.11% in 2000-2001 and 2015-2016, respectively. In the analysis of interaction between the presence of Specialized Dentistry Centers and coverage greater than 80% by the oral health teams, there were lower proportions of dental extractions in relation to preventive and curative dental procedures (OR = 0.71; 95%CI: 0.71-0.72). In the multiple regression analysis, municipalities with Human Development Index of 0.6-0.7 (OR = 0.77; 95%CI: 0.77-0.77), annual per capita GDP greater than BRL 20,000 (OR = 0.45; 95%CI: 0.45-045), and proportionally higher urban populations (OR = 0.72; 95%CI: 0.72-0.72) showed fewer dental extractions as a proportion of all preventive and curative dental procedures in 2015-2016. In conclusion, there were lower proportions of tooth extractions in municipalities with at least one Specialized Dentistry Center and with a coverage of greater than 80% by the oral health teams, highlighting that municipalities with a consolidated Oral Health Care Network present better performance in the supply of dental care.

Objetivou-se avaliar a associação entre presença de Centros de Especialidades Odontológicas (CEO) e a proporção de exodontias em relação ao total de procedimentos odontológicos em serviços públicos do Brasil. Trata-se de um estudo ecológico, em que foram avaliados dados sociodemográficos, dos serviços de saúde bucal e produção ambulatorial de 5.333 municípios nos biênios de 2000/2001 e 2015/2016. A principal variável de exposição foi a presença de CEO, e o desfecho a média nacional da proporção de exodontias em relação ao número de procedimentos odontológicos preventivos e curativos. Foram realizadas análises de interação e regressão múltipla usando modelo binomial com função de ligação logito. A média nacional da proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos foi 27,07% e 15,11% em 2000/2001 e 2015/2016, respectivamente. Na análise de interação entre a presença de CEO e a cobertura superior a 80% de equipes de saúde bucal (ESB), houve menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos (OR = 0,71; IC95%: 0,71-0,72). Na análise de regressão múltipla, municípios com Índice de Desenvolvimento Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), Produto Interno Bruto per capita maior que 20 mil Reais (OR = 0,45; IC95%: 0,45-045) e maior população residente em zona urbana (OR = 0,72; IC95%: 0,72-0,72) apresentaram menor proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos em 2015/2016. Conclui-se que ocorreram menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos em municípios com ao menos um CEO e com mais de 80% de cobertura de ESB, o que aponta que municípios com Rede de Atenção à Saúde Bucal consolidada têm melhor desempenho na oferta de cuidados odontológicos.

Este trabajo tuvo el objetivo de evaluar la asociación entre la presencia de Centros de Especialidades Odontológicas (CEO) y su proporción de exodoncias, en relación con el total de procedimientos odontológicos en los servicios públicos de Brasil. Se trata de un estudio ecológico, en que se evaluaron datos sociodemográficos, servicios de salud bucal y atención ambulatoria en 5.333 municipios, durante los bienios de 2000/2001 y 2015/2016. La principal variable de exposición fue la presencia de CEO y el resultado la media nacional de la proporción de exodoncias, respecto al número de procedimientos odontológicos preventivos y curativos. Se realizó tanto un análisis de interacción, como de regresión múltiple, usando un modelo binomial con función de vinculación logit. La media nacional de la proporción de exodoncias, en relación con los procedimientos odontológicos preventivos y curativos, fue 27,07% y 15,11% en 2000/2001 y 2015/2016, respectivamente. En el análisis de interacción entre la presencia de CEO y la cobertura superior a un 80% de equipos de salud bucal (ESB) hubo menores proporciones de exodoncias, en relación con los procedimientos odontológicos preventivos y curativos (OR = 0,71; IC95%: 0,71-0,72). En el análisis de regresión múltiple, los municipios con un Índice de Desarrollo Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), PIB per cápita mayor que BRL 20.000 (OR = 0,45; IC95%: 0,45-045) y mayor población residente en zona urbana (OR = 0,72; IC95%: 0,72-0,72) presentaron una menor proporción de exodoncias, respecto a los procedimientos odontológicos preventivos y curativos en 2015/2016. Se concluye que hubo menores proporciones de exodoncias, en lo que respecta a los procedimientos odontológicos preventivos y curativos en municipios con al menos un CEO, y con más de un 80% de cobertura de ESB, lo que apunta a que los municipios con una Red de Atención a la Salud Bucal consolidada tienen un mejor desempeño en la oferta de cuidados odontológicos.

