摘要:

AbstractSince 1973 the government of Alberta, a Canadian province of 2.4 million people, has funded a dental care plan for all residents over 64 years old and their dependents. It is the only dental plan in North America that covers all seniors and their dependents residing in a state or province. Under this plan, just over 270,000 persons (in 1990–91) are eligible for comprehensive, premium‐free dental services provided by dentists and denturists in private practice on a fee‐for‐service basis. The plan's design, administration, utilization, and costs are reviewed. Utilization increased from 27 percent of eligibles using the plan in 1974–75 to 44 percent in 1990–91, and the mean number of services per user rose from 4.9 to 6.9 during the same time period. Although the cost per eligible person has increased about 200 percent, from Canadian (C) $42 to C $131, these costs only began to exceed the rate of inflation in 1986–87. Even though just 12 percent of the two main providers participating in the plan are denturists, nearly 22 percent of plan patients attended denturists rather than dentists for their complete dentures. Fees paid to dentists by the plan have decreased over time relative to the standard fees for the various services listed annually in the Alberta Dental Association fee guide. The apparent growth of direct additional billing by dentists of plan users to recover the difference between their usual fees and those paid by the plan and the effects of greater plan utilization are discussed, as are future potential difficulties in the plan's a

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1992.tb02286.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractThe DEMCAD dental office assessment instrument was developed to evaluate practice quality using Donebedian's quality assessment model of structure, process, and outcome. This previously validated instrument takes about six hours to complete. Subsequent analysis was undertaken to determine whether an abbreviated office assessment based on the evaluation of radiology items was sufficiently sensitive, specific, and practical to be used as a screening instrument for identifying dental offices with very low evaluation scores. Data for this analysis were obtained from 300 volunteer general dental practices evaluated in the field testing of the DEMCAD instrument. The nine radiology structure items predicted very poorly the overall structure scores. How‐ever, 13 radiology process items predicted overall process scores quite accurately. Four of the 13 radiology process items (periodontal diagnoses recorded, interdental bone shown on x‐rays, caries diagnoses recorded, and current x‐rays mounted) produced a combined R2of. 58. These four radiology variables predicted the 10 percent of the dental practices with the lowest overall process score with 87 percent sensitivity and 93 percent specificity. This analysis showed that an abbreviated dental practice process quality assessment using oral radiology items in an audit of patients' records may be feasible as a screening test for dental office asses

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1992.tb02287.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractAs part of a smokeless tobacco (ST) intervention study, we collected data on tobacco use habits and oral health for 245 male ST users aged 15 to 77. The study sample was identified during routine dental office visits and represents a relatively diverse population of patients. Oral health data collection included grading the clinical appearance of oral mucosal lesions using Greer and Poulson's classification system, as well as identifying and recording the primary anatomic location of ST placement. Results show that 78.6 percent of ST users had observable oral lesions, 23.6 percent of which were in the most clinically advanced category (degree III). Of the lesions noted, 85 percent were in the same location the patient identified as his primary area of smokeless tobacco placement. In a comparison sample of 223 non‐ST‐users with the same age distribution, only 6.3 percent had observable lesions. A multiple logistic regression model for ST users showed that lesion presence and severity were most significantly related to current frequency of ST

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1992.tb02288.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractVeterans who were eligible for dental care in Department of Veterans Affairs (VA) facilities at no monetary cost responded to a mailed questionnaire. Seventy‐one percent were aware that they were actually eligible for VA dental care. However, only 48 percent reported the VA as their only or primary source of dental care. Eligibility status, perceived quality of VA dental care, use of VA medical care, perception that one's income meets expenses, and perceived need for dental care were significant correlates of using the VA as one's current source of dental care. Level of formal education, perception that one's income meets expenses, transportation pattern, geographic distance from a VA facility, and eligibility status were significant correlates of using the VA as one's current medical care source. Research on VA utilization offers the opportunity to study issues of access to, and use of, a large public health care system whose patients largely receive care at no monetary cost. Veterans' use of VA dental and medical care is apparently influenced by a wide variety of factors, ranging from barriers to access to non‐VA systems, to characteristics of the VA delivery system itself, to need for treatm

