Intervals for oral health examinations among Finnish children and adolescents: recommendations for the future.

AIM: To review the frequency of routine annual dental examinations for children in Finland and to make recommendations for appropriate examination intervals for children and adolescents. METHOD: The National Research and Development Centre for Welfare and Health in Finland appointed an expert group to prepare a review. RESULTS: According to the literature, examination intervals for individuals with low caries risk can be extended to 1.5-2.0 years without jeopardising their oral health. If implemented, this would lead to a saving of 15% in treatment and examination times for children. Although there is no accurate measure for identifying high-risk individuals, a considerable proportion of low-risk children can be identified fairly accurately. CONCLUSIONS: The expert group recommended prolonging the average examination intervals to 1.5-2.0 years, taking into account the risk of each individual, the local distribution of oral health problems and cost-effective use of resources. Part of the savings could be redirected to children with high levels of dental need and/or at risk of dropping out from the oral health services.

Caries prediction by multiple salivary mutans streptococcal counts in caries-free children with different levels of fluoride exposure, oral hygiene and sucrose intake.

The aims of this study were to assess whether multiple salivary mutans streptococcal (ms) counts have a higher predictive power than a single one, and whether the predictive power of the test is different at different levels of fluoride exposure, oral hygiene and sucrose consumption. Three salivary ms tests were performed at 3-month intervals (positive test: salivary ms >/=5x10(5) cfu/ml) on a sample of 304, initially caries-free, 6- to 7-year-olds. Plaque index was also assessed and the parents filled out a questionnaire concerning sucrose-containing eating events and fluoride exposure. Sensitivity, specificity and Youden's index (J) were used to compare the predictive power. Thirty-six percent of the children developed caries during the 2-year follow-up. The highest J value for a single ms test (the second) was 0.24 (sensitivity 29.1%, specificity 95.4%). The multiple ms test with the highest J value (0.29) was obtained by the dichotomies 0 vs. 1-3 positive tests (sensitivity 50.0%, specificity 79.9%) and 0-1 vs. 2-3 positive tests (sensitivity 31.8%, specificity 97.4%). The predictive power of the multiple test was passable for children with low fluoride exposure and high plaque index (sensitivity 57.4%, specificity 93.7%, J 0.51), while it was low for the other groups. Sucrose exposure did not significantly affect the predictive power of the ms test.sion.

The perceptions of users about barriers to the use of free systematic oral care among Finnish pre-school children--a qualitative study.

With the economic recession in the early 1990s in mind, and the change in the provision of healthcare services, our aim was to explore qualitatively what barriers families of Finnish pre-school children had perceived related to the use of free systematic oral healthcare. Qualitative interviews were carried out with the parents of 12 pre-school children attending an oral health examination to ascertain what barriers those using oral services had overcome, and what they considered to be the reasons for the non-attendance of other families. Content analysis was used by classifying groups of barriers and their reported importance as well as the reasons for non-attendance. The barriers discovered were related to: difficulties in the (i) change of daily routines or (ii) booking time for care, (iii) poor coordination with other healthcare services, (iv) fear and negative image of oral care, and (v) inconsistent content of oral health information. When parents replied to the externalized question about reasons for the non-attendance of some families, they most often mentioned difficulties in changing daily routines, laziness, lack of interest and fear. Barriers to attending oral healthcare could be lowered by emphasizing the positive image of oral health services, by providing more effective coordination with mother and child health services, and by providing appointment times later in the day.