Dental service patterns among private and public adult patients in Australia.

BACKGROUND: While the majority of dental care in Australia is provided in the private sector those patients who attend for public care remain a public health focus due to their socioeconomic disadvantage. The aims of this study were to compare dental service profiles provided to patients at private and public clinics, controlling for age, sex, reason for visit and income. METHODS: Data were collected in 2004-06, using a three-stage, stratified clustered sample of Australians aged 15+ years, involving a computer-assisted telephone interview (CATI), oral examination and mailed questionnaire. Analysis was restricted to those who responded to the CATI. RESULTS: A total of 14,123 adults responded to the CATI (49% response) of whom 5,505 (44% of those interviewed) agreed to undergo an oral epidemiological examination. Multivariate analysis controlling for age, sex, reason for visit and income showed that persons attending public clinics had higher odds [Odds ratio, 95%CI] of extraction (1.69, 1.26-2.28), but lower odds of receiving oral prophylaxis (0.50, 0.38-0.66) and crown/bridge services (0.34, 0.13-0.91) compared to the reference category of private clinics. CONCLUSION: Socio-economically disadvantaged persons who face barriers to accessing dental care in the private sector suffer further oral health disadvantage from a pattern of services received at public clinics that has more emphasis on extraction of teeth and less emphasis on preventive and maintenance care.

Identification and description of mobile dental programs--a brief communication.

OBJECTIVES: The purpose of this study was to identify and describe mobile dental programs in California. METHODS: The programs were identified by Internet searches, county health officers, local dental society directors, mobile program directors, and others. A cross-sectional survey was mailed to program directors if their programs provide clinical dental services beyond screening and education. RESULTS: In California, 33 programs were identified; survey response rate was 70 percent. The populations most likely to be served were those with low-income (100 percent), elementary (77 percent) and preschool (68 percent) children, non-English speakers (64 percent), and the Medicaid-eligible (64 percent). At least half of the programs were providing services in designated Dental Health Professional Shortage Areas. Most program directors indicated that if their program was discontinued, it would be "very difficult" (61 percent) or "difficult" (35 percent) for the target populations to get dental services. CONCLUSIONS: Mobile dental programs are a highly variable, but important, strategy for bringing dental care to many underserved populations.

Endodontic treatment in young permanent teeth. Prevalence, quality and potential risk factors.

National epidemiologic data on oral health in children and adolescents in Sweden are restricted to caries, such as the number of decayed and filled teeth (DFT) and decayed and filled surfaces (DFS). Information about more complicated and time-consuming procedures such as endodontic treatment is scarce. The aims were to study the prevalence, quality and potential risk factors for endodontic treatment in young permanent teeth. The material consisted of dental records and radiographs. The subjects were all 19-year-olds born in 1979 (paper I-III) and all 15-year-olds born in 1990 (paper IV) belonging to the public dental clinics in Malmo. Paper III also included a control group.

Frequency and distribution patterns of sealants among 15-year-olds in Denmark in 2003.

AIMS: To provide information on the frequency and distribution patterns of sealants in the Public Dental Health Service for Children (PDHSC) in Denmark. A further aim was to determine whether there was a correlation between DMF-S and sealants. DESIGN: A cross sectional survey using data from 15-year-old Danes in 2003. SAMPLE AND SUBJECTS: The sample consisted of 50 randomly selected municipalities from the 204 municipalities with public clinics. Thirty-nine municipalities (78%) forwarded useful data. A total number of 3,184 15-year-olds were involved in the study. RESULTS: The mean DMF-S was 2.97 (SD = 1.40) and 42% had a DMF-S = 0. The mean number of sealants was 3.06 (SD = 1.60). Two-thirds of all participants had one or more sealed surfaces. At the individual level the correlation coefficient (rs) between sealants and DMF-S was -0.05 (p < 0.01). The mean number of sealants in one municipality was 0.26, in another 6.00. The surfaces most often sealed, were the occlusal surfaces on permanent second molars (35%), closely followed by the occlusal surfaces on permanent first molars (32%). Sealants on premolars were rare (1.5%). At the municipality level there was no significant correlation between mean DMF-S, % 15-year-olds with a DMF-S = 0 and mean number of sealants (rs = 0.02 (p = 0.90) and rs = 0.06 (p = 0.73), respectively). CONCLUSION: The data indicate a high use of sealants on molar teeth, a very large inter-municipality variation, no correlation between sealants and DMF-S. These findings suggest that there are no clear guidelines for use of sealants in the PDHSC in Denmark.

