RESUMEN
Background: The reduction in dental caries seen between Irish national surveys of children's oral health in 1984 and 2002 was accompanied by an increase in the prevalence of enamel fluorosis. To minimise the risk of enamel fluorosis in Irish children, in 2007, the level of fluoride in drinking water was reduced from 0.8-1.0 ppm to 0.6-0.8 ppm fluoride. Recommendations on the use of fluoride toothpastes in young children were issued in 2002. Fluoride and Caring for Children's Teeth (FACCT) is a collaborative project between the Oral Health Services Research Centre, University College Cork and the Health Service Executive dental service, with funding from the Health Research Board. Aim: FACCT aims to evaluate the impact and the outcome of the change in community water fluoridation (CWF) policy (2007) on dental caries and enamel fluorosis in Irish schoolchildren, while also considering the change in policy on the use of fluoride toothpastes (2002). Methods/Design: A cross-sectional study with nested longitudinal study will be conducted in school year (SY) 2013-2014 by trained and calibrated dental examiners in primary schools in counties Dublin, Cork and Kerry for a representative sample of children born either prior to or post policy changes; age 12 (born 2001) and age 5, (born 2008). Five-year-olds will be followed-up when they are 8-year-olds (SY 2016-2017). The main explanatory variable will be fluoridation status of the children (lifetime exposure to CWF yes/no). Information about other explanatory variables will be collected via parent (of 5-, 8- and 12-year-olds) and child completed (8- and 12-year-olds only) questionnaires. The main outcomes will be dental caries (dmf/DMF Index), enamel fluorosis (Dean's Index) and oral health-related quality of life (OHRQoL). Multivariate regression analyses will be used to determine the impact and outcome of the change in CWF policy on oral health outcomes controlling for other explanatory variables.
RESUMEN
BACKGROUND: Valid estimation of dental treatment needed at population level is important for service planning. In many instances, planning is informed by survey data, which provide epidemiologically estimated need from the dental fieldworkers' perspective. The aim of this paper is to determine the validity of this type of information for planning. A comparison of normative (epidemiologically estimated) need for selected treatments, as measured on a randomly-selected representative sample, is compared with treatment actually provided in the population from which the sample was drawn. METHODS: This paper compares dental treatment need-estimates, from a national survey, with treatment provided within two choice-of-dentist schemes: Scheme 1, a co-payment scheme for employed adults, and Scheme 2, a 'free' service for less-well-off adults. Epidemiologically estimated need for extractions, restorations, advanced restorations and denture treatments was recorded for a nationally representative sample in 2000/02. Treatments provided to employed and less-well-off adults were retrieved from the claims databases for both schemes. We used the chi-square test to compare proportions, and the student's t-test to compare means between the survey and claims databases. RESULTS: Among employed adults, the proportion of 35-44-year-olds whose teeth had restorations was greater than estimated as needed in the survey (55.7% vs. 36.7%;p <0.0001). Mean number of teeth extracted was less than estimated as needed among 35-44 and 65+ year-olds. Among less-well-off adults, the proportion of 16-24-year-olds who had teeth extracted was greater than estimated as needed in the survey (27.4% vs. 7.9%;p <0.0001). Mean number of restorations provided was greater than estimated as needed in the survey for 16-24-year-olds (3.0 vs. 0.9; p <0.0001) and 35-44-year-olds (2.7 vs. 1.4;p <0.01). CONCLUSIONS: Significant differences were found between epidemiologically estimated need and treatment provided for selected treatments, which may be accounted for by measurement differences. The gap between epidemiologically estimated need and treatment provided seems to be greatest for less-well-off adults.