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Levels of restorative care under capitation
1Division of Restorative Dentistry, Leeds Dental Institute.
Objectives:
1. To compare the prevalences of fissure sealants in similar groups of 14-15-year-old, regularly-attending patients treated under fee-for-service in 1989 and capitation in 1994. 2. To calculate the effect of including sealants in the restorative index on estimates of interventional treatment carried out on 14-15-year-old regularly attending patients treated by general dental practitioners in 1994.
Design:
A randomised epidemiological study.
Setting:
Secondary schools in the Wycombe, Doncaster and Hereford/Worcester areas.
Method:
Random samples of 14-15-year-old, regularly attending patients treated by dentists practising under capitation in three contrasting areas of England were examined in 1994 for the presence of decayed, missing and filled teeth and fissure sealants. Restorative indices were calculated with and without the inclusion of sealants. The latter were compared with restorative indices calculated without the inclusion of sealants on regularly attending patients of the same age group when the dentists in the same three areas were working under fee-for-service in 1989.
Results:
The prevalence of fissure sealants increased between 1989 and 1994 from 16% to 30% in Wycombe, from 13% to 50% in Doncaster and from 25% to 47% in Hereford/Worcester. Without fissure sealants the restorative indices fell between 1989 and 1994 from a range of 76.5-94.4 to 63.3-87.1. When sealants were included in the restorative indices for 1994, they ranged from 79.5-92.9.
Conclusions:
There were increases in the prevalences of fissure sealants between 1989-1994. When these sealants were included in the calculation of restorative indices for 1994, the level of restorative care provided by general dental practitioners remained relatively high since the introduction of capitation. Although there has been some increase in the level of untreated disease, if the restorative index is calculated without the inclusion of sealants then there is a risk of underestimating the treatment provided by general dental practitioners to control the carious process. Dentists appear to be redirecting their efforts into newer treatment/preventive items.