Frequency and type of tooth extractions in adults vary by age: register-based nationwide observations in 2012-2017.

OBJECTIVE: This register-based study assessed the frequency of and age-specified variation in tooth extractions in adults visiting private dentists in Finland in 2012-2017. MATERIAL AND METHODS: Retrospective study design was used on the register-based data of private sector services. Data of the entire 6 years, 2012-2017, included records of a total of 6,252,039 patients. From among these, further detailed information was gathered in 2012 for 1,058,305 patients, and in 2017, for 985,043 patients. For each 6 years, the data were aggregated into patients' 5-year age groups that were observation elements. Proportions of patients undergoing oral surgical treatments were compared during the 6 years 2012-2017, and details of tooth extractions in 2012 and 2017. Linear regression modelling was used to analyse thinkable age- and year-related inclinations in oral surgical treatments. RESULTS: Across the 6 years, a total of 848,362 patients (13.6%) underwent oral surgical treatments, and the rates varied by year 13.3-13.8%. By age group, the smallest rates (9-10%) were for 35-49-year-olds and greatest (20-22%) for those aged below 25 or over 84. The rates in same-age groups were stable. In 2012 and 2017, mean numbers of tooth extractions per patient by year were 0.17 and 0.18, and per patients undergoing oral surgical treatments, 1.29 and 1.27, respectively. Proportion of patients undergoing oral surgical treatments and mean number of tooth extractions per patient was greater in younger and older age groups. CONCLUSIONS: Tooth extractions in adults are age-dependent and age-specified differences remain stable across the years.

Why and when older people lose their teeth: A study of public healthcare patients aged 60 years and over in 2007-2015.

OBJECTIVES: This register-based study on public sector patients aged 60 years and over assessed annual age-specific volume of and reasons for tooth extractions as well as changes in these across the period 2007-2015. BACKGROUND: Alongside the rapidly ageing population, the demand for public oral healthcare services is growing. Damaged teeth may induce a long-lasting inflammation burden in old age. MATERIALS AND METHODS: Data used the electronic documentation of oral healthcare procedures recorded according to healthcare regulation. The study population consisted of all patients over 60 years of age (n = 216 059) who were treated 2007-2015 in public oral health care available to all citizens of Helsinki, Finland. Data for the 9-year time series included reasons for tooth extractions and were aggregated by patient age into 5-year groups. Statistical analyses included rates and proportions, mean values, correlation coefficients and linear regression modelling. RESULTS: Extraction patients (n = 48 623) were more likely in the older age groups: 21.8% in the age group 60-64 and 27.5% in the age group 90+. Mean number of tooth extractions among all patients was 0.4 per patient and 1.7 per extraction patient. Among all tooth extractions (n = 82 677), main reasons were caries 29.5%, apical periodontitis 19.4%, tooth remnant 19.4% and periodontitis 18.0%. Tooth remnant predominated as extraction reason in the oldest age groups, while apical periodontitis displayed an upward trend by calendar year. CONCLUSION: Tooth extractions attributable to caries were common in all old-age groups, tooth remnant extractions were most common in older age groups, and apical periodontitis abounded as extraction reason during 2007-2015.

Retained dental roots of adults: A nationwide population study with panoramic radiographs.

The aim of this study was to assess the occurrence and nature of retained dental roots and their associations with demographics in the Finnish adult population. From the cross-sectional nationwide Health 2000 Survey of the Finnish population aged 30 years and older, 6005 participants with clinical oral examination and panoramic radiographs were included. Occurrence and characteristics of all retained dental roots were examined. Statistical analyses included χ2 , Kruskal-Wallis and Mann-Whitney U tests, and SAS-SUDAAN calculations. The mean age of the 6005 participants (46% men and 54% women) was 53 (SD 14.6) years. At least one retained dental root was observed in 13% (n = 754) of the participants. The 1350 retained roots included 461 (34%) roots retained entirely in bone and 889 (66%) partly in bone. The most common location of a retained dental root was the third molar region. Occurrence of retained roots partly in bone was associated with male sex and lower education. Occurrence of retained third molar roots entirely in bone was associated with female sex, younger age, higher education, and living in a city. Among all retained dental roots, the preponderance of third molars emphasized the demanding nature of extracting the third molar in women.

Varying Manpower Alters Dental Health in a Developing Health Care System.

