Can organised dental care for children be both good and cheap?

Children's dental services evolved from emergency, pain-relieving and later amalgam-based care systems of the early and middle 20th century. The pattern of occurrence of dental caries is different today and young teenagers have very few teeth affected by caries. Restoration of lesions in permanent teeth, typically on occlusal or buccal/lingual surfaces, is technically simple. Paradoxically, dental students today are expected to master a vast amount of knowledge, including information on new dental materials and techniques. New dentists who choose to provide dental care for children as a career will spend most of their days placing fissure sealants, applying topical fluorides and inserting predominantly single-surface restorations. Because of their expensive training, new dentists will nevertheless expect high earnings, and this results in a high cost for children's dental care. The opportunity cost is other health services foregone. In developing countries where there are few dentists, they are almost not available for children at all. Costs could be reduced by reducing the number of interventions, and by reducing staff costs. Fewer interventions could be achieved by longer recall intervals: several studies and experience from places where this has been implemented indicate that is safe and effective. Widespread delegation of operative work to appropriately trained dental hygienists or therapists would reduce staff costs. Dental therapists are better substitutes for dentists in children's care because they are trained to do most of the clinical procedures that are necessary in children's dentistry. In Western Australia and South Australia, most dental care for children is provided by dental therapists. The costs of care are much lower and the outcome, as measured by caries experience and numbers of treated patients, is equivalent to or even better than European dentist-based services. Already, in some places, politicians and others are querying the need for organised children's dental care. Increased effectiveness will make continuation of children's dental services easier to sustain.