Secular changes in treatment in a school dental service

The caries decline has affected child dental treatment in many countries. There has been a change towards fewer extractions and pulpotomies in deciduous teeth, and restorative techniques and restorations in deciduous and permanent teeth have become less complex. New materials, particularly glass ionomer cements (GIC), have found acceptance. The School Dental Service (SDS) in Western Australia (WA), one of the world's largest dental care organisations, holds good data on children's dental health and on the types of treatment provided since 1980. This paper reports these data. Oral health is recorded as caries experience on a random sample of patients. Treatment provided is recorded by operators after each patient visit and collated monthly. About 240,000 children (> 90 per cent of those eligible) and currently enrolled in the SDS and the clinical staffing is about 150-160 dental therapists and 27 dentists. Caries experience has fallen in all age groups in recent years, except that in 1992 and 1993 dmft rose slightly in six-year-old children. All types of operative treatment are used less frequently now than in 1980. In deciduous teeth restorations, GIC dominates but amalgam remains the most widely chosen material in permanent teeth. The use of fissure sealants (using GIC) peaked in 1988 and, as a result of management decisions, has declined since then. The decline in the need for dental treatment has reduced costs and enabled the SDS to offer care to an expanding group of children in WA. The results achieved by the SDS in WA demonstrate that a service based primarily on dental auxiliaries is viable and efficient.