OBJECTIVES: This study assessed relationships between oral health care workforce and dental health in 12-year-olds in a developing health care system in Iran from 1992 to 2014 and compared these findings with the most recent corresponding findings in selected countries. METHODS: Data regarding oral health care workers from 1962 to 2014 were extracted from the comprehensive human resource data bank of the Shahid Beheshti Research Institute of Dental Sciences. Data regarding decayed, missing, and filled permanent teeth (DMFT) of 12-year-olds, extracted from official statistics, described dental health. Comparisons with other countries utilised the database of the World Health Organization. Changes in the DMFT index with fluctuations in the number of oral health care workers were investigated using exploratory data analysis methods. Associations of DMFT with the density of the oral health care workforce were evaluated using a multiple linear regression model. RESULTS: The trend in supply of dental workforce in Iran began to expand in the 1970s and, after a reduction in 2003 to 2007, reached a peak by 2014. Means of DMFT indices of 12-year-olds in Iran fluctuated between 1.50 and 2.40 from 1992 to 2014. The relationship between the dentist to population ratio and the DMFT index of 12-year-olds showed a downwards trend (r = -0.994; P < .001) until 1998 and afterwards an upwards trend (r = 0.887; P < .001). Globally, the DMFT index decreased in countries with a preventively-oriented oral health care workforce. CONCLUSIONS: Increased numbers of dentists have no significant impact on improving dental health in 12-year-olds. To promote dental health, the system providing health services should implement a preventively-oriented approach when planning for the oral health workforce.

Compliance with Key Practices of Root Canal Treatment Varies by the Reward System Applied in Public Dental Services.

INTRODUCTION: To assess clinical practices in root canal treatments (RCTs) performed by general dental practitioners under 2 different reward schemes applied in public dental services. METHODS: This study used a retrospective design with tooth as the observation unit. The data included all teeth (n = 547) with nonsurgical primary RCT completed in 2016. Electronic documents included treatment details and radiographs. RCT assessment covered 4 key items: taking pre- and postoperative radiographs, using a rubber dam, measuring working length. Assessed dichotomies indicated whether practices were adequate. Dentists' reward schemes were "salaried" and "fee-for-service." Chi squared tests analyzed frequency differences. RESULTS: RCTs formed 2 groups by the reward scheme: 305 RCTs were performed by salaried dentists and 242 by fee-for-service dentists. Preoperative radiographs were diagnosable for 76.1% and postoperative radiographs, for 95.1% of all RCTs. Rubber dam use was documented for 28.9% of the RCTs, more frequently when performed by salaried than by fee-for-service dentists (43.9% vs 9.9%, P < .001). Working length measurement was documented for 72.9% of the RCTs, more frequently for RCTs performed by salaried than by fee-for-service dentists (85.2% vs 57.4%, P < .001). All 4 key items were assessed as adequate in 19.0% of all RCTs, more frequently when performed by salaried than by fee-for-service dentists (29.5% vs 5.8%, P < .001). CONCLUSIONS: Deficiencies in RCTs, particularly underuse of rubber dams call for further research to understand the reasons for noncompliance with good clinical practice guidelines.

Age- and Time-Related Trends in Oral Health Care for Patients Aged 60 Years and Older in 2007-2017 in Public Oral Health Services in Helsinki, Finland.

BACKGROUND: Population aging will likely have an impact on oral health care trends. The aim of this study was to describe age- and time-related trends in oral health care in people ages 60 and older in Public Oral Health Services (POHS) in Helsinki, Finland. MATERIALS AND METHODS: Material for the study comprised the electronic documentation of oral health care procedures performed on patients 60 years and older (N = 282,143) in POHS during 2007-2017. Patients were aggregated into 5-year age groups. The 5 most common treatment categories, restorations, periodontal treatment, extractions, endodontics, and prosthetics, were selected for analysis. Changes by time (calendar year) and differences by age group were shown as percentages and percentage points; corresponding trends were assessed by applying linear regression models to the data. RESULTS: The attendance rate for these patients increased from 14.5% in 2007 to 23.1% in 2017, with the total number of visits increasing by 76.4% in the 11-year period. The average number of visits per patient decreased from 3.5 visits in 2007 to 3.0 visits in 2017. In 2007, 60.5% of patients received restorative treatment and 41.3% received periodontal care. In 2017, the corresponding figures were 55.5% and 49.8%, respectively. The older the patient, the fewer the visits and restorative, periodontal, and endodontic treatments and the greater the rate of tooth extractions and prosthetics. CONCLUSION: A declining age group-related trend was recognized for restorative, periodontal, and endodontic treatments. Owing to ongoing population growth, POHS will be facing huge challenges in providing treatment for all individuals seeking services.

