RECALL INTERVALS, DENTAL HYGIENISTS AND QUALITY IN CHILD DENTAL-CARE

Decline in dental disease and the need to provide dental care efficien tly suggest changes in clinical and administrative routines in public dental care provision for children. A field project in Norway demonstr ated productivity gains after the introduction of individualized recal l intervals and using dental hygienists to conduct recall examinations . The purpose of the present study was to assess changes in the qualit y of dental health outcome and changes in the quality of the process o f dental care provision. Recall intervals were increased from a target of 12 months to 16 and 18 months in two districts. Dental hygienists undertook all recall examinations and referred to dentists those patie nts who required operative care. Bitewing radiographs were inspected f or all 18-yr-olds who were examined in 1989, 1990 and 1991 (n=956) and for those who were examined before the changes were implemented in 19 87 (n=300). For each child, approximal caries on 24 surfaces was score d according to a 4-point severity scale. Clinical records were examine d to determine what treatment had been provided. For each year after t he changes were implemented, the quality of health outcome was assesse d by comparing the radiographic caries prevalence and the number of so und surfaces with 1987 data. Quality in the process of care provision was indicated by the treatment decisions for approximal caries and by the proportion of uninterpretable surfaces on radiographs for each stu dy year. The mean number of sound surfaces increased over time. A decl ining proportion of sound surfaces was restored over the study period, and almost all caries lesions extending deep into dentine were restor ed. Radiographic quality improved during the project period. The overa ll finding was that the changes to clinical and administrative routine s were not associated with major changes in the quality of care provid ed in the short run.