Heavy use of dental services among Finnish children and adolescents.
OBJECTIVE
Our aim was to identify the heavy use of dental services among children and adolescents in the Public Dental Service (PDS) of one of the biggest cities in Finland, and compare oral health and treatments provided for heavy and low users.


METHODS
All patients under 18 years of age having had 6 or more dental visits (n. 2,285) in 2004 and a comparison group of those having had 3 or fewer visits (n. 27,957) were selected from the patient register of the PDS of the city of Espoo. A sample of 245 patients was randomly selected from each group and information on age, sex, dental status, number and types of visits and treatments provided was collected from their treatment records.


RESULTS
Seven percent of the children and adolescents who had visited the PDS in 2004 were heavy users according to the definition used. Their visits accounted for 26.3% of all dental visits of children and adolescents. The heavy users were classified as basic care heavy users and orthodontic heavy users. The mean treatment time for the basic care heavy users was 3 hours and 50 minutes, and for orthodontic heavy users 3 hours and 23 minutes; it was 40 minutes for the low users. Heavy users were on average 1.8 years older than low users. The basic care heavy users had more treated and untreated caries (mean DMFT/dmft = 4.0 and D/d = 2.4) than the low users (DMFT/dmft = 0.95 and D/d = 0.4). Of the low users, 43.6% had a healthy periodontium (CPI = 0) compared with 27.4% of the basic care heavy users and with 30.8% of the orthodontic heavy users. The most frequently provided treatments for heavy users were orthodontic care and fillings by dentists and for low users preventive measures and examinations. Most of the heavy users (66.4%) received less complicated orthodontic treatment given by a dentist compared with only 7.9% of the low users. Despite the low users' significantly better oral status compared with basic care heavy users there were only minor differences in the type of preventive measures provided for the two groups. The orthodontic heavy users received fewer preventive measures than low users.


CONCLUSIONS
Our study revealed two main reasons for heavy use of dental services: high numbers of orthodontic treatments provided by dentists and high numbers of decayed teeth in a small number of children. To increase productivity, orthodontic care should be provided more efficiently and preventive care needs to be targeted more carefully.
Espoo City Social and Health Services and Network of Academic Health Centres, Institute of Clinical Medicine, Department of General Practice and Primary Health Care, University of Helsinki, Finland. amnamari.nihtila@espoo.fi
A
A
Nihtilä
E
E
Widström
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004245:DMF Index; D019140:Dental Care for Children / Q000706:statistics & numerical data; D003731:Dental Caries / Q000628:therapy; D003752:Dental Health Services / Q000706:statistics & numerical data*; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D009909:Oral Health; D009971:Orthodontics, Corrective / Q000706:statistics & numerical data; D010512:Periodontal Index; D011313:Preventive Dentistry / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013218:State Dentistry / Q000706:statistics & numerical data; D013997:Time Factors; D019037:Urban Health Services / Q000706:statistics & numerical data