Radiographic outcome of root canal treatment in general dental practice: tooth type and quality of root filling as prognostic factors.

OBJECTIVE: This study evaluated the radiographic outcome of root canal treatments (RCTs) performed by general dental practitioners (GDPs) with focus on tooth type and quality of root filling. MATERIALS AND METHODS: The target population included all patients receiving root filling by GDPs in City of Helsinki in 2010-2011. Equal numbers of each tooth type (anteriors, premolars, molars) by jaw were included, resulting in 426 teeth. Pre- and post-operative periapical radiographs were assessed to evaluate periapical status and quality of root filling. Statistical evaluation utilized Chi-squared tests, Cohen's kappa and logistic regression modelling. RESULTS: The overall success rate of RCT was 67.4%, being 76.8%, 69.7% and 55.6% (p < .001) for anteriors, premolars and molars, respectively. The quality of root fillings varied by tooth type (p < .001); optimal fillings were least frequent (43%) in molars. In multifactorial analysis, RCTs were more likely to succeed in non-molars (OR = 1.8), in teeth with optimal root fillings (OR = 3.6) and in teeth without apical periodontitis (OR = 3.2). CONCLUSION: The quality of root fillings and radiographic outcome of RCTs varied considerably according to tooth type; success was least likely in molars. Improvement is needed in quality of RCTs by GDPs.

Age-related variation in volume and content of restorative private dental care for adults in Finland in 2012-2017: A nationwide register-based observation.

OBJECTIVES: This study assessed age-related variation in the volume and content of restorative dental care performed by private dentists for adults in Finland in 2012-2017. METHODS: This retrospective register-based observational study utilized the Social Insurance database of private dental services in 2012 and 2017, including all patients. The data were aggregated into 5-year age groups for 20-89-year-olds; those aged 90+ formed one group. A patient was one who had received at least one treatment, and a restoration patient one who received at least one restoration (direct/indirect), excluding prosthetic crowns. Attendance rate was the proportion of the population treated. Volume of restorative treatment was the proportion of restoration patients among all patients using private dental services. Content of restorative treatment was described as the number of teeth receiving restoration and the size of restoration (number of surfaces restored). Correlation coefficient demonstrated associations between age groups and numbers of restorations. RESULTS: Rate of restoration patients was 64.8 % in 2012 and 61.1 % in 2017, the rate for individuals aged under 80 years in each calendar year being smaller than in previous years. Mean number of restorations received per patient was 1.59 in 2012 and 1.42 in 2017, increasing with age (r = 0.85 in 2012; r = 0.95 in 2017). Small restorations dominated; one to two surfaces were covered in 72.3 % and 75.5 % of restorations in 2012 and 2017, respectively. CONCLUSIONS: Volume and content of restorative dental care for adults vary by age and have decreased slightly over time. CLINICAL SIGNIFICANCE: Restorative treatments are a prominent part of dental care for adults. This paper sheds light on the entity of restorative dental care for adults visiting private dentists. Variation in restoration volume and content is shown according to patient's age group, and changes are assessed across six years.

Accidental perforations during root canal treatment: an 8-year nationwide perspective on healthcare malpractice claims.