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1992.tb02289.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractThe most recent report on fluoride concentrations ([f]) in human bone was published over a decade ago. Such data are of interest in the context of changing patterns in systemic fluoride exposure. In the study reported here, bone samples were collected from 24 human subjects who underwent orthopedic surgery. Medical histories and the best possible life‐time systemic fluoride exposure information were obtained from each subject. Bone samples were assayed for fluoride concentration using the acid diffusion, ion selective electrode method. For ash from whole bone, the lowest value was 378 ppm in a 16‐year‐old subject, and the highest value was 3,708 ppm in a 79‐year‐old person. Fluoride concentrations in bone were significantly correlated with age (r=.62). The regression line intercept at birth was 442 ppm, and the slope was 22 ppm per year. When measured separately, trabecular bone ash fluoride concentrations were significantly higher than the corresponding cortical bone values. Trabecular and cortical bone samples from rats' drinking water containing 75 ppm F were assayed for F. The mean trabecular bone fluoride concentration was significantly higher than the mean cortical bone concentration. There was close agreement between F assay results using a modification of the acid diffusion method and the method originally reported by Singer and Armstrong. The human bone ash [F]values reported in this study are similar to those reported from other North American subjects over the last three decades. These findings are of interest in the context of evidence indicating increased systemic fluoride exposure in the United States population. They may also be considered in efforts to evaluate the relevance of the National Institute of Environmental Health Sciences fluoride carcinogene

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1992.tb02290.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractDecision makers in the areas of health policy, resource allocation, and manpower requirements rely implicitly on estimations of treatment needs on which to base their forecasts. The less specific the treatment‐need estimate, the less precise the forecast. In previous decades, high caries rates were so prevalent that the dental profession could risk having inexact projections because overwhelming need and demand existed. However, rampant decay is no longer a common occurrence. Decay levels are declining in our nation's children and adults have fewer missing teeth. Therefore, restorative treatment needs and patterns in adult populations are transforming at a time when health care costs are spiraling and budget analysts at all levels of government are questioning the priority of continued support of dental care, dental education, and dental research at current levels. The purpose of this review is to present the existing methods of forecasting restorative treatment needs and to postulate the development of a new method based on the collective experiences of practicing dentists nationwide, an empirical method, to convert surface‐specific oral health status data to restorative treatment need information. Need estimations based on empirical data would more accurately reflect the actual distribution of services that practicing dentists prov

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1992.tb02291.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1992.tb02292.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractDental amalgam has been the subject of intermittent controversy since it was introduced into dental practice approximately 150 years ago. The controversy has centered on the use of mercury in dental amalgam and the potential health implications to dental patients and dental health professionals from mercury exposure. In recent years the debate over the use of dental amalgam has intensified due to several articles in professional journals and media coverage by television and the press. This paper reviews the recent literature regarding dental amalgam, describes the activities of the antiamalgamists, examines the alternatives to dental amalgam, and reviews the recommendations for additional research. The existing scientific evidence does not demonstrate that mercury in dental amalgam poses a public health hazard. However, researchers on both sides of the controversy agree that much remains to be examined about the health implications of dental amalgam and that the subject merits continued research.

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1992.tb02293.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractThe traditions of social dentistry in Germany represent early forms of dental public health development. It was promoted in dental care facilities where salaried dentists delivered services to target groups, i.e., schoolchildren and sickness fund members. They enabled larger numbers of patients to receive dental care, especially those of lower class origin who otherwise would have remained untreated because of lack of financial resources or scar‐city of manpower. School dental clinics not only delivered dental treatment, but also distributed oral hygiene and nutritional information to school‐aged children. Social dentistry in the prefluoride era in Germany pursued an egalitarian and social‐class oriented concept of dental care delivery, aiming at compensating the detrimental effects that the private practice‐based, fee‐for‐service financed dental care system had produced in the lower classes of the population. The impact of the Nazi regime nearly abolished the institutions of social dentistry. They never were restored in West Germany after World War II. In East Germany dental care had been organized according to traditions of social dentistry, i.e., delivering services in dental treatment centers. Since the unification of the two German states, the institutions of dental care delivery in former East Germany have been restructured to fit the private practice‐based model of former West Germany, eliminating most of the social dentistry institutions i

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1992.tb02294.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1992.tb02295.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY