RESTORATIVE TREATMENTS RECEIVED BY CHILDREN COVERED BY A UNIVERSAL, PUBLICLY FINANCED, DENTAL INSURANCE PLAN

Objectives: This study sought to identify risk markers associated with the provision of new restorations in children and to investigate whet her the carious status of a tooth surface is associated with the resto rative decisions of dentists. Methods: A total of 911 schoolchildren i n grades one, two, and three were randomly selected from the island of Montreal, Quebec, Canada. Dental examinations were carried out in 199 0, 1991, and 1992. Tooth surfaces of first permanent molars were class ified as sound, noncavitated, and cavitated. The carious status of a t ooth was matched with restorative decisions reported to the insurance board. Results: The presence of a carious cavity was a strong risk mar ker for placement of new restorations (odds ratios greater than or equ al to 4.11). After one year, less than 2 percent of sound tooth surfac es of first permanent molars were restored and about 21 percent of non cavitated tooth surfaces were restored. When new class I restorations placed in maxillary first permanent molars within 3-6 months after the baseline examination were evaluated, we found that between 73 percent and 86 percent of these new restorations were placed in sound or nonc avitated tooth surfaces. A similar trend also was observed in mandibul ar first permanent molars. Poor agreement between epidemiologic diagno sis and restorative decisions was found. The restorative profile of de ntists was a significant risk marker for placement of new restorations . Conclusion: The majority of new restorations in first permanent mola rs were placed in sound and noncavitated tooth surfaces because of the ubiquitous prevalence of these tooth surfaces and the validity proble ms of current caries diagnosis methods.