The concept of need in dental care

The most commonly used methods of assessing need for treatment are based solely on clinical criteria. Recently, it has been recognized that a wider interpretation than that provided by clinically assessed need is required. Measures of need should include the impact of ill health upon individuals, the degrees of dysfunction and the perceptions and attitudes of patients. Although there is no generally agreed definition of need, the taxonomy suggested by Bradshaw (1972) is recommended. He divides need into normative, felt, expressed and comparative types. One of the major shortcomings of all methods of assessing need is that they do not assess the need and propensity for preventive care and health education. A more realistic assessment of treatment needs should include the functional and social dimensions of dental disease and an assessment of the social and motivational factors which predispose people towards dental ill health and influence the effectiveness of treatment and health education. Some dental needs are not very well assessed. In particular, the assessment of the need for treatment of malocclusion, whilst claiming to be objective, does not incorporate measures of lay perception or impact of the condition. Instead of relying only upon purely clinical methods of assessing needs, the development of sociodental indicators is required. This will encourage a shift in emphasis away from the mechanical to the behavioural aspects of treatment and the development of a health-orientated model of care in preference to the sickness model that dominates current dental services.