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Biomedical subjects

M C Downer

Publications and source records attributed to M C Downer.

At least 91 records · Page 5Linked to original sources

The Danish oral health care service for children: an evaluation.

An evaluation of the children's oral health care service was performed by an international assessment team who undertook a field programme in Denmark. Three counties were visited, one metropolitan, one urban and one rural. Data on dental health costs were collected and dental services in six municipalities selected at random were examined. Opinions of administrators at all levels and those of clients and providers were obtained and interviews also took place with staff and students at the two dental schools. The service was considered effective insofar as active dental disease was closely controlled by restorative care and a high level of dental awareness was instilled in all sections of the child population. The service was also clearly adequate since participation of schoolchildren was almost universal. However, resource expenditure on both professional personnel and clinical facilities was considered high and the efficiency of the service was possibly rendered less than optimal by a degree of over-provision in 'passive' prevention and orthodontics. The appropriateness of devoting so much resource to children at the expense of the population as a whole was also regarded as questionable as was the lack of a fluoridation programme. Client groups wholeheartedly supported the service as a result of the high quality of care and the attractive, considerate image projected by clinics and staff. The overall excellence of the service was a matter of satisfaction to administrators, of gratification to clients and of pride to the providers whose morale was high.

Adolescent↗

The Danish oral health care service for children: a comparison with alternative systems.

Aarhus in Denmark, Adelaide in Australia, Saskatchewan in Canada, Bristol in England and Limerick in Ireland were chosen as representing five different systems for improving the dental health of children. Fluoridation apart, the system of dental care delivery seems to have little influence on the level of dental disease, but appears to have remarkable cost implications. The most expensive system employs salaried dentists to carry out all the operative procedures. Employing dental therapists to do the simple operative procedures reduces costs materially, but utilizing private dentists in an insurance scheme that encourages efficient practice may be less expensive still. The results of this study highlight the need for more detailed comparison of delivery systems, in order to advise public dental health authorities on the most effective and efficient systems for children.

Adolescent↗

The Danish oral health care service for children: an international appraisal.

The Danish children's oral health care service has been so successful in achieving its objectives that it will need to change and adapt in order to survive. It is suggested that the service should gradually become community-based rather than child-based. This process can be commenced by introducing treatment for the elderly, the handicapped and the indigent, converting the school clinics to municipal oral health units. Although it is important that private practice is maintained, private dentists should be encouraged to work in the system part-time, leading teams of supporting auxiliary personnel trained within an integrated system. Eventually, the facilities could form the basis of primary health care centres. The lessons to be learnt from the Danish experience have a wider application to other countries. In developing countries it is obvious that they should first place limited dental resources into public health prevention and only invest in expensive treatment clinics as funds become more available. Manpower planning should ensure that personnel are not overtrained for the needs of the community. In developed countries, increasingly more resources will need to be channelled into adult dental care, and dental education must lead the profession into this new era. Difficult though these changes will be, the stable relationships that have developed between the various arms of the service under the guidance of the Danish Dental Association, will ensure that the profession will survive and flourish for the benefit of the Danish people.

Adolescent↗

Evaluation of a practice based preventive programme for adolescents.

A field study of a practice based preventive programme was conducted over 18 months in a health centre in a socially deprived urban area. The programme comprised chairside education, including dietary advice and oral hygiene instruction, and a therapeutic intervention based on home consumption of a 1 mg of fluoride tablet daily. Participants were 242 boys and girls aged 11-13 years accepting routine dental care. They were allocated at random to a test and control group. Control subjects received all routine operative treatment needed to maintain dental fitness while test subjects received similar routine treatment but with the addition of the preventive regimen. Although the test subject's knowledge of dental self-care improved during the course of the study, this was evidently not translated into change of behavior and no significant differences in dental health between test and control groups could be detected at the conclusion.

Adolescent↗

Effect of fluoridation on the cost of dental treatment among urban Scottish schoolchildren.

Dental treatment needs of 230 children aged 4 and 5 years and 288 aged 9 and 10 years who were lifetime residents of two towns, one fluoridated and the other non-fluoridated, were costed on the Resource Related Index. This index is based on the British National Health Service scale of fees for general dental practitioners. The overall cost of dental treatment required by 4- and 5-year-olds in the fluoridated community was 45% less than in the non-fluoridated community, The corresponding difference for 9- and 10-year-olds was 47%. The differences in the cost of treatment for dental caries only (fillings, extractions and general anaesthetics) were 56% in 4- and 5-year-olds and 76% in 9- and 10-year-olds in favour of the fluoridated community. In the latter community, no child examined required dental extractions under general anaesthesia. Certain assumptions made in the study and the implications of the findings in terms of cost savings brought about by fluoridation are discussed.

Child↗

The effect of fluoridation on the dental health of urban Scottish Schoolchildren.