OBJECTIVES: To assess occurrence and its variation over time of serious accidental perforations during endodontic treatment and the fate of perforated teeth by tooth type and characteristics of patients and dentists. MATERIALS AND METHODS: Data, based on patient documents on healthcare malpractice claims, comprised all endodontic injuries (n = 970) verified by the Patient Insurance Centre in Finland in 2002-2006 and 2011-2013. Two specialists in endodontics scrutinized the documents. Accidental perforations were recorded by location (tooth type, chamber/canals) and dichotomized as avoidable (could have been avoided by following good clinical practice) or unavoidable (normal treatment-related risks). Fate of perforation cases was recorded as treatment discontinued, root canal(s) filled, or tooth extracted. Background information included patients' and dentists' sex and age and the service sector. Statistical evaluation used Chi-square tests. RESULTS: Serious accidental perforations comprised 29% of all verified injuries. Most perforations were judged as avoidable: 93% in patients aged below 35 years, 87% when located in the pulp chamber or in molars (84%); 70% of all perforations and 75% of those in molars resulted in tooth extraction. The overall rate of serious accidental perforations was 17.6 cases per 100,000 endodontic patients per year. CONCLUSIONS: The rate of serious accidental perforations increased over time. The majority was in molars and resulted in tooth extraction. CLINICAL RELEVANCE: Accidental perforations comprise almost a third of serious injuries during root canal treatment. However, four of five perforations could be avoided by following good clinical practice. Therefore, training is needed before adopting new working equipment and methods.

Type and time of first re-intervention of posterior restorations - 13-year scenario at the public dental service.

Objectives: We investigated the first re-interventions of two- and three-surface direct restorations on posterior teeth, specifically noting the type and time of the first re-intervention.Materials and methods: In 2002, altogether 5542 posterior two- and three-surface composite and amalgam restorations were done for 3051 patients aged 25-30 years at Helsinki City Public Dental Service (PDS). Based on electronic patient records, we analysed all restorations (n = 2445) having re-intervention during a 13-year follow-up. We recorded the type of tooth, restoration size, and type of first re-intervention. The time to re-intervention was the interval between the date of the placement of restoration at the year 2002 and its first re-intervention.Results: Restorative treatment was the most common (77.9%) first re-intervention, followed by endodontics (11.5%), extractions (5.2%), and other (5.4%). Males, more frequently than females, had extraction or endodontics as first re-intervention. The average time to re-intervention was 5.7 years (SD 3.8; median 5.2). Both median and mean times were shortest for cases involving endodontics or extractions.Conclusions: For the majority of two- and three-surface posterior restorations, the first re-intervention is restorative (replacement or repair of restoration). The shortest time to re-intervention is for restorations that have endodontics or extraction as the first re-intervention.

Prevalence of third molars determined by panoramic radiographs in a population-based survey of adult Finns.

OBJECTIVES: The aim of the study was to examine the prevalence of third molars in panoramic radiographs in a population-based study of adults aged ≥30 years. METHODS: Out of a sample of 8028 inhabitants of Finland, selected with two-staged stratified cluster-sampling method for the Health 2000 Survey, 5989 participated in clinical oral examination and panoramic radiography. Mean age was 52.5 years (SD 14.6; range 30-97 years). The following variables were included in the analysis: participant characteristics, clinical number of all teeth, and radiographic prevalence and characteristics of third molars. Statistics included chi-squared, Fisher's exact, and Kruskal-Wallis tests and SAS-SUDAAN calculations. RESULTS: A total of 5912 third molars in 47.8% of the study population were recorded from panoramic radiographs. At least one impacted third molar was found in 21.9% of the study population. More than half (57.3%) of the remaining third molars were located in the mandible. A preponderance of participants with all third molars missing were observed in the oldest age group, women, those with lower education and those living in the countryside. Third molars or remnants thereof were observed radiographically in 3.9% of clinically edentulous study population. CONCLUSIONS: The panoramic radiographs disclosed many remaining third molars in adult Finns aged ≥30 years. One-third of the third molars located impacted which may cause unexpected need for care.

Impact of type of tooth on outcome of non-surgical root canal treatment.

OBJECTIVES: We assessed the impact of type of tooth on the outcome of root canal treatment (RCT) according to factors potentially weakening the prognosis such as preoperative apical periodontitis (AP) and treatment modality (primary or secondary RCT). MATERIALS AND METHODS: We scrutinized patient documents including pre- and postoperative radiographs of 640 permanent teeth receiving non-surgical RCT at Helsinki University Clinic in 2008-2011. Of teeth, 44% were molars, 32% premolars, and 24% anterior teeth. Patients' mean age was 51.5 years; 51% were male. AP was present in 60.5% of teeth preoperatively. We used the periapical index (PAI) to assess the radiographs and defined radiographically "healthy" and "healing" cases as successful. Statistical evaluation included chi-squared tests, Fisher's exact tests, t tests, and logistic regression modeling. RESULTS: The overall success rate (SR) was 84.1%; 88.3% for primary and 75.5% for secondary RCT (p < 0.001). The SRs for anterior teeth, premolars and molars were 85.6%, 88.8%, and 79.7%, respectively. Teeth with and without AP had SRs of 77.3% and 94.5%, respectively (p < 0.001). The RCTs were more likely to succeed in anterior teeth and premolars than in molars (OR 1.7; 95% CI 1.1-2.7) and in females than in males (OR 1.9; 95% CI 1.2-3.1). CONCLUSIONS: Apart from existing AP and retreatment scenario, also, the type of tooth and gender had a significant influence on the outcome of RCT in this study. CLINICAL RELEVANCE: The prognosis of RCT varies by type of tooth; special attention should be given to RCT of molar teeth.

