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Dental caries, socio-economic development and national oral health policies.

A relationship between a population's level of socio-economic development and dental caries has often been assumed. Proxy measures such as sugar consumption have been used to reflect this. This study tests the hypothesis that there is a relationship between dental caries and the level of socio-economic development, using recent international data. It goes on to explore the implications of this relationship for the development of national oral health policies. Dental caries data was obtained from the WHO, Global Oral Epidemiology Data Bank for the period 1981-1996. Socio-economic data was obtained from the United Nations Development Programme (UNDP). Countries were ranked according to the Human Development Index (HDI) and their GNP. The study confirms the existence of a relationship between dental caries and development. Caries is a good proxy measure for socio-economic development. Countries in the throes of socio-economic transition have the highest DMFT scores.

Child↗

Dental materials for posterior restorations.

Assessment of the quality of dental restorations by the Ryge system is described. Generally, the quality of dental restorations is shown to be dependent on the technique sensitivity of the restorative material as well as the skill and experience of the dentist. Concerning biocompatibility, adverse reactions related to amalgam restorations are unlikely or scarce, due to small amounts of released mercury. Resin based restorative materials contain a large number of organic compounds and, as such, the toxic and allergenic potentials are unknown. Gold and ceramics turn out to be the most biotolerable dental materials. Based on studies on longevity, data indicate that the median age of amalgam restorations is 10-12 years, of gold castings 13-14 years and more, and of composite restorations 4 years. Data on longevity of ceramic restorations are sparse. Secondary caries appears to be the most frequent cause for replacement of the different restorations, followed by marginal degradation. Secondary caries account for more failures among the resin based restorations than among amalgam. Reviewing the literature, it appears that amalgam is the best and most economic dental material for routine posterior restorations with reasonable durability. Gold is recommended for complex restorations. Resin based composites may be limited to small restorations where cosmetics is the main aspect, as wear and recurrent caries are main problems. Ceramic restorations comprise aesthetic restorations with excellent biocompatibility, however, data on longevity and marginal adaptation are not encouraging.

Bicuspid↗

Willingness to pay for dentin regeneration in a sample of dentate adults.

OBJECTIVES: Measurement of individuals' valuation of dental treatments is important in the evaluation of new technologies. In this paper the value of dentin regeneration, a new treatment for teeth with reversible pulpitis, is measured based on what individuals say they would be willing to pay to receive the treatment. METHODS: A total of 611 randomly selected dentate adults answered willingness to pay (WTP) and dental insurance questions. Detailed descriptions of the process and expected outcomes for dentin regeneration were presented to subjects as part of a larger study measuring preferences for different treatments. WTP was determined for two different levels of success for dentin regeneration. RESULTS: At a success rate of 95%, the mean WTP for dentin regeneration was $262.70 (noninsured) and $11.00 per month (insured subjects). For success rate of 75%, the corresponding values were $210.90 and $9.20 per month. Multivariate analyses were used to identify any significant relationships between WTP and a range of variables covering socio-demographic, socio-economic, dental experience and oral health status variables. The findings indicate that individuals' valuations of treatments involve substantial unexplained variation. About half of the noninsured subjects would pay for dentin regeneration if it cost $200 per tooth. CONCLUSIONS: The data on the WTP for dentin regeneration indicate that a substantial percentage of adults will pay for this new technology. This study provides for the first time an estimate of WTP for dentin regeneration among the population.

Adult↗

Economic aspects of dental care in Finnish health centers.

In recent years economic evaluations of publicly funded governmental and community based activities have become more common. Although the Public Dental Service in Finland has been in operation for 17 yr, little is known of the effectiveness of the system. The aim of this study was to assess the effectiveness, output and costs of dental care using available data from 34 randomly selected health centers during 1982-85. Great differences were found in running expenses and productivity between the health centers studied. The study indicated that dental care arrangements tended to be more expensive in communities with high governmental subsidies than in those with low ones. The ratio of chairside assistants to dentists was also shown to have a statistically significant positive correlation with the cost of a dental visit.

Adolescent↗

Water fluoridation, poverty and tooth decay in 12-year-old children.

AIM: To examine the influence of water fluoridation, and socio-economic deprivation on tooth decay in the permanent dentition of 12 year old children. SETTING: The North of England, fluoridated Newcastle and non-fluoridated Liverpool. A total of 6,638 children were examined. OUTCOME MEASURES: Multiple Regression analysis of fluoride status, mean electoral ward DMFT in 1992/93 and ward Townsend Scores from the 1991 census. RESULTS: Social deprivation and tooth decay were significantly correlated in areas with and without water fluoridation. Multiple linear regression showed a statistically significant interaction between ward Townsend score, mean DMFT and water fluoridation, showing that the more deprived the area the greater the reduction in tooth decay. At a Townsend score of zero (the English average) there was a predicted 37% reduction in decay in 12-year-olds in fluoridated wards. CONCLUSIONS: Tooth decay is strongly associated with social deprivation. The findings confirm that the implementation of water fluoridation has markedly reduced tooth decay in 12-year-old children and that socio-economic dental health inequalities are reduced.

Child↗

Cooling off.

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Economics, Dental↗

After all that.

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Economics, Dental↗