Private dentists assess treatment required as more extensive, demanding and costly, than public sector dentists.

OBJECTIVES: The aim was to evaluate whether contracted private practitioners assess required treatment more extensive, demanding and economically more rewarding than mainly salaried public sector dentists and to estimate the cost consequences of using these alternative providers. METHODS: All dental services included in comprehensive treatments funded by the city of Turku and provided to adult patients during the year 2009 were recorded. Patients were distributed randomly without any determination of treatment needs before appointing them to different dentists. Treatment courses for 7432 patients in public clinics included 63 906 procedures and for 2932 patients assigned to treatment by contracted private practitioners included 21 194 procedures. Public sector dentists were mainly salaried with production incentives, and private practitioners worked purely on a fee-for-service basis. The cost estimates were based on the distributions of competence classifications recorded by the providers, which also formed the basis for reimbursement. RESULTS: For each studied treatment category with more than one competence classification, private contractors were less likely than their public sector counterparts to give an assessment of simple or less demanding: 8% versus 29% of examinations, 46% versus 69% of periodontal treatments, 63% versus 85% of extractions, 31% versus 46% of fillings, 18% versus 35% of root canals. The excess cost to society varied from 7.0% for root canal treatments to 21.3% for extractions, causing on average 14.4% higher cost level from use of private practitioners compared with public sector dentists. CONCLUSIONS: Private practitioners systematically classified the treatment procedures they provided as more demanding, and therefore more economically rewarding, than their public sector counterparts. The findings indicate that the costs of publicly funded dental care may be increased by the use of private dental contractors.

Patient experiences during waiting time for dental treatment.

OBJECTIVES: The aim of this study was to evaluate patient experiences of inconvenience and treatment need while waiting for dental treatment. MATERIALS AND METHODS: A systematic sample of 210 patients with varying lengths of waiting time was drawn from the waiting list for non-emergency treatment in the City of Turku. A questionnaire covering socio-demographic background was mailed to the patients. The level of inconvenience caused by waiting was assessed by a linear visual analogue scale (0-100). RESULTS: A total of 112 subjects (60%) completed and returned the questionnaire and 109 (58%) gave permission to collect data from their patient records. The average inconvenience score was 42.9, with those who had waited for 3 months or less reporting less inconvenience than those that had waited for 4 months or more. There was not a straightforward linear correlation between length of waiting time and level of inconvenience experienced. Experiences of inconvenience were independent of socio-demographic background. The patient-reported maximum acceptable waiting time for non-urgent dental treatment was 45.8 days. Fewer than half (42.0%) of the subjects had received treatment while waiting for comprehensive care; women (51.7%) significantly (p < 0.05) more often than men (31.5%). Fillings and unspecified emergency treatments were the most commonly needed treatment. CONCLUSIONS: Waiting for dental treatment appears to be well-tolerated, as long as the waiting time remains reasonable. Treatment providers seem to have few means with which to rank dental patients into several queues with different urgencies.

A study on moral hazard in dentistry: costs of care in the private and the public sector.

OBJECTIVES: The aim of this study was to evaluate the costs of subsidized care for an adult population provided by private and public sector dentists. METHODS: A sample of 210 patients was drawn systematically from the waiting list for nonemergency dental treatment in the city of Turku. Questionnaire data covering sociodemographic background, dental care utilization and marginal time cost estimates were combined with data from patient registers on treatment given. Information was available on 104 patients (52 from each of the public and the private sectors). RESULTS: The overall time taken to provide treatment was 181 days in the public sector and 80 days in the private sector (P<0.002). On average, public sector patients had significantly (P < 0.01) more dental visits (5.33) than private sector patients (3.47), which caused higher visiting fees. In addition, patients in the public sector also had higher other out-of-pocket costs than in the private sector. Those who needed emergency dental treatment during the waiting time for comprehensive care had significantly more costly treatment and higher total costs than the other patients. Overall time required for dental visits significantly increased total costs. The total cost of dental care in the public sector was slightly higher (P<0.05) than in the private sector. CONCLUSIONS: There is no direct evidence of moral hazard on the provider side from this study. The observed cost differences between the two sectors may indicate that private practitioners could manage their publicly funded patients more quickly than their private paying patients. On the other hand, private dentists providing more treatment per visit could be explained by private dentists providing more than is needed by increasing the content per visit.

Mutans streptococci colonization associates with the occupation of caretaker, a practise-based study.

BACKGROUND: The early mutans streptococci (MS) bacteria colonization is connected to early childhood caries. The aim of this study is to examine associations between the MS-colonization and background factors in young children, in order to enhance the oral health program in a low caries prevalence community. SUBJECTS AND DESIGN: An age cohort of 512 children was screened for MS in the oral biofilm at the age of 18 months. The caretakers were, using a structured form, interviewed of demographical factors and habits connected to oral health: antibiotic treatments, child's appetite, frequency of night feeding, use of sugary products or drinks, and maternal xylitol use. The associations were evaluated with logistic regression analysis. RESULTS: Mutans streptococci colonization was significantly associated with both the occupation of the caretaker and the non-Finnish background. CONCLUSION: The early MS-colonization, in preschool children, strongly associates with the socioeconomic status of the family.

Oral health programme for preschool children: a prospective, controlled study.

BACKGROUND: New perspectives are needed for oral health programmes (OHPs). The aim was to evaluate the preventive effect of a risk-based OHP in comparison with a traditional programme. DESIGN: An age cohort of 794 Finnish children, 446 in the intervention group and 348 in the control group, was followed from 18 months to 5 years of age. The children were screened for mutans streptococci (MS) in the dental biofilm. The main outcome measure was the proportion of children with dental caries (decayed, missing, or filled primary teeth > 0) at the age of 5 years. The intervention, targeted to MS-positive subjects in the intervention group only, was based on repeated health education to the caretakers and xylitol lozenges for the child. Dental hygienists carried out the programme. RESULTS: OHP was effective in white-collar families [numbers needed to treat (NNT) = 3, 95% CI 2-11]. Factors significantly associated with caries at 5 years were MS colonization at 18 months, occupation of caretaker, but also gender when incipient carious lesions were included in the index. CONCLUSION: Early risk-based OHP, targeted to the families of MS-positive children, can reduce the risk for caries in white-collar families. For blue-collar families, different kinds of methods in caries prevention and support are needed.