LEVELS OF RESTORATIVE CARE UNDER CAPITATION

Objectives 1. To compare the prevalences of fissure sealants in simila r groups of 14-15-year-old, regularly-attending patients treated under fee-for-service in 1989 and capitation in 1994. 2. To calculate the e ffect of including sealants in the restorative index on estimates of i nterventional treatment carried out on 14-15-year-old regularly attend ing patients treated by general dental practitioners in 1994. Design A randomised epidemiological study. Setting Secondary schools in the Wy combe, Doncaster and Hereford/Worcester areas. Method Random samples o f 14-15-year-old, regularly attending patients treated by dentists pra ctising under capitation in three contrasting areas of England were ex amined in 1994 for the presence of decayed, missing and filled teeth a nd fissure sealants. Restorative indices were calculated with and with out the inclusion of sealants. The latter were compared with restorati ve indices calculated without the inclusion of sealants on regularly a ttending patients of the same age group when the dentists in the same three areas were working under fee-for-service in 1989. Results The pr evalence 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. Whe n sealants were included in the restorative indices for 1994, they ran ged from 79.5-92.9. Conclusions There were increases in the prevalence s of fissure sealants between 1989-1994. When these sealants were incl uded in the calculation of restorative indices for 1994, the level of restorative care provided by general dental practitioners remained rel atively high since the introduction of capitation. Although there has been some increase in the level of untreated disease, if the restorati ve index is calculated without the inclusion of sealants then there is a risk of underestimating the treatment provided by general dental pr actitioners to control the carious process. Dentists appear to be redi recting their efforts into newer treatment/preventive items.