title: Heavy consumption of dental services; a longitudinal cohort study among Finnish adults.
abstract: BACKGROUND
  A reform to Dental Care legislation in 2002 abolished age limits restricting adults' use of public dental services in Finland. In the Public Dental Service (PDS) unit of Espoo, the proportion of adult patients rose from 36% to 57%. The aim of this study was to investigate heavy use of dental services by adults and its determinants.
  
  
  METHODS
  A longitudinal cohort study was undertaken based on a PDS patient register. Of all adults who attended the PDS in Espoo in 2004, those who had six or more visits (n=3,173) were assigned to the heavy user group and a comparison group of low users (n=22,820) had three or fewer dental visits. A sample of 320 patients was randomly selected from each group. Baseline information (year 2004) on age, sex, number and type of visit, oral health status and treatment provided was collected from treatment records. Each group was followed-up for five years and information on the number and types of visit was recorded for each year from 2005 to 2009.
  
  
  RESULTS
  Most heavy users (61.6%) became low users and only 11.2% remained chronic heavy users. Most low users (91.0%) remained low users. For heavy users, the mean number of dental visits per year (3.0) during the follow-up period was significantly lower than initially in 2004 (8.3) (p<0.001) but 74.8% of heavy users had had emergency visits compared with 21.6% of the low users (p<0.001).A third (33%) of the visitors in each group had no proper examination and treatment planning during the 5-year follow-up period and two or more examinations were provided to fewer than half of the heavy (46.1%) or low (46.5%) users.The mean number of treating dentists was 5.7 for heavy users and 3.8 for low users (p<0.001).
  
  
  CONCLUSIONS
  Frequent emergency visits were characteristic of heavy users of dental services. Treatment planning was inadequate, probably partly due to the many dentists involved and too many patients requesting care. Better local management and continuous education are needed to ensure good quality adult dental care and to reduce heavy consumption.
authors.affiliation: Helsinki Health Centre and Institute of Dentistry, University of Helsinki, Helsinki, Finland. annamari.nihtila@helsinki.fi
authors.forename: Annamari
authors.initials: A
authors.lastname: Nihtilä
authors.forename: Eeva
authors.initials: E
authors.lastname: Widström
authors.forename: Outi
authors.initials: O
authors.lastname: Elonheimo
mesh_terms: D000328:Adult; D000367:Age Factors; D016009:Chi-Square Distribution; D003752:Dental Health Services / Q000706:statistics & numerical data*; D003815:Dentists / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012923:Social Class; D018709:Statistics, Nonparametric