What kind of third molars are disease-free in a population aged 30 to 93 years?

OBJECTIVES: The aim of the study was to characterize third molars that have remained disease-free in a representative sample of the Finnish population aged 30 years and older. MATERIALS AND METHODS: Two-staged stratified cluster sampling (N = 8028) was used, and 6005 subjects participated in a clinical oral examination and panoramic radiography. Disease-free third molars were characterized as follows: no dentinal caries, no filling, periodontal pocket depths of neighboring second molars less than 4 mm, and no radiographic pathological findings. Logistic regression analyses served for assessment of the strength of characteristics of third molars for disease-free status. RESULTS: Of the subjects, 2653 (44%) had at least one third molar. Of them, the majority (62%) had only diseased third molars, 16% had only disease-free ones, and 22% had both. Participants had in total 5665 third molars; 29% of them were disease-free. Female gender, higher level of education, and younger age were related to disease-free status (P < 0.001). Disease-free status was more likely for third molars at cervical or apical level than at occlusal level: odds ratio was 10.1 for all teeth, 8.5 for maxillary teeth, and 6.2 for mandibular teeth. CONCLUSION: A third molar situated deeper in the bone was more likely to be disease-free than a tooth at occlusal level in the population aged 30 years and older. CLINICAL RELEVANCE: Our results suggest that the number of disease-free third molars decreased with increasing age, and most dramatically, this occurred among teeth at cervical level with the neighboring second molar.

Root Canal Irrigants and Medicaments in Endodontic Malpractice Cases: A Nationwide Longitudinal Observation.

INTRODUCTION: The aim of this study was to assess the role of root canal irrigants and medicaments in endodontic injuries verified in Finland and to estimate the rate of such events over time. METHODS: The study material comprised all endodontic injuries verified by the Patient Insurance Centre in 2002 to 2006 (n = 521) and 2011 to 2013 (n = 449). The data, based on patient documents scrutinized by 2 specialists in endodontics, included patients' and dentists' sex and age and the service sector. We recorded the use of root canal irrigants and medicaments, each as a dichotomy. Furthermore, we dichotomized the injuries as those related to root canal irrigants/medicaments and any other injuries. The injuries were also dichotomized as avoidable (could have been avoided by following good clinical practice) or unavoidable (normal treatment-related risks). Statistical evaluation used chi-square tests and t tests; logistic regression produced odds ratios (ORs). RESULTS: The verified injuries (N = 970) comprised 635 (65%) avoidable and 335 (35%) unavoidable injuries. The number of irrigant-/medicament-related injuries was 69, accounting for 7.1% of all verified injuries; all resulted from sodium hypochlorite and calcium hydroxide, and 87% were avoidable. The overall rate of sodium hypochlorite/calcium hydroxide injuries was 4.3 cases per 100,000 endodontic patients per year. Compared with other injuries, sodium hypochlorite/calcium hydroxide injuries were more likely avoidable (OR = 3.8) and more than 5-fold likely in 2011 to 2013 than in 2002 to 2006 (OR = 5.6). CONCLUSIONS: Extreme care is needed when applying sodium hypochlorite and calcium hydroxide into root canals to avoid increasing harmful consequences.

Education-related inequality in restorative dental treatment need over 11 years in two areas of Finland.

