[Relations between participation in school dental care, dental health, and socio-economic class].
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Recent studies have found more equal access to physicians, both in terms of volume of visits and having a regular source. This paper compares physician care with dental care, looking particularly at a regular source of dental care. A regular source should be very important in dental care, given the emphasis on prevention and regular visits. This paper examines data from a statewide sample of 1,329 Rhode Island residents in 1974 to determine what percentage of the population has a regular source and what the relationship is with socioeconomic variables. Most persons (91 per cent) report a regular source of medical care. The figure is somewhat lower (73 per cent) for reporting of a regular source of dental care. Socioeconomic differentials are still important, as only one-half of those in families earning less than $5,000 and 59 per cent of those in families where the head of the household has less than an eighth grade education have a regular source of dental care. The relationship held when controlling for variety of social and demographic variables and partial correlation analysis was used to determine that income, as compared with education, is the more important variable in explaining differentials. Using discriminant function analysis, age, sex, race, education and income allowed one to correctly predict 70.7 per cent of those who have a regular source of dental care and 61.5 per cent of those without a regular source of dental care.
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The problems of continuing dental care once eligibility for school care ceases have been discussed. A questionnaire of 18,976 high school students at 29 South Australian schools indicated that, compared with students with no history of school care, fewer students treated by the School Dental Service reported visiting a dentist since leaving primary school. Several programmes designed to encourage continuing dental care have been described.
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Methods for controlling dental care expenditures are taking on greater importance with the rapid increase in prepaid dental plans. The use of regulatory systems to monitor provider performance are necessary to prevent gross over-utilization but are unlikely to result in net savings of more than five per cent of total gross premiums. Theoretically, prepaid group dental practice (PGDP) may reduce expenditures by changing the mix of services patients receive. The modest estimated savings and the small number of PGDPs presently in operation limit the importance of this alternative for the next five to ten years. If substantial reductions in dental expenditures are to be obtained, it will be necessary to limit dental insurance plans to cover only those services which have demonstrated cost-effectiveness in improving health for the majority of people. The concept that richer benefit plans may have small marginal effects on improving oral health may not be easy for the public to accept but, until they do, expenditures for dental care will be difficult to control.
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The dental public health literature contains almost no information on caries experience and treatment needs of Appalachian children, and little information concerning resource requirements for children's dental care programs in general. Data from three dental treatment programs in Appalachia are summarized for purposes of planning and evaluation of similar programs. Age specific caries and service experiences are presented, and evaluation criteria and planning considerations are discussed. Resource requirements, including time, cost and manpower are also presented, and special considerations for planning programs are discussed.
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