title: Prosthodontics and the patient. Part 2: Need becoming demand, demand becoming utilization.
abstract: OBJECTIVE
  Patients' oral health needs are estimated through dialogue and professional assessment. The concepts of need and demand are vital to studies of dental care and oral health. Need does not always lead to demand for treatment or to utilization, depending on the gatekeeping processes between need and demand and between demand and utilization. Demand must be accepted with the understanding that there is no objective need and that demand depends on the patient's opinion. In accordance with this, the need for prosthodontic treatment is highly individual and is not automatically related to oral health status, making need and demand difficult to measure in that respect. Therefore, sociodental factors should be included and evaluated in studies of need and demand for utilization of prosthodontic care.
  
  
  METHODS
  This theoretical and analytic paper focuses on the gatekeeping processes between need and demand and between demand and utilization of prosthodontic care.
  
  
  RESULTS
  The concept of gatekeeping refers to the social and psychologic processes that transform need into demand and demand into utilization. It implies that they are complex processes that can render great differences between demand and actual utilization.
  
  
  CONCLUSIONS
  It is not possible to estimate a patient's needs for prosthodontic care, since there is no objective need. Demand and utilization are factors that play an important role in the gatekeeping process. These factors are dependent on the patient's opinion, which is influenced by numerous factors.
authors: Department of Prosthetic Dentistry, Public Dental Health Service, Uppsala, Sweden. birger.narby@lul.se
authors: Birger
authors: B
authors: Narby
authors: Mats
authors: M
authors: Kronström
authors: Björn
authors: B
authors: Söderfeldt
authors: Sigvard
authors: S
authors: Palmqvist
mesh_terms: D000367:Age Factors; D001294:Attitude to Health; D017266:Dental Prosthesis / Q000706:statistics & numerical data; D003812:Dentist-Patient Relations; D005260:Female; D020793:Gatekeeping; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics; D006301:Health Services Needs and Demand; D006801:Humans; D007347:Insurance, Dental; D007575:Jaw, Edentulous / Q000503:physiopathology / Q000523:psychology; D007576:Jaw, Edentulous, Partially / Q000503:physiopathology / Q000523:psychology; D008297:Male; D020380:Needs Assessment; D009909:Oral Health; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D012737:Sex Factors; D012959:Socioeconomic Factors