OBJECTIVES: This study aimed to analyse education-related inequality in restorative dental treatment need among adults aged 30 years and older living in Northern and Southern Finland in 2000 and 2011. METHODS: Data were taken from the Health 2000 and 2011 population-based follow-up surveys, including information gathered by interviews and clinical dental examination. Final effective sample sizes were 2423 people in 2000 and 1192 people in 2011. Restorative dental treatment need was measured with number of decayed and/or fractured teeth (DT + FrT). Education-related inequality in number of DT + FrT and factors explaining it were analysed using the Poisson regression analysis, relative index of inequality and slope index of inequality. RESULTS: Average number of DT + FrT decreased from 2000 to 2011. Absolute and relative education-related inequalities in them decreased approximately 50% and 25% from 2000 to 2011, respectively. Tooth brushing frequency and time since last dental visit explained approximately 30%-40% of the education-related inequality. The contribution of time since last dental visit to the education-related inequality was smaller in 2011 than in 2000. CONCLUSIONS: It seems that, from 2000 to 2011, the need for restorative dental treatment decreased simultaneously with the education-related inequality in it among adults aged 30 years and older living in Northern and Southern Finland.

Frequent consumption of sugar-sweetened beverages and sweets starts at early age.

OBJECTIVES: We aimed to investigate the habitual consumption of sugar-sweetened beverages (SSBs) and sweets in relation to mothers' behaviours and practices with their infants. METHODS: We targeted mothers with children 1-24 months (N = 200) visiting Public Child Health clinics in Finland. During routine visits mothers (N = 179) volunteered to complete a self-administered anonymous questionnaire about their child's health-related behaviours (consumption of sweets and SSBs, tooth brushing frequency). The questionnaires also included questions about the mothers' background (age, education) and health-related behaviours (consumption of sweets, tooth brushing frequency and smoking habits). The children were categorised by age, and Chi-squared tests, Fischer's exact test, ANOVA and correlation coefficient served for the statistical analyses. RESULTS: Of those under 6 months, almost half (44%) received SSBs, and 45% of them more than once a week. Their use gradually increased by age such that by 19-24 months, all received SSBs at least sometimes, and 56%, frequently. Fewer than half of the mothers (33-43%) gave sweets to their children between the ages of 10-15 months, but 92% by the age of 2 years. Children's twice-a-day tooth brushing increased from 14% to 33%. The child's age and tooth brushing frequency correlated with the consumption of sugar-sweetened products (r = 0.458). CONCLUSIONS: Infants frequent consumption of sugar-sweetened products begins early in childhood. Thus, tackling these common risk factors in the first years of life is essential and calls for health-promoting actions in multiple areas that target primarily the parents of infants.

Longevity of 2- and 3-surface restorations in posterior teeth of 25- to 30-year-olds attending Public Dental Service-A 13-year observation.

OBJECTIVES: The aim of this patient document-based retrospective study among 25- to 30-year-old Finnish adults was to evaluate longevity of 2- and 3-surface posterior restorations according to type of tooth, size of restoration, and restorative material used. METHODS: Data were extracted from electronic patient files of the Helsinki City Public Dental Service (PDS), Finland. A total of 5542 2- and 3-surface posterior composite and amalgam restorations were followed indirectly from 2002 to 2015. Longevity of restorations was illustrated using Kaplan-Meier curves. Annual failure rates (AFRs) of the restorations were calculated separately by type of tooth, size, and material. Differences in longevity were statistically tested with log-rank tests. RESULTS: Composite restorations formed the majority (93%). The longest median survival times and the smallest failure rates were found for teeth in the upper jaw, for premolars, and for 2-surface restorations. Median survival time of all restorations was 9.9 years (95% CI 9.6, 10.2) and re-intervention of restorations occurred less often in the maxilla (AFR 4.0%) than in the mandible (AFR 4.7%). Median survival time of composite restorations was greater for 2-surface than for 3-surface restorations: in premolars 12.3 vs. 9.6 years (p<0.001) and in molars, 9.2 vs. 6.3 years (p<0.001); for molar amalgams the difference (8.0 vs. 6.3 years) was non-significant (p=0.38). Median survival time of 2- and 3-surface restorations in premolars exceeded that in molars (12.0 vs. 8.7 years; p<0.001). CONCLUSIONS: Longevity of posterior composite multisurface restoration is comparable to amalgam longevity. CLINICAL SIGNIFICANCE: Regarding material choices for posterior multisurface restorations, composite and amalgam perform quite similarly in molars, 3-surface restoration being challenge for both materials.