[Dental health in German and Turkish school children--a 10-year comparison]. / Zahngesundheit deutscher und türkischer Schüler--Ein 10-Jahresvergleich.

The purpose of this cross-sectional study was to assess the changes in dental health in 12- and 15-year-old Turkish immigrants and German students who were included in a school-based caries-preventive programme for ten years (1993-2003). In 1993 352 and 402 12- and 15-year-olds and in 2003 352 and 402 12- and 15-year-olds were investigated, respectively. 23.6% of the 12-year-olds and 21.5% of the 15-year-olds were of Turkish origin. The clinical examination was performed with support of artificial light at school. Caries was diagnosed according to the WHO standard using the DMFT Index for permanent dentition. Within the ten-year period the highest increment of caries-free dentitions was found in 12- and 15-year old Germans attending grammar schools with 41,5% and 27% and secondary modern schools with 22,3% and 17%, respectively. The proportion of caries-free Turkish students attending secondary modern schools, only increased imperceptible in both age groups (1.2%). A significant caries decline of 1.5 DMFT was observed in 12-year old Germans at grammar schools, only. In 15-year olds caries declined in German students at secondary modern schools (2.5 DMFT), and at Grammar schools (2.2 DMFT), significantly, however caries experience in Turkish students remained nearly unchanged (0.3 DMFT). A strong polarisation of dental caries was found in 2003. Among the 12-year-olds 23% of those at secondary modern school accumulated 70% of the total caries experience (>3 DMFT) and at grammar school 9% of students accumulated 76% of the whole amount of caries (>1 DMFT). Among the 15-year-olds 73% of the total caries experience (>3 DMFT) was concentrated in 32% of the students at secondary modern schools, while 25% of the students at grammar schools exhibited 84% of the whole amount of caries (>1 DMFT). Intended concepts in caries prevention in the future should aim to improve dental health especially in Turkish students at secondary modern schools while taking social inequality of this risk group into account.

Oral health service systems in Gauteng Province, South Africa.

OBJECTIVES: To describe the provision of restorative care and dental operators' opinion about their conditions of service in a South African provincial oral health service system. DESIGN: Assessment of oral health service over a four-month period. SETTING: Gauteng Province, South Africa. SUBJECTS: Dental operators in public oral health service. INTERVENTIONS: Operator interview, collection of treatment statistics, calculation of the mean score of restoration-extraction ratio per operator. MAIN OUTCOME MEASURES: Number and type of restorations and tooth extractions rendered, daily patient load, perceived occupational stress level and opinion about main reasons for operator stress. RESULTS: A total of 88,705 patients had been treated. The mean number of patients treated daily was 26 (SD = 8.4). Operators extracted 39,242 teeth and placed 2992 restorations. The main type of dental treatment was extraction. The mean score of the restoration-extraction ratio per operator was 0.09 in the primary, and 0.07 in the permanent dentition. The mean level of stress was 4.9 (SD = 1.9). The majority of operators regarded patients' high dental anxiety as the main reason for stress, followed by high patient load. The mean level of stress increased with the increase in number of patients treated per day (r = 0.44, p = 0.004) and also with the increase in the number of tooth extractions performed per day (r = 0.41, p = 0.008). CONCLUSIONS: Restorative dental care in this public oral health service is limited, tooth extraction being the predominant treatment provided. High patient load and high patient levels of dental anxiety determine this situation, according to the operators. The health authority should introduce appropriate solutions in order to address the prevailing situation adequately.

Dental treatment for disabled children in the Spanish Public Health System.

The Spanish Public Health System is stepping up its efforts to meet all the medical needs of the population. Oral health is of increasing interest for society, especially for parents who are keen for their children to have healthy teeth. Disabled children with both physical and mental disabilities do not always receive the dental care they need. The purpose of this bibliographical review is to evaluate the services provided by the Spanish Public Health System to such children. We have noted marked differences in the types of dental treatment given to these patients in the different Autonomous Communities of Spain. Some, such as Asturias, Navarra and Extremadura, offer specific care for disabled children. Others, such as Ceuta and Melilla, provide more general care.