A comparison was made of the dental health of children aged 4-5 and 9-10 in two Scottish towns, one with fluoridated drinking water and the other without. Striking differences were observed. A 44% reduction in decayed, missing, and filled deciduous teeth was found in 4-5 year-olds in the fluoridated compared with the non-fluoridated town and a 50% reduction in decayed, missing, and filled permanent teeth was recorded for the 9-10-year-olds. Larger percentage differences were found for the anterior teeth: a 65% reduction in deciduous incisors and canines, and an 81% reduction in permanent incisors and canines. Fluoridation of public water supplies in urban areas of Scotland would be a safe and effective way of dramatically improving dental health.

Child↗

Field testing of an information system for planning and evaluating dental services.

A survey of the dental health and need for treatment of 796 children, one in 10 of those in the 1st and 3rd years of high schools in a health administrative area, was carried out using a comprehensive, computerized, epidemiological information system. The system was designed to aid in planning and evaluating services and expressed treatment need on the Resource Related Index as well as utilizing conventional indices. A baseline profile of the dental condition of children in four districts was obtained. This was compared with findings from other surveys. The problem of interexaminer reliability was also discussed.

Adolescent↗

Factors influencing the local planning of dental services.

Findings from a survey of 796 high school children in four districts constituting a health administrative area were examined to ascertain the factors influencing their dental disease experience, treatment received and attendance pattern. In three of the four districts, over 60% of the children were regular attenders, enjoying the benefit of less active caries than irregular attenders. However, in the remaining district, much of which consisted of depressed, inner city areas undergoing re-development, only one third were regular attenders. Several local factors, such as availability and accessibility of services, probably influenced the numbers seeking regular care, but one of the most important appeared to be the level of provision in the salaried Community Dental Service. The implications of the findings for planning improvements in local services are discussed.

Adolescent↗

The benefit of preventive procedures for high risk groups.

The clinical effectiveness of many caries prophylactic agents has been demonstrated but their public health value questioned from the viewpoint of economic efficiency. However, some groups within the population may have enhanced response to certain agents and for these subjects a more acceptable cost-value situation may occur. The effectiveness of agents may be measured by the extent to which they reduce operative treatment need. Therefore by costing treatment carried out in both groups in a clinical trial and adding, for the test group, the cost of prevention, the cost effectiveness of treatment plus prevention compared with treatment alone can be investigated. A computer was programmed to estimate from DMFS data, maintenance treatment carried out during clinical trials and that needed at the end to render subjects free of caries. Treatment was costed on the Resource Related Index. In an examination of two experimental clinical trials among adolescents it was found that supervised daily brushing in school with MFP dentifrice produced a 25 per cent reduction in DMFS over three years, but cost six and a half times as much as the operative treatment saved. However, for a high risk group of girls the cost was only two and a half times as much. When APF topical applications by hygienists were added to the same brushing programme it became even less economically efficient. Neither experimental programme was cost-effective for any group unless a weighting factor was introduced to take account of the desirablity of a sound as opposed to a filled tooth.

Child↗

Periodontal bone loss in English secondary school children. A longitudinal radiological study.

The prevalence and incidence of periodontal bone loss during a 3-year period was investigated in 373 English secondary school children aged initially 11--12 years. Bone loss was diagnosed from standard radiographs obtained at the baseline and third year examinations of a caries prophylactic clinical trial in which the children were participating. The interproximal spaces mesial and distal to the first permanent molar teeth were examined: 18.5% of subjects had evidence of bone loss at these sites at baseline and 44.0% at third year. In 60 subjects who had all second premolars and first and second permanent molars fully erupted and present at both examinations, the prevalence of bone loss was 36.7% at baseline and 68.3% at third year. Those children who had bone loss recorded at both the initial and final examinations had evidence of significantly more bone destruction at the conclusion of the study than those in whom bone loss was recorded only at the final examination (P less than 0.001).

Bone Resorption↗

Caries prediction from initial measurements in clinical trial subjects.

The correlation between future caries activity and predictor variables of initial caries experience and surfaces at risk was examined in control-group adolescents in two clinical trials conducted over three years. By modifying and combining the predictors in accordance with clinical observation, 25% of the variance of the DMFS increment was explained compared with the 13% attributable to initial DMFS alone. Seventy percent of the variability in DMFS experience at 14 to 15 years of age was accounted for by caries experience two years earlier.

Adolescent↗

Reliability of caries data in three clinical trials.

The reliability of caries data obtained during three clinical trials is presented. Each of the three trials, conducted by different examiners, lasted 3 years and involved children aged 12 to 15 years. Reliability was quantified in terms of reliability coefficient and error variance, which allowed the effect of error upon the efficiency of each study to be measured. Reliability tended to be reduced when precaviation (initial) lesions were included in the DMFS count, but there was little difference between the reliability coefficients for each of four different surface-types. Error was more important in 3-year incremental rather than prevalence data, but nevertheless had a rather small influence upon sample size estimation or confidence limits of percent caries reductions.

Adolescent↗