Use of oral health care services in Finnish adults - results from the cross-sectional Health 2000 and 2011 Surveys.

BACKGROUND: During the 2000s, two major legislative reforms concerning oral health care have been implemented in Finland. One entitled the whole population to subsidized care and the other regulated the timeframes of access to care. Our aim was, in a cross-sectional setting, to assess changes in and determinants of use of oral health care services before the first reform in 2000 and after both reforms in 2011. METHODS: The data were part of the nationally representative Health 2000 and 2011 Surveys of adults aged ≥ 30 years and were gathered by interviews and questionnaires. The outcome was the use of oral health care services during the previous year. Determinants of use among the dentate were grouped according to Andersen's model: predisposing (sex, age group), enabling (education, recall, dental fear, habitual use of services, household income, barriers of access to care), and need (perceived need, self-rated oral health, denture status). Chi square tests and logistic regression analyses were used for statistical evaluation. RESULTS: No major changes or only a minor increase in overall use of oral health care services was seen between the study years. An exception were those belonging to oldest age group who clearly increased their use of services. Also, a significant increase in visiting a public sector dentist was observed, particularly in the age groups that became entitled to subsidized care in 2000. In the private sector, use of services decreased in younger age groups. Determinants for visiting a dentist, regardless of the service sector, remained relatively stable. Being a regular dental visitor was the most significant determinant for having visited a dentist during the previous year. Enabling factors, both organizational and individual, were emphasized. They seemed to enable service utilization particularly in the private sector. CONCLUSIONS: Overall changes in the use of oral health care services were relatively small, but in line with the goals set for the reform. Older persons increased use of services in both sectors, implying growing need. Differences between public and private sectors persisted, and recall, costs of care and socioeconomic factors steered choices between the sectors, sustaining inequity in access to care.

Operator-related aspects in endodontic malpractice claims in Finland.

OBJECTIVE: We analyzed operator-related differences in endodontic malpractice claims in Finland. MATERIALS AND METHODS: Data comprised the endodontic malpractice claims handled at the Patient Insurance Centre (PIC) in 2002-2006 and 2011-2013. Two dental advisors at the PIC scrutinized the original documents of the cases (n = 1271). The case-related information included patient's age and gender, type of tooth, presence of radiographs, and methods of instrumentation and apex location. As injuries, we recorded broken instrument, perforation, injuries due to root canal irrigants/medicaments, and miscellaneous injuries. We categorized the injuries according to the PIC decisions as avoidable, unavoidable, or no injury. Operator-related information included dentist's age, gender, specialization, and service sector. We assessed level of patient documentation as adequate, moderate, or poor. Chi-squared tests, t-tests, and logistic regression modelling served in statistical analyses. RESULTS: Patients' mean age was 44.7 (range 8-85) years, and 71% were women. The private sector constituted 54% of claim cases. Younger patients, female dentists, and general practitioners predominated in the public sector. We found no sector differences in patients' gender, dentists' age, or type of injured tooth. PIC advisors confirmed no injury in 24% of claim cases; the advisors considered 65% of injury cases (n = 970) as avoidable and 35% as unavoidable. We found no operator-related differences in these figures. Working methods differed by operator's age and gender. Adequate patient documentation predominated in the public sector and among female, younger, or specialized dentists. CONCLUSIONS: Operator-related factors had no impact on endodontic malpractice claims.

Association of current employment status with oral health-related behaviors: findings from the Finnish Health 2000 Survey.

The aim of this study was to compare the oral health-related behaviors of unemployed people with those of employed people and to assess whether they differ according to the length of unemployment. This study is part of the Health 2000 Survey in Finland. The cross-sectional data were based on interviews and questionnaires. The present study comprised dentate participants, 30-63 yr of age (n = 4,670). Current employment status (employed vs. unemployed) and length of current unemployment (≤1, >1-2, >2-5, and >5 yr) were used as exposures. Binary logistic regression models were fitted separately for the oral health-related behaviors, and latent class analysis (LCA) was used to form behavioral clusters. Current unemployment and being unemployed for longer than 5 yr were inversely associated with regular use of dental services. Current unemployment indicated non-regular dental attendance, infrequent use of xylitol, daily smoking, and risky use of alcohol. Findings from the LCA supported the assumption that unemployed people could be considered as a risk group for poor oral health